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Reported covered position: Senior Legislative Assistant, Representative Mike
How to read the money
Income and expense are whole-filing amounts associated with this lobbyist, not personal compensation or an allocated share.
No topic inference: each bill number appears in source LDA issue text assigned to this lobbyist.
Federal Broadband Deployment in Unserved Areas Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 205 - Accelerating Broadband Connectivity Act of 2021 - Rep. Kelly, Trent [R-MS-1] - broadband H.R. 341 - Ensuring Telehealth Expansion Act of 2021 - Rep. Williams, Roger [R-TX-25] - telehealth H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 - Rep. Thompson, Mike [D-CA-5] - telehealth H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - SDOH H.R. 434 - Preventing Mental Health and Substance Use Crises During Emergencies Act - Rep. Trone, David J. [D-MD-6] - mental health and SUD H.R. 596 - ACCESS Act - Rep. Schakowsky, Janice D. [D-IL-9] - telehealth H.R. 675 - COVID-19 Price Gouging Prevention Act - Rep. Schakowsky, Janice D. [D-IL-9] - price gouging H.R. 747 - Access to TESTs Act - Rep. DeGette, Diana [D-CO-1] - COVID-19 H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - maternal health H.R. 925 - Data to Save Moms Act - Rep. Davids, Sharice [D-KS-3] - maternal health H.R. 937 - Tech To Save Moms Act - Rep. Johnson, Eddie Bernice [D-TX-30] - maternal health H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy [D-GA-6] - maternal health H.R. 951 - Maternal Vaccination Act - Rep. Sewell, Terri A. [D-AL-7] - maternal health H.R. 959 - To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes - Rep. Underwood, Lauren [D-IL-14] - maternal health H.R. 1046 - Federal Broadband Deployment in Unserved Areas Act - Rep. Curtis, John R. [R-UT-3] - broadband H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. [D-NC-1] - maternal health H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John A. [D-KY-3] - COVID-19 relief H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl L. "Buddy" [R-GA-1] - telehealth H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes - Rep. Veasey, Marc A. [D-TX-33] - broadband and telehealth H.R. 1872 - MORE Health Education Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - health education H.R. 1888 - Improving Access to Indian Health Services Act- Rep. Ruiz, Raul [D-CA-36] - FMAP for Indian health services H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter A. [D-OR-4] - public option H.R. 3063 - MOMMIES Act - Rep. Pressley, Ayanna [D-MA-7] - maternal health H.R. 3126 - Healthy MOM Act - Rep. Watson Coleman, Bonnie [D-NJ-12] - maternal health H.R. 3407 - MOMMAs Act - Rep. Kelly, Robin L. [D-IL-2] - maternal health H.R. 3688 - To address maternal mortality and morbidity - Rep. Adams, Alma S. [D-NC-12] - maternal health H.R. 3753 - Parity Implementation Assistance Act - Rep. Cardenas, Tony [D-CA-29] - mental health and SUD H.R. 4026 - To require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health - Rep. Burgess, Michael C. [R-TX-26] - SDOH S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina [D-MN] - SDOH S. 168 - TREAT Act - Sen. Murphy, Christopher [D-CT] - telehealth S. 287 - A bill to direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes - Sen. Baldwin, Tammy [D-WI] - maternal health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert P., Jr. [D-PA] - maternal health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim [D-VA] - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory A. [D-NJ] - maternal health S. 347 - Data to Save Moms Act - Sen. Smith, Tina [D-MN] - maternal health S. 368 - Telehealth Modernization Act - Sen. Scott, Tim [R-SC] - telehealth S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat [R-PA] - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard J. [D-IL] - maternal health S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard [D-CT] - SDOH S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon [D-RI] - public option S. 1333 - A bill to address maternal mortality and morbidity - Sen. Gillibrand, Kirsten E. [D-NY] - maternal health S. 1542 - MOMMIES Act - Sen. Booker, Cory A. [D-NJ] - maternal health S. 1622 - HEALTH for MOM Act of 2021 - Sen. Portman, Rob [R-OH] - maternal health S. 1704 - Telehealth Expansion Act of 2021 - Sen. Daines, Steve [R-MT] - telehealth S. 1804 - Mothers and Newborns Success Act - Sen. Kaine, Tim [D-VA] - maternal health S. 1833 - Ensuring Access to Primary Care for Women & Children Act - Sen. Brown, Sherrod [D-OH] - maternal health S. 1962 - Parity Implementation Assistance Act - Sen. Murphy, Christopher [D-CT] - mental health and SUD S. 1988 - Protecting Rural Telehealth Access Act - Sen. Manchin, Joe, III [D-WV] - telehealth S. 2061 - Telemental Health Care Access Act of 2021 - Sen. Cassidy, Bill [R-LA] - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Specific issues are shown only where the LDA source assigned them to this lobbyist. Targets apply to the associated filing.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2021 · second_quarter · Q2
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Source: Senate LDA
Advancing Enrollment and Reducing Drug Costs Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Advancing Enrollment and Reducing Drug Costs Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Kira Johnson Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Data Mapping to Save Moms’ Lives Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Data Mapping to Save Moms’ Lives Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 205 - Accelerating Broadband Connectivity Act of 2021 - Rep. Kelly, Trent [R-MS-1] - broadband H.R. 341 - Ensuring Telehealth Expansion Act of 2021 - Rep. Williams, Roger [R-TX-25] - telehealth H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 - Rep. Thompson, Mike [D-CA-5] - telehealth H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - SDOH H.R. 434 - Preventing Mental Health and Substance Use Crises During Emergencies Act - Rep. Trone, David J. [D-MD-6] - mental health and SUD H.R. 596 - ACCESS Act - Rep. Schakowsky, Janice D. [D-IL-9] - telehealth H.R. 675 - COVID-19 Price Gouging Prevention Act - Rep. Schakowsky, Janice D. [D-IL-9] - price gouging H.R. 747 - Access to TESTs Act - Rep. DeGette, Diana [D-CO-1] - COVID-19 H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - maternal health H.R. 925 - Data to Save Moms Act - Rep. Davids, Sharice [D-KS-3] - maternal health H.R. 937 - Tech To Save Moms Act - Rep. Johnson, Eddie Bernice [D-TX-30] - maternal health H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy [D-GA-6] - maternal health H.R. 951 - Maternal Vaccination Act - Rep. Sewell, Terri A. [D-AL-7] - maternal health H.R. 959 - To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes - Rep. Underwood, Lauren [D-IL-14] - maternal health H.R. 1046 - Federal Broadband Deployment in Unserved Areas Act - Rep. Curtis, John R. [R-UT-3] - broadband H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. [D-NC-1] - maternal health H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John A. [D-KY-3] - COVID-19 relief H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl L. "Buddy" [R-GA-1] - telehealth H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes - Rep. Veasey, Marc A. [D-TX-33] - broadband and telehealth H.R. 1872 - MORE Health Education Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - health education H.R. 1888 - Improving Access to Indian Health Services Act- Rep. Ruiz, Raul [D-CA-36] - FMAP for Indian health services H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter A. [D-OR-4] - public option H.R. 3063 - MOMMIES Act - Rep. Pressley, Ayanna [D-MA-7] - maternal health H.R. 3126 - Healthy MOM Act - Rep. Watson Coleman, Bonnie [D-NJ-12] - maternal health H.R. 3407 - MOMMAs Act - Rep. Kelly, Robin L. [D-IL-2] - maternal health H.R. 3688 - To address maternal mortality and morbidity - Rep. Adams, Alma S. [D-NC-12] - maternal health H.R. 3753 - Parity Implementation Assistance Act - Rep. Cardenas, Tony [D-CA-29] - mental health and SUD H.R. 4026 - To require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health - Rep. Burgess, Michael C. [R-TX-26] - SDOH S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina [D-MN] - SDOH S. 168 - TREAT Act - Sen. Murphy, Christopher [D-CT] - telehealth S. 287 - A bill to direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes - Sen. Baldwin, Tammy [D-WI] - maternal health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert P., Jr. [D-PA] - maternal health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim [D-VA] - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory A. [D-NJ] - maternal health S. 347 - Data to Save Moms Act - Sen. Smith, Tina [D-MN] - maternal health S. 368 - Telehealth Modernization Act - Sen. Scott, Tim [R-SC] - telehealth S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat [R-PA] - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard J. [D-IL] - maternal health S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard [D-CT] - SDOH S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon [D-RI] - public option S. 1333 - A bill to address maternal mortality and morbidity - Sen. Gillibrand, Kirsten E. [D-NY] - maternal health S. 1542 - MOMMIES Act - Sen. Booker, Cory A. [D-NJ] - maternal health S. 1622 - HEALTH for MOM Act of 2021 - Sen. Portman, Rob [R-OH] - maternal health S. 1704 - Telehealth Expansion Act of 2021 - Sen. Daines, Steve [R-MT] - telehealth S. 1804 - Mothers and Newborns Success Act - Sen. Kaine, Tim [D-VA] - maternal health S. 1833 - Ensuring Access to Primary Care for Women & Children Act - Sen. Brown, Sherrod [D-OH] - maternal health S. 1962 - Parity Implementation Assistance Act - Sen. Murphy, Christopher [D-CT] - mental health and SUD S. 1988 - Protecting Rural Telehealth Access Act - Sen. Manchin, Joe, III [D-WV] - telehealth S. 2061 - Telemental Health Care Access Act of 2021 - Sen. Cassidy, Bill [R-LA] - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Medicare-X Choice Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Medicare-X Choice Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Living Donor Protection Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 31 - Health Coverage Choice Act - Rep. Biggs, Andy [R-AZ-5] - short-term, limited-duration health insurance plans H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. [R-OH-14] - pre-existing conditions H.R. 317 - To amend the Public Health Service Act to establish a health insurance Federal Invisible Risk Sharing Program - Rep. Schweikert, David [R-AZ-6] - federal risk sharing program H.R. 477 - To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and the Patient Protection and Affordable Care Act to require coverage of hearing devices and systems in certain private health insurance plans, and for other purposes - Rep. Neguse, Joe [D-CO-2] - coverage for hearing devices H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie [D-TX-7] - surprise medical bills H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael C. [R-TX-26] - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa [D-DE-At Large] - coverage for COVID-19 drugs H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - pre-existing conditions H.R. 1255 - Living Donor Protection Act of 2021 - Rep. Nadler, Jerrold [D-NY-10] - coverage for organ donors H.R. 1790 - To amend the Patient Protection and Affordable Care Act to require the Secretary of Health and Human Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia [D-IA-3] - maximum out of pocket costs and premium tax credits H.R. 2264 - Tele-Mental Health Improvement Act - Rep. Trone, David J. [D-MD-6] - telehealth H.R. 2808 - To amend the Internal Revenue Code of 1986 to make improvements to Health Savings Accounts - Rep. Rosendale Sr., Matthew M. [R-MT-At Large] - HSAs H.R. 3029 - Health Care PRICE Transparency Act - Rep. Davidson, Warren [R-OH-8] - price transparency H.R. 3783 - Medical Nutrition Equity Act of 2021 - Rep. McGovern, James P. [D-MA-2] - coverage of medical foods H.R. 3947 - To prohibit the inclusion of mandatory predispute arbitration clauses and clauses limiting class action lawsuits in health insurance contracts - Rep. Porter, Katie [D-CA-45] - health insurance contracts H.R. 3969 - To amend title XXVII of the Public Health Service Act to include activities to address social determinants of health in the calculation of medical loss ratios - Rep. Curtis, John R. [R-UT-3] - SDOH and MLRs H.R. 4123 - To codify certain rules related to health reimbursement arrangements and other account-based group health plans - Rep. Bishop, Dan [R-NC-9] - health reimbursement arrangements H.R. 4289 - To amend title II of the Social Security Act to provide for long-term care insurance benefits - Rep. Suozzi, Thomas R. [D-NY-3] - long-term care insurance benefits S. 125 - Protecting Life in Health Savings Accounts Act - Sen. Lee, Mike [R-UT] - HSAs S. 377 - Living Donor Protection Act of 2021 - Sen. Gillibrand, Kirsten E. [D-NY] - coverage for organ donors S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco [R-FL] - HSAs S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina [D-MN] - SUD and mental health S. 754 - A bill to provide health insurance benefits for outpatient and inpatient items and services related to the diagnosis and treatment of a congenital anomaly or birth defect - Sen. Baldwin, Tammy [D-WI] - insurance benefits S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John [R-LA] - pre-existing conditions S. 1524 - Health Care PRICE Transparency Act- Sen. Braun, Mike [R-IN] - price transparency S. 2097 - A bill to amend the Internal Revenue Code of 1986 to make permanent the permissible first-dollar coverage of telehealth services for purposes of health savings accounts - Sen. Kennedy, John [R-LA] - HSAs S. 2099 - A bill to amend the Internal Revenue Code of 1986 to allow individuals who are not enrolled in a high deductible health plan to have access to health savings accounts - Sen. Sasse, Ben [R-NE] - HSAs Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020, including disclosure of agent broker compensation (Section 202c); issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
Building COVID–19 Vaccine Confidence Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
American Rescue Plan Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
American Rescue Plan Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 205 - Accelerating Broadband Connectivity Act of 2021 - Rep. Kelly, Trent [R-MS-1] - broadband H.R. 341 - Ensuring Telehealth Expansion Act of 2021 - Rep. Williams, Roger [R-TX-25] - telehealth H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 - Rep. Thompson, Mike [D-CA-5] - telehealth H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - SDOH H.R. 434 - Preventing Mental Health and Substance Use Crises During Emergencies Act - Rep. Trone, David J. [D-MD-6] - mental health and SUD H.R. 596 - ACCESS Act - Rep. Schakowsky, Janice D. [D-IL-9] - telehealth H.R. 675 - COVID-19 Price Gouging Prevention Act - Rep. Schakowsky, Janice D. [D-IL-9] - price gouging H.R. 747 - Access to TESTs Act - Rep. DeGette, Diana [D-CO-1] - COVID-19 H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - maternal health H.R. 925 - Data to Save Moms Act - Rep. Davids, Sharice [D-KS-3] - maternal health H.R. 937 - Tech To Save Moms Act - Rep. Johnson, Eddie Bernice [D-TX-30] - maternal health H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy [D-GA-6] - maternal health H.R. 951 - Maternal Vaccination Act - Rep. Sewell, Terri A. [D-AL-7] - maternal health H.R. 959 - To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes - Rep. Underwood, Lauren [D-IL-14] - maternal health H.R. 1046 - Federal Broadband Deployment in Unserved Areas Act - Rep. Curtis, John R. [R-UT-3] - broadband H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. [D-NC-1] - maternal health H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John A. [D-KY-3] - COVID-19 relief H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl L. "Buddy" [R-GA-1] - telehealth H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes - Rep. Veasey, Marc A. [D-TX-33] - broadband and telehealth H.R. 1872 - MORE Health Education Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - health education H.R. 1888 - Improving Access to Indian Health Services Act- Rep. Ruiz, Raul [D-CA-36] - FMAP for Indian health services H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter A. [D-OR-4] - public option H.R. 3063 - MOMMIES Act - Rep. Pressley, Ayanna [D-MA-7] - maternal health H.R. 3126 - Healthy MOM Act - Rep. Watson Coleman, Bonnie [D-NJ-12] - maternal health H.R. 3407 - MOMMAs Act - Rep. Kelly, Robin L. [D-IL-2] - maternal health H.R. 3688 - To address maternal mortality and morbidity - Rep. Adams, Alma S. [D-NC-12] - maternal health H.R. 3753 - Parity Implementation Assistance Act - Rep. Cardenas, Tony [D-CA-29] - mental health and SUD H.R. 4026 - To require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health - Rep. Burgess, Michael C. [R-TX-26] - SDOH S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina [D-MN] - SDOH S. 168 - TREAT Act - Sen. Murphy, Christopher [D-CT] - telehealth S. 287 - A bill to direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes - Sen. Baldwin, Tammy [D-WI] - maternal health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert P., Jr. [D-PA] - maternal health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim [D-VA] - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory A. [D-NJ] - maternal health S. 347 - Data to Save Moms Act - Sen. Smith, Tina [D-MN] - maternal health S. 368 - Telehealth Modernization Act - Sen. Scott, Tim [R-SC] - telehealth S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat [R-PA] - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard J. [D-IL] - maternal health S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard [D-CT] - SDOH S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon [D-RI] - public option S. 1333 - A bill to address maternal mortality and morbidity - Sen. Gillibrand, Kirsten E. [D-NY] - maternal health S. 1542 - MOMMIES Act - Sen. Booker, Cory A. [D-NJ] - maternal health S. 1622 - HEALTH for MOM Act of 2021 - Sen. Portman, Rob [R-OH] - maternal health S. 1704 - Telehealth Expansion Act of 2021 - Sen. Daines, Steve [R-MT] - telehealth S. 1804 - Mothers and Newborns Success Act - Sen. Kaine, Tim [D-VA] - maternal health S. 1833 - Ensuring Access to Primary Care for Women & Children Act - Sen. Brown, Sherrod [D-OH] - maternal health S. 1962 - Parity Implementation Assistance Act - Sen. Murphy, Christopher [D-CT] - mental health and SUD S. 1988 - Protecting Rural Telehealth Access Act - Sen. Manchin, Joe, III [D-WV] - telehealth S. 2061 - Telemental Health Care Access Act of 2021 - Sen. Cassidy, Bill [R-LA] - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Telehealth Modernization Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Telehealth Modernization Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 205 - Accelerating Broadband Connectivity Act of 2021 - Rep. Kelly, Trent [R-MS-1] - broadband H.R. 341 - Ensuring Telehealth Expansion Act of 2021 - Rep. Williams, Roger [R-TX-25] - telehealth H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 - Rep. Thompson, Mike [D-CA-5] - telehealth H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - SDOH H.R. 434 - Preventing Mental Health and Substance Use Crises During Emergencies Act - Rep. Trone, David J. [D-MD-6] - mental health and SUD H.R. 596 - ACCESS Act - Rep. Schakowsky, Janice D. [D-IL-9] - telehealth H.R. 675 - COVID-19 Price Gouging Prevention Act - Rep. Schakowsky, Janice D. [D-IL-9] - price gouging H.R. 747 - Access to TESTs Act - Rep. DeGette, Diana [D-CO-1] - COVID-19 H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - maternal health H.R. 925 - Data to Save Moms Act - Rep. Davids, Sharice [D-KS-3] - maternal health H.R. 937 - Tech To Save Moms Act - Rep. Johnson, Eddie Bernice [D-TX-30] - maternal health H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy [D-GA-6] - maternal health H.R. 951 - Maternal Vaccination Act - Rep. Sewell, Terri A. [D-AL-7] - maternal health H.R. 959 - To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes - Rep. Underwood, Lauren [D-IL-14] - maternal health H.R. 1046 - Federal Broadband Deployment in Unserved Areas Act - Rep. Curtis, John R. [R-UT-3] - broadband H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. [D-NC-1] - maternal health H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John A. [D-KY-3] - COVID-19 relief H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl L. "Buddy" [R-GA-1] - telehealth H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes - Rep. Veasey, Marc A. [D-TX-33] - broadband and telehealth H.R. 1872 - MORE Health Education Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - health education H.R. 1888 - Improving Access to Indian Health Services Act- Rep. Ruiz, Raul [D-CA-36] - FMAP for Indian health services H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter A. [D-OR-4] - public option H.R. 3063 - MOMMIES Act - Rep. Pressley, Ayanna [D-MA-7] - maternal health H.R. 3126 - Healthy MOM Act - Rep. Watson Coleman, Bonnie [D-NJ-12] - maternal health H.R. 3407 - MOMMAs Act - Rep. Kelly, Robin L. [D-IL-2] - maternal health H.R. 3688 - To address maternal mortality and morbidity - Rep. Adams, Alma S. [D-NC-12] - maternal health H.R. 3753 - Parity Implementation Assistance Act - Rep. Cardenas, Tony [D-CA-29] - mental health and SUD H.R. 4026 - To require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health - Rep. Burgess, Michael C. [R-TX-26] - SDOH S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina [D-MN] - SDOH S. 168 - TREAT Act - Sen. Murphy, Christopher [D-CT] - telehealth S. 287 - A bill to direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes - Sen. Baldwin, Tammy [D-WI] - maternal health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert P., Jr. [D-PA] - maternal health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim [D-VA] - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory A. [D-NJ] - maternal health S. 347 - Data to Save Moms Act - Sen. Smith, Tina [D-MN] - maternal health S. 368 - Telehealth Modernization Act - Sen. Scott, Tim [R-SC] - telehealth S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat [R-PA] - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard J. [D-IL] - maternal health S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard [D-CT] - SDOH S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon [D-RI] - public option S. 1333 - A bill to address maternal mortality and morbidity - Sen. Gillibrand, Kirsten E. [D-NY] - maternal health S. 1542 - MOMMIES Act - Sen. Booker, Cory A. [D-NJ] - maternal health S. 1622 - HEALTH for MOM Act of 2021 - Sen. Portman, Rob [R-OH] - maternal health S. 1704 - Telehealth Expansion Act of 2021 - Sen. Daines, Steve [R-MT] - telehealth S. 1804 - Mothers and Newborns Success Act - Sen. Kaine, Tim [D-VA] - maternal health S. 1833 - Ensuring Access to Primary Care for Women & Children Act - Sen. Brown, Sherrod [D-OH] - maternal health S. 1962 - Parity Implementation Assistance Act - Sen. Murphy, Christopher [D-CT] - mental health and SUD S. 1988 - Protecting Rural Telehealth Access Act - Sen. Manchin, Joe, III [D-WV] - telehealth S. 2061 - Telemental Health Care Access Act of 2021 - Sen. Cassidy, Bill [R-LA] - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Supporting Best Practices for Healthy Moms Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Coronavirus Medicaid Response Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Parity Enforcement Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
CHIPPER Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
TIKES Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
COVID–19 Health Disparities Action Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
COVID–19 Emergency Telehealth Impact Reporting Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Continuing Coverage for Preexisting Conditions Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 31 - Health Coverage Choice Act - Rep. Biggs, Andy [R-AZ-5] - short-term, limited-duration health insurance plans H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. [R-OH-14] - pre-existing conditions H.R. 317 - To amend the Public Health Service Act to establish a health insurance Federal Invisible Risk Sharing Program - Rep. Schweikert, David [R-AZ-6] - federal risk sharing program H.R. 477 - To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and the Patient Protection and Affordable Care Act to require coverage of hearing devices and systems in certain private health insurance plans, and for other purposes - Rep. Neguse, Joe [D-CO-2] - coverage for hearing devices H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie [D-TX-7] - surprise medical bills H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael C. [R-TX-26] - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa [D-DE-At Large] - coverage for COVID-19 drugs H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - pre-existing conditions H.R. 1255 - Living Donor Protection Act of 2021 - Rep. Nadler, Jerrold [D-NY-10] - coverage for organ donors H.R. 1790 - To amend the Patient Protection and Affordable Care Act to require the Secretary of Health and Human Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia [D-IA-3] - maximum out of pocket costs and premium tax credits H.R. 2264 - Tele-Mental Health Improvement Act - Rep. Trone, David J. [D-MD-6] - telehealth H.R. 2808 - To amend the Internal Revenue Code of 1986 to make improvements to Health Savings Accounts - Rep. Rosendale Sr., Matthew M. [R-MT-At Large] - HSAs H.R. 3029 - Health Care PRICE Transparency Act - Rep. Davidson, Warren [R-OH-8] - price transparency H.R. 3783 - Medical Nutrition Equity Act of 2021 - Rep. McGovern, James P. [D-MA-2] - coverage of medical foods H.R. 3947 - To prohibit the inclusion of mandatory predispute arbitration clauses and clauses limiting class action lawsuits in health insurance contracts - Rep. Porter, Katie [D-CA-45] - health insurance contracts H.R. 3969 - To amend title XXVII of the Public Health Service Act to include activities to address social determinants of health in the calculation of medical loss ratios - Rep. Curtis, John R. [R-UT-3] - SDOH and MLRs H.R. 4123 - To codify certain rules related to health reimbursement arrangements and other account-based group health plans - Rep. Bishop, Dan [R-NC-9] - health reimbursement arrangements H.R. 4289 - To amend title II of the Social Security Act to provide for long-term care insurance benefits - Rep. Suozzi, Thomas R. [D-NY-3] - long-term care insurance benefits S. 125 - Protecting Life in Health Savings Accounts Act - Sen. Lee, Mike [R-UT] - HSAs S. 377 - Living Donor Protection Act of 2021 - Sen. Gillibrand, Kirsten E. [D-NY] - coverage for organ donors S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco [R-FL] - HSAs S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina [D-MN] - SUD and mental health S. 754 - A bill to provide health insurance benefits for outpatient and inpatient items and services related to the diagnosis and treatment of a congenital anomaly or birth defect - Sen. Baldwin, Tammy [D-WI] - insurance benefits S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John [R-LA] - pre-existing conditions S. 1524 - Health Care PRICE Transparency Act- Sen. Braun, Mike [R-IN] - price transparency S. 2097 - A bill to amend the Internal Revenue Code of 1986 to make permanent the permissible first-dollar coverage of telehealth services for purposes of health savings accounts - Sen. Kennedy, John [R-LA] - HSAs S. 2099 - A bill to amend the Internal Revenue Code of 1986 to allow individuals who are not enrolled in a high deductible health plan to have access to health savings accounts - Sen. Sasse, Ben [R-NE] - HSAs Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020, including disclosure of agent broker compensation (Section 202c); issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
Continuing Coverage for Preexisting Conditions Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. - preexisting conditions H.R. 526 - Ensuring Coverage in Public Health Emergencies Act of 2021 - Rep. Doggett, Lloyd - SEP H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie - COVID-19 diagnostic testing H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa - COVID-19 H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy - preexisting conditions H.R. 898 - Care for COVID-19 Act of 2021 - Rep. Ruiz, Raul - COVID-19 H.R. 1790 - To amend the Patient Protection and ACA to require HHS Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia - MOOP & premium tax credit eligibility H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen - coverage for foster youth H.R. 1796 - To direct HHS to award grants to eligible State agencies to promote State innovations to expand health insurance coverage - Rep. Bera, Ami - state innovations and insurance coverage H.R. 1806 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program - Rep. Castor, Kathy - navigator program H.R. 1874 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program, and for other purposes - Rep. Castor, Kathy - navigator program H.R. 1875 - To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage - Rep. Castor, Kathy - short-term limited duration insurance H.R. 1878 - To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund - Rep. Craig, Angie - affordability H.R. 2264 - To require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Rep. Trone, David - mental health and SUD S. 263 - Worker Health Coverage Protection Act - Sen. Durbin, Richard - coverage continuity & COBRA S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco - HSAs S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne - cost-sharing subsidies S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina - mental health and SUD S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John -preexisting conditions S. 934 - A bill to amend title XVIII of the Social Security Act to improve rural health clinic payments - Sen. Warner, Mark - rural health clinic payments S. 942 - A bill to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect - Sen. Baldwin, Tammy - Short-Term, Limited Duration Insurance Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
Jim Ramstad Legacy of Recovery Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Protecting Consumer Access to Generic Drugs Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021- Rep. Rush, Bobby - patent infringement settlements H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana - PBMs H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require HHS to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter - drug prices H.R. 2139 - To amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by HHS under Medicare part D, and for other purposes - Rep. Doggett, Lloyd - drug prices S. 250 - Fairness in Orphan Drug Exclusivity Act - Sen. Cassidy, Bill - orphan drugs S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha - PBMs and pharmaceutical supply chain S. 833 - A bill to amend XVIII of the Social Security Act to allow HHS to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy -drug prices S. 908 - A bill to amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D, and for other purposes - Sen. Sanders, Bernard - drug prices Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Protecting Consumer Access to Generic Drugs Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act - Rep. Pallone, Frank, Jr. [D-NJ-6] - drug pricing H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021 - Rep. Rush, Bobby L. [D-IL-1] - generic drugs H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana [R-TN-1] - PBMs H.R. 1873 - To educate health care providers and the public on biosimilar biological products, and for other purposes - Rep. Bucshon, Larry [R-IN-8] - drug education H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require the Secretary of Health and Human Services to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter [D-VT-At Large] - Part D price negotiation H.R. 2139 - Medicare Drug Price Negotiation Act - Rep. Doggett, Lloyd [D-TX-35] - Part D price negotiation H.R. 2148 - Prescription Drug Price Relief Act of 2021 - Rep. Khanna, Ro [D-CA-17] - excessive drug pricing H.R. 2608 - Ensuring Seniors Access to Local Pharmacies Act of 2021 - Rep. Welch, Peter [D-VT-At Large] - rural health H.R. 2829 - To require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Rep. Welch, Peter [D-VT-At Large] - reference prices H.R. 2846 - Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021 - Rep. McKinley, David B. [R-WV-1] - biosimilar drugs H.R. 2855 - Star Rating for Biosimilars Act - Rep. Tonko, Paul [D-NY-20] - biosimilar drugs H.R. 2891 - Preserve Access to Affordable Generics and Biosimilars Act - Rep. Nadler, Jerrold [D-NY-10] - biosimilar drugs H.R. 3831 - Seniors Securing Access to Vital and Essential Prescription Drugs Act - Rep. Lee, Susie [D-NV-3] - Part D H.R. 4121 - To codify a final rule issued by the Secretary of Health and Human Services relating to fraud and abuse and the removal of safe harbor protection for certain drug rebates - Rep. Arrington, Jodey C. [R-TX-19] - drug rebates S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha [R-TN] - PBMs S. 833 - A bill to amend XVIII of the Social Security Act to allow the Secretary of Health and Human Services to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy [D-MN] - Part D price negotiation S. 898 - Fair Accountability and Innovative Research Drug Pricing Act of 2021 - Sen. Baldwin, Tammy [D-WI] - reporting price increases S. 908 - Medicare Drug Price Negotiation Act - Sen. Sanders, Bernard [I-VT] - Part D price negotiation S. 1123 - PING Act - Sen. Blackburn, Marsha [R-TN] - Part D non-interference S. 1132 - A bill to establish a cap on out-of-pocket costs for insulin - Sen. Kennedy, John [R-LA] - out-of-pocket costs S. 1323 - A bill to require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Sen. Merkley, Jeff [D-OR] - reference prices S. 1428 - Preserve Access to Affordable Generics and Biosimilars Act - Sen. Klobuchar, Amy [D-MN] - biosimilar drugs S. 2257 - A bill to provide Federal support for nonprofit generic and essential medicine and device manufacturers to increase the availability of drugs and devices in order to reduce drug or device shortages and drug and device costs - Sen. Rosen, Jacky [D-NV] - drug shortages and costs S. 2304 - A bill to amend title XI of the Social Security Act to require that direct-to-consumer advertisements for prescription drugs and biological products include an appropriate disclosure of pricing information - Sen. Durbin, Richard J. [D-IL] - drug pricing Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Virtual Community Support Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Treatment in Place Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
TREATS Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Jack Reynolds Memory Medigap Expansion Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
KEEP Telehealth Options Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Protecting Married Seniors from Impoverishment Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Protecting Married Seniors from Impoverishment Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes.
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 205 - Accelerating Broadband Connectivity Act of 2021 - Rep. Kelly, Trent [R-MS-1] - broadband H.R. 341 - Ensuring Telehealth Expansion Act of 2021 - Rep. Williams, Roger [R-TX-25] - telehealth H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 - Rep. Thompson, Mike [D-CA-5] - telehealth H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - SDOH H.R. 434 - Preventing Mental Health and Substance Use Crises During Emergencies Act - Rep. Trone, David J. [D-MD-6] - mental health and SUD H.R. 596 - ACCESS Act - Rep. Schakowsky, Janice D. [D-IL-9] - telehealth H.R. 675 - COVID-19 Price Gouging Prevention Act - Rep. Schakowsky, Janice D. [D-IL-9] - price gouging H.R. 747 - Access to TESTs Act - Rep. DeGette, Diana [D-CO-1] - COVID-19 H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - maternal health H.R. 925 - Data to Save Moms Act - Rep. Davids, Sharice [D-KS-3] - maternal health H.R. 937 - Tech To Save Moms Act - Rep. Johnson, Eddie Bernice [D-TX-30] - maternal health H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy [D-GA-6] - maternal health H.R. 951 - Maternal Vaccination Act - Rep. Sewell, Terri A. [D-AL-7] - maternal health H.R. 959 - To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes - Rep. Underwood, Lauren [D-IL-14] - maternal health H.R. 1046 - Federal Broadband Deployment in Unserved Areas Act - Rep. Curtis, John R. [R-UT-3] - broadband H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. [D-NC-1] - maternal health H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John A. [D-KY-3] - COVID-19 relief H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl L. "Buddy" [R-GA-1] - telehealth H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes - Rep. Veasey, Marc A. [D-TX-33] - broadband and telehealth H.R. 1872 - MORE Health Education Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - health education H.R. 1888 - Improving Access to Indian Health Services Act- Rep. Ruiz, Raul [D-CA-36] - FMAP for Indian health services H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter A. [D-OR-4] - public option H.R. 3063 - MOMMIES Act - Rep. Pressley, Ayanna [D-MA-7] - maternal health H.R. 3126 - Healthy MOM Act - Rep. Watson Coleman, Bonnie [D-NJ-12] - maternal health H.R. 3407 - MOMMAs Act - Rep. Kelly, Robin L. [D-IL-2] - maternal health H.R. 3688 - To address maternal mortality and morbidity - Rep. Adams, Alma S. [D-NC-12] - maternal health H.R. 3753 - Parity Implementation Assistance Act - Rep. Cardenas, Tony [D-CA-29] - mental health and SUD H.R. 4026 - To require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health - Rep. Burgess, Michael C. [R-TX-26] - SDOH S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina [D-MN] - SDOH S. 168 - TREAT Act - Sen. Murphy, Christopher [D-CT] - telehealth S. 287 - A bill to direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes - Sen. Baldwin, Tammy [D-WI] - maternal health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert P., Jr. [D-PA] - maternal health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim [D-VA] - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory A. [D-NJ] - maternal health S. 347 - Data to Save Moms Act - Sen. Smith, Tina [D-MN] - maternal health S. 368 - Telehealth Modernization Act - Sen. Scott, Tim [R-SC] - telehealth S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat [R-PA] - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard J. [D-IL] - maternal health S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard [D-CT] - SDOH S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon [D-RI] - public option S. 1333 - A bill to address maternal mortality and morbidity - Sen. Gillibrand, Kirsten E. [D-NY] - maternal health S. 1542 - MOMMIES Act - Sen. Booker, Cory A. [D-NJ] - maternal health S. 1622 - HEALTH for MOM Act of 2021 - Sen. Portman, Rob [R-OH] - maternal health S. 1704 - Telehealth Expansion Act of 2021 - Sen. Daines, Steve [R-MT] - telehealth S. 1804 - Mothers and Newborns Success Act - Sen. Kaine, Tim [D-VA] - maternal health S. 1833 - Ensuring Access to Primary Care for Women & Children Act - Sen. Brown, Sherrod [D-OH] - maternal health S. 1962 - Parity Implementation Assistance Act - Sen. Murphy, Christopher [D-CT] - mental health and SUD S. 1988 - Protecting Rural Telehealth Access Act - Sen. Manchin, Joe, III [D-WV] - telehealth S. 2061 - Telemental Health Care Access Act of 2021 - Sen. Cassidy, Bill [R-LA] - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes.
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Stabilize Medicaid and CHIP Coverage Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Medicaid REACH Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Fair Indexing for Health Care Affordability Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 31 - Health Coverage Choice Act - Rep. Biggs, Andy [R-AZ-5] - short-term, limited-duration health insurance plans H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. [R-OH-14] - pre-existing conditions H.R. 317 - To amend the Public Health Service Act to establish a health insurance Federal Invisible Risk Sharing Program - Rep. Schweikert, David [R-AZ-6] - federal risk sharing program H.R. 477 - To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and the Patient Protection and Affordable Care Act to require coverage of hearing devices and systems in certain private health insurance plans, and for other purposes - Rep. Neguse, Joe [D-CO-2] - coverage for hearing devices H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie [D-TX-7] - surprise medical bills H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael C. [R-TX-26] - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa [D-DE-At Large] - coverage for COVID-19 drugs H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - pre-existing conditions H.R. 1255 - Living Donor Protection Act of 2021 - Rep. Nadler, Jerrold [D-NY-10] - coverage for organ donors H.R. 1790 - To amend the Patient Protection and Affordable Care Act to require the Secretary of Health and Human Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia [D-IA-3] - maximum out of pocket costs and premium tax credits H.R. 2264 - Tele-Mental Health Improvement Act - Rep. Trone, David J. [D-MD-6] - telehealth H.R. 2808 - To amend the Internal Revenue Code of 1986 to make improvements to Health Savings Accounts - Rep. Rosendale Sr., Matthew M. [R-MT-At Large] - HSAs H.R. 3029 - Health Care PRICE Transparency Act - Rep. Davidson, Warren [R-OH-8] - price transparency H.R. 3783 - Medical Nutrition Equity Act of 2021 - Rep. McGovern, James P. [D-MA-2] - coverage of medical foods H.R. 3947 - To prohibit the inclusion of mandatory predispute arbitration clauses and clauses limiting class action lawsuits in health insurance contracts - Rep. Porter, Katie [D-CA-45] - health insurance contracts H.R. 3969 - To amend title XXVII of the Public Health Service Act to include activities to address social determinants of health in the calculation of medical loss ratios - Rep. Curtis, John R. [R-UT-3] - SDOH and MLRs H.R. 4123 - To codify certain rules related to health reimbursement arrangements and other account-based group health plans - Rep. Bishop, Dan [R-NC-9] - health reimbursement arrangements H.R. 4289 - To amend title II of the Social Security Act to provide for long-term care insurance benefits - Rep. Suozzi, Thomas R. [D-NY-3] - long-term care insurance benefits S. 125 - Protecting Life in Health Savings Accounts Act - Sen. Lee, Mike [R-UT] - HSAs S. 377 - Living Donor Protection Act of 2021 - Sen. Gillibrand, Kirsten E. [D-NY] - coverage for organ donors S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco [R-FL] - HSAs S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina [D-MN] - SUD and mental health S. 754 - A bill to provide health insurance benefits for outpatient and inpatient items and services related to the diagnosis and treatment of a congenital anomaly or birth defect - Sen. Baldwin, Tammy [D-WI] - insurance benefits S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John [R-LA] - pre-existing conditions S. 1524 - Health Care PRICE Transparency Act- Sen. Braun, Mike [R-IN] - price transparency S. 2097 - A bill to amend the Internal Revenue Code of 1986 to make permanent the permissible first-dollar coverage of telehealth services for purposes of health savings accounts - Sen. Kennedy, John [R-LA] - HSAs S. 2099 - A bill to amend the Internal Revenue Code of 1986 to allow individuals who are not enrolled in a high deductible health plan to have access to health savings accounts - Sen. Sasse, Ben [R-NE] - HSAs Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020, including disclosure of agent broker compensation (Section 202c); issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
Fair Indexing for Health Care Affordability Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. - preexisting conditions H.R. 526 - Ensuring Coverage in Public Health Emergencies Act of 2021 - Rep. Doggett, Lloyd - SEP H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie - COVID-19 diagnostic testing H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa - COVID-19 H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy - preexisting conditions H.R. 898 - Care for COVID-19 Act of 2021 - Rep. Ruiz, Raul - COVID-19 H.R. 1790 - To amend the Patient Protection and ACA to require HHS Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia - MOOP & premium tax credit eligibility H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen - coverage for foster youth H.R. 1796 - To direct HHS to award grants to eligible State agencies to promote State innovations to expand health insurance coverage - Rep. Bera, Ami - state innovations and insurance coverage H.R. 1806 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program - Rep. Castor, Kathy - navigator program H.R. 1874 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program, and for other purposes - Rep. Castor, Kathy - navigator program H.R. 1875 - To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage - Rep. Castor, Kathy - short-term limited duration insurance H.R. 1878 - To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund - Rep. Craig, Angie - affordability H.R. 2264 - To require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Rep. Trone, David - mental health and SUD S. 263 - Worker Health Coverage Protection Act - Sen. Durbin, Richard - coverage continuity & COBRA S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco - HSAs S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne - cost-sharing subsidies S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina - mental health and SUD S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John -preexisting conditions S. 934 - A bill to amend title XVIII of the Social Security Act to improve rural health clinic payments - Sen. Warner, Mark - rural health clinic payments S. 942 - A bill to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect - Sen. Baldwin, Tammy - Short-Term, Limited Duration Insurance Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
CHIPP Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
CHIPP Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Ensuring Kids Have Access to Medically Necessary Dental Care Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Immediate Coverage for Former Foster Youth Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Foster Youth Dental Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Expanded Coverage for Former Foster Youth Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. - preexisting conditions H.R. 526 - Ensuring Coverage in Public Health Emergencies Act of 2021 - Rep. Doggett, Lloyd - SEP H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie - COVID-19 diagnostic testing H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa - COVID-19 H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy - preexisting conditions H.R. 898 - Care for COVID-19 Act of 2021 - Rep. Ruiz, Raul - COVID-19 H.R. 1790 - To amend the Patient Protection and ACA to require HHS Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia - MOOP & premium tax credit eligibility H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen - coverage for foster youth H.R. 1796 - To direct HHS to award grants to eligible State agencies to promote State innovations to expand health insurance coverage - Rep. Bera, Ami - state innovations and insurance coverage H.R. 1806 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program - Rep. Castor, Kathy - navigator program H.R. 1874 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program, and for other purposes - Rep. Castor, Kathy - navigator program H.R. 1875 - To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage - Rep. Castor, Kathy - short-term limited duration insurance H.R. 1878 - To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund - Rep. Craig, Angie - affordability H.R. 2264 - To require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Rep. Trone, David - mental health and SUD S. 263 - Worker Health Coverage Protection Act - Sen. Durbin, Richard - coverage continuity & COBRA S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco - HSAs S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne - cost-sharing subsidies S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina - mental health and SUD S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John -preexisting conditions S. 934 - A bill to amend title XVIII of the Social Security Act to improve rural health clinic payments - Sen. Warner, Mark - rural health clinic payments S. 942 - A bill to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect - Sen. Baldwin, Tammy - Short-Term, Limited Duration Insurance Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
Expanded Coverage for Former Foster Youth Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Health Care Enrollment Innovation Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. - preexisting conditions H.R. 526 - Ensuring Coverage in Public Health Emergencies Act of 2021 - Rep. Doggett, Lloyd - SEP H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie - COVID-19 diagnostic testing H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa - COVID-19 H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy - preexisting conditions H.R. 898 - Care for COVID-19 Act of 2021 - Rep. Ruiz, Raul - COVID-19 H.R. 1790 - To amend the Patient Protection and ACA to require HHS Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia - MOOP & premium tax credit eligibility H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen - coverage for foster youth H.R. 1796 - To direct HHS to award grants to eligible State agencies to promote State innovations to expand health insurance coverage - Rep. Bera, Ami - state innovations and insurance coverage H.R. 1806 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program - Rep. Castor, Kathy - navigator program H.R. 1874 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program, and for other purposes - Rep. Castor, Kathy - navigator program H.R. 1875 - To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage - Rep. Castor, Kathy - short-term limited duration insurance H.R. 1878 - To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund - Rep. Craig, Angie - affordability H.R. 2264 - To require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Rep. Trone, David - mental health and SUD S. 263 - Worker Health Coverage Protection Act - Sen. Durbin, Richard - coverage continuity & COBRA S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco - HSAs S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne - cost-sharing subsidies S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina - mental health and SUD S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John -preexisting conditions S. 934 - A bill to amend title XVIII of the Social Security Act to improve rural health clinic payments - Sen. Warner, Mark - rural health clinic payments S. 942 - A bill to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect - Sen. Baldwin, Tammy - Short-Term, Limited Duration Insurance Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
ENROLL Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. - preexisting conditions H.R. 526 - Ensuring Coverage in Public Health Emergencies Act of 2021 - Rep. Doggett, Lloyd - SEP H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie - COVID-19 diagnostic testing H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa - COVID-19 H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy - preexisting conditions H.R. 898 - Care for COVID-19 Act of 2021 - Rep. Ruiz, Raul - COVID-19 H.R. 1790 - To amend the Patient Protection and ACA to require HHS Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia - MOOP & premium tax credit eligibility H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen - coverage for foster youth H.R. 1796 - To direct HHS to award grants to eligible State agencies to promote State innovations to expand health insurance coverage - Rep. Bera, Ami - state innovations and insurance coverage H.R. 1806 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program - Rep. Castor, Kathy - navigator program H.R. 1874 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program, and for other purposes - Rep. Castor, Kathy - navigator program H.R. 1875 - To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage - Rep. Castor, Kathy - short-term limited duration insurance H.R. 1878 - To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund - Rep. Craig, Angie - affordability H.R. 2264 - To require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Rep. Trone, David - mental health and SUD S. 263 - Worker Health Coverage Protection Act - Sen. Durbin, Richard - coverage continuity & COBRA S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco - HSAs S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne - cost-sharing subsidies S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina - mental health and SUD S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John -preexisting conditions S. 934 - A bill to amend title XVIII of the Social Security Act to improve rural health clinic payments - Sen. Warner, Mark - rural health clinic payments S. 942 - A bill to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect - Sen. Baldwin, Tammy - Short-Term, Limited Duration Insurance Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals.
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Territories Medicare Prescription Drug Assistance Equality Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Fairness in Medicare Part B Enrollment Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Pharmacy Benefit Manager Accountability Study Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act - Rep. Pallone, Frank, Jr. [D-NJ-6] - drug pricing H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021 - Rep. Rush, Bobby L. [D-IL-1] - generic drugs H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana [R-TN-1] - PBMs H.R. 1873 - To educate health care providers and the public on biosimilar biological products, and for other purposes - Rep. Bucshon, Larry [R-IN-8] - drug education H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require the Secretary of Health and Human Services to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter [D-VT-At Large] - Part D price negotiation H.R. 2139 - Medicare Drug Price Negotiation Act - Rep. Doggett, Lloyd [D-TX-35] - Part D price negotiation H.R. 2148 - Prescription Drug Price Relief Act of 2021 - Rep. Khanna, Ro [D-CA-17] - excessive drug pricing H.R. 2608 - Ensuring Seniors Access to Local Pharmacies Act of 2021 - Rep. Welch, Peter [D-VT-At Large] - rural health H.R. 2829 - To require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Rep. Welch, Peter [D-VT-At Large] - reference prices H.R. 2846 - Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021 - Rep. McKinley, David B. [R-WV-1] - biosimilar drugs H.R. 2855 - Star Rating for Biosimilars Act - Rep. Tonko, Paul [D-NY-20] - biosimilar drugs H.R. 2891 - Preserve Access to Affordable Generics and Biosimilars Act - Rep. Nadler, Jerrold [D-NY-10] - biosimilar drugs H.R. 3831 - Seniors Securing Access to Vital and Essential Prescription Drugs Act - Rep. Lee, Susie [D-NV-3] - Part D H.R. 4121 - To codify a final rule issued by the Secretary of Health and Human Services relating to fraud and abuse and the removal of safe harbor protection for certain drug rebates - Rep. Arrington, Jodey C. [R-TX-19] - drug rebates S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha [R-TN] - PBMs S. 833 - A bill to amend XVIII of the Social Security Act to allow the Secretary of Health and Human Services to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy [D-MN] - Part D price negotiation S. 898 - Fair Accountability and Innovative Research Drug Pricing Act of 2021 - Sen. Baldwin, Tammy [D-WI] - reporting price increases S. 908 - Medicare Drug Price Negotiation Act - Sen. Sanders, Bernard [I-VT] - Part D price negotiation S. 1123 - PING Act - Sen. Blackburn, Marsha [R-TN] - Part D non-interference S. 1132 - A bill to establish a cap on out-of-pocket costs for insulin - Sen. Kennedy, John [R-LA] - out-of-pocket costs S. 1323 - A bill to require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Sen. Merkley, Jeff [D-OR] - reference prices S. 1428 - Preserve Access to Affordable Generics and Biosimilars Act - Sen. Klobuchar, Amy [D-MN] - biosimilar drugs S. 2257 - A bill to provide Federal support for nonprofit generic and essential medicine and device manufacturers to increase the availability of drugs and devices in order to reduce drug or device shortages and drug and device costs - Sen. Rosen, Jacky [D-NV] - drug shortages and costs S. 2304 - A bill to amend title XI of the Social Security Act to require that direct-to-consumer advertisements for prescription drugs and biological products include an appropriate disclosure of pricing information - Sen. Durbin, Richard J. [D-IL] - drug pricing Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Pharmacy Benefit Manager Accountability Study Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021- Rep. Rush, Bobby - patent infringement settlements H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana - PBMs H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require HHS to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter - drug prices H.R. 2139 - To amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by HHS under Medicare part D, and for other purposes - Rep. Doggett, Lloyd - drug prices S. 250 - Fairness in Orphan Drug Exclusivity Act - Sen. Cassidy, Bill - orphan drugs S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha - PBMs and pharmaceutical supply chain S. 833 - A bill to amend XVIII of the Social Security Act to allow HHS to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy -drug prices S. 908 - A bill to amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D, and for other purposes - Sen. Sanders, Bernard - drug prices Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Making emergency supplemental appropriations for the fiscal year ending September 30, 2021, and for other purposes.
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
LIFT America Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Responsible Additions and Increases To Sustain Employee Health Benefits Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 369 - Health Care Affordability Act of 2021 - Rep. Underwood, Lauren - tax credits H.R. 1860 - To amend the Internal Revenue Code of 1986 to provide the opportunity for responsible health savings to all American families - Rep. Stivers, Steve - health savings accounts Regulatory Issues: Issues concerning the patient-centered outcomes research fee; employer coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; issues relating to COVID-19; health insurer and employer reporting of health coverage; issues related to health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); and other issues relating to health care reform implementation.
MORE Health Education Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 205 - Accelerating Broadband Connectivity Act of 2021 - Rep. Kelly, Trent [R-MS-1] - broadband H.R. 341 - Ensuring Telehealth Expansion Act of 2021 - Rep. Williams, Roger [R-TX-25] - telehealth H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 - Rep. Thompson, Mike [D-CA-5] - telehealth H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - SDOH H.R. 434 - Preventing Mental Health and Substance Use Crises During Emergencies Act - Rep. Trone, David J. [D-MD-6] - mental health and SUD H.R. 596 - ACCESS Act - Rep. Schakowsky, Janice D. [D-IL-9] - telehealth H.R. 675 - COVID-19 Price Gouging Prevention Act - Rep. Schakowsky, Janice D. [D-IL-9] - price gouging H.R. 747 - Access to TESTs Act - Rep. DeGette, Diana [D-CO-1] - COVID-19 H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - maternal health H.R. 925 - Data to Save Moms Act - Rep. Davids, Sharice [D-KS-3] - maternal health H.R. 937 - Tech To Save Moms Act - Rep. Johnson, Eddie Bernice [D-TX-30] - maternal health H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy [D-GA-6] - maternal health H.R. 951 - Maternal Vaccination Act - Rep. Sewell, Terri A. [D-AL-7] - maternal health H.R. 959 - To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes - Rep. Underwood, Lauren [D-IL-14] - maternal health H.R. 1046 - Federal Broadband Deployment in Unserved Areas Act - Rep. Curtis, John R. [R-UT-3] - broadband H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. [D-NC-1] - maternal health H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John A. [D-KY-3] - COVID-19 relief H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl L. "Buddy" [R-GA-1] - telehealth H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes - Rep. Veasey, Marc A. [D-TX-33] - broadband and telehealth H.R. 1872 - MORE Health Education Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - health education H.R. 1888 - Improving Access to Indian Health Services Act- Rep. Ruiz, Raul [D-CA-36] - FMAP for Indian health services H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter A. [D-OR-4] - public option H.R. 3063 - MOMMIES Act - Rep. Pressley, Ayanna [D-MA-7] - maternal health H.R. 3126 - Healthy MOM Act - Rep. Watson Coleman, Bonnie [D-NJ-12] - maternal health H.R. 3407 - MOMMAs Act - Rep. Kelly, Robin L. [D-IL-2] - maternal health H.R. 3688 - To address maternal mortality and morbidity - Rep. Adams, Alma S. [D-NC-12] - maternal health H.R. 3753 - Parity Implementation Assistance Act - Rep. Cardenas, Tony [D-CA-29] - mental health and SUD H.R. 4026 - To require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health - Rep. Burgess, Michael C. [R-TX-26] - SDOH S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina [D-MN] - SDOH S. 168 - TREAT Act - Sen. Murphy, Christopher [D-CT] - telehealth S. 287 - A bill to direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes - Sen. Baldwin, Tammy [D-WI] - maternal health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert P., Jr. [D-PA] - maternal health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim [D-VA] - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory A. [D-NJ] - maternal health S. 347 - Data to Save Moms Act - Sen. Smith, Tina [D-MN] - maternal health S. 368 - Telehealth Modernization Act - Sen. Scott, Tim [R-SC] - telehealth S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat [R-PA] - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard J. [D-IL] - maternal health S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard [D-CT] - SDOH S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon [D-RI] - public option S. 1333 - A bill to address maternal mortality and morbidity - Sen. Gillibrand, Kirsten E. [D-NY] - maternal health S. 1542 - MOMMIES Act - Sen. Booker, Cory A. [D-NJ] - maternal health S. 1622 - HEALTH for MOM Act of 2021 - Sen. Portman, Rob [R-OH] - maternal health S. 1704 - Telehealth Expansion Act of 2021 - Sen. Daines, Steve [R-MT] - telehealth S. 1804 - Mothers and Newborns Success Act - Sen. Kaine, Tim [D-VA] - maternal health S. 1833 - Ensuring Access to Primary Care for Women & Children Act - Sen. Brown, Sherrod [D-OH] - maternal health S. 1962 - Parity Implementation Assistance Act - Sen. Murphy, Christopher [D-CT] - mental health and SUD S. 1988 - Protecting Rural Telehealth Access Act - Sen. Manchin, Joe, III [D-WV] - telehealth S. 2061 - Telemental Health Care Access Act of 2021 - Sen. Cassidy, Bill [R-LA] - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
MORE Health Education Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Advancing Education on Biosimilars Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act - Rep. Pallone, Frank, Jr. [D-NJ-6] - drug pricing H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021 - Rep. Rush, Bobby L. [D-IL-1] - generic drugs H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana [R-TN-1] - PBMs H.R. 1873 - To educate health care providers and the public on biosimilar biological products, and for other purposes - Rep. Bucshon, Larry [R-IN-8] - drug education H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require the Secretary of Health and Human Services to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter [D-VT-At Large] - Part D price negotiation H.R. 2139 - Medicare Drug Price Negotiation Act - Rep. Doggett, Lloyd [D-TX-35] - Part D price negotiation H.R. 2148 - Prescription Drug Price Relief Act of 2021 - Rep. Khanna, Ro [D-CA-17] - excessive drug pricing H.R. 2608 - Ensuring Seniors Access to Local Pharmacies Act of 2021 - Rep. Welch, Peter [D-VT-At Large] - rural health H.R. 2829 - To require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Rep. Welch, Peter [D-VT-At Large] - reference prices H.R. 2846 - Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021 - Rep. McKinley, David B. [R-WV-1] - biosimilar drugs H.R. 2855 - Star Rating for Biosimilars Act - Rep. Tonko, Paul [D-NY-20] - biosimilar drugs H.R. 2891 - Preserve Access to Affordable Generics and Biosimilars Act - Rep. Nadler, Jerrold [D-NY-10] - biosimilar drugs H.R. 3831 - Seniors Securing Access to Vital and Essential Prescription Drugs Act - Rep. Lee, Susie [D-NV-3] - Part D H.R. 4121 - To codify a final rule issued by the Secretary of Health and Human Services relating to fraud and abuse and the removal of safe harbor protection for certain drug rebates - Rep. Arrington, Jodey C. [R-TX-19] - drug rebates S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha [R-TN] - PBMs S. 833 - A bill to amend XVIII of the Social Security Act to allow the Secretary of Health and Human Services to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy [D-MN] - Part D price negotiation S. 898 - Fair Accountability and Innovative Research Drug Pricing Act of 2021 - Sen. Baldwin, Tammy [D-WI] - reporting price increases S. 908 - Medicare Drug Price Negotiation Act - Sen. Sanders, Bernard [I-VT] - Part D price negotiation S. 1123 - PING Act - Sen. Blackburn, Marsha [R-TN] - Part D non-interference S. 1132 - A bill to establish a cap on out-of-pocket costs for insulin - Sen. Kennedy, John [R-LA] - out-of-pocket costs S. 1323 - A bill to require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Sen. Merkley, Jeff [D-OR] - reference prices S. 1428 - Preserve Access to Affordable Generics and Biosimilars Act - Sen. Klobuchar, Amy [D-MN] - biosimilar drugs S. 2257 - A bill to provide Federal support for nonprofit generic and essential medicine and device manufacturers to increase the availability of drugs and devices in order to reduce drug or device shortages and drug and device costs - Sen. Rosen, Jacky [D-NV] - drug shortages and costs S. 2304 - A bill to amend title XI of the Social Security Act to require that direct-to-consumer advertisements for prescription drugs and biological products include an appropriate disclosure of pricing information - Sen. Durbin, Richard J. [D-IL] - drug pricing Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Expand Navigators’ Resources for Outreach, Learning, and Longevity Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. - preexisting conditions H.R. 526 - Ensuring Coverage in Public Health Emergencies Act of 2021 - Rep. Doggett, Lloyd - SEP H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie - COVID-19 diagnostic testing H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa - COVID-19 H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy - preexisting conditions H.R. 898 - Care for COVID-19 Act of 2021 - Rep. Ruiz, Raul - COVID-19 H.R. 1790 - To amend the Patient Protection and ACA to require HHS Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia - MOOP & premium tax credit eligibility H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen - coverage for foster youth H.R. 1796 - To direct HHS to award grants to eligible State agencies to promote State innovations to expand health insurance coverage - Rep. Bera, Ami - state innovations and insurance coverage H.R. 1806 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program - Rep. Castor, Kathy - navigator program H.R. 1874 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program, and for other purposes - Rep. Castor, Kathy - navigator program H.R. 1875 - To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage - Rep. Castor, Kathy - short-term limited duration insurance H.R. 1878 - To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund - Rep. Craig, Angie - affordability H.R. 2264 - To require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Rep. Trone, David - mental health and SUD S. 263 - Worker Health Coverage Protection Act - Sen. Durbin, Richard - coverage continuity & COBRA S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco - HSAs S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne - cost-sharing subsidies S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina - mental health and SUD S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John -preexisting conditions S. 934 - A bill to amend title XVIII of the Social Security Act to improve rural health clinic payments - Sen. Warner, Mark - rural health clinic payments S. 942 - A bill to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect - Sen. Baldwin, Tammy - Short-Term, Limited Duration Insurance Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage.
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. - preexisting conditions H.R. 526 - Ensuring Coverage in Public Health Emergencies Act of 2021 - Rep. Doggett, Lloyd - SEP H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie - COVID-19 diagnostic testing H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa - COVID-19 H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy - preexisting conditions H.R. 898 - Care for COVID-19 Act of 2021 - Rep. Ruiz, Raul - COVID-19 H.R. 1790 - To amend the Patient Protection and ACA to require HHS Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia - MOOP & premium tax credit eligibility H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen - coverage for foster youth H.R. 1796 - To direct HHS to award grants to eligible State agencies to promote State innovations to expand health insurance coverage - Rep. Bera, Ami - state innovations and insurance coverage H.R. 1806 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program - Rep. Castor, Kathy - navigator program H.R. 1874 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program, and for other purposes - Rep. Castor, Kathy - navigator program H.R. 1875 - To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage - Rep. Castor, Kathy - short-term limited duration insurance H.R. 1878 - To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund - Rep. Craig, Angie - affordability H.R. 2264 - To require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Rep. Trone, David - mental health and SUD S. 263 - Worker Health Coverage Protection Act - Sen. Durbin, Richard - coverage continuity & COBRA S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco - HSAs S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne - cost-sharing subsidies S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina - mental health and SUD S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John -preexisting conditions S. 934 - A bill to amend title XVIII of the Social Security Act to improve rural health clinic payments - Sen. Warner, Mark - rural health clinic payments S. 942 - A bill to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect - Sen. Baldwin, Tammy - Short-Term, Limited Duration Insurance Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
State Health Care Premium Reduction Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. - preexisting conditions H.R. 526 - Ensuring Coverage in Public Health Emergencies Act of 2021 - Rep. Doggett, Lloyd - SEP H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie - COVID-19 diagnostic testing H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa - COVID-19 H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy - preexisting conditions H.R. 898 - Care for COVID-19 Act of 2021 - Rep. Ruiz, Raul - COVID-19 H.R. 1790 - To amend the Patient Protection and ACA to require HHS Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia - MOOP & premium tax credit eligibility H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen - coverage for foster youth H.R. 1796 - To direct HHS to award grants to eligible State agencies to promote State innovations to expand health insurance coverage - Rep. Bera, Ami - state innovations and insurance coverage H.R. 1806 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program - Rep. Castor, Kathy - navigator program H.R. 1874 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program, and for other purposes - Rep. Castor, Kathy - navigator program H.R. 1875 - To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage - Rep. Castor, Kathy - short-term limited duration insurance H.R. 1878 - To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund - Rep. Craig, Angie - affordability H.R. 2264 - To require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Rep. Trone, David - mental health and SUD S. 263 - Worker Health Coverage Protection Act - Sen. Durbin, Richard - coverage continuity & COBRA S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco - HSAs S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne - cost-sharing subsidies S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina - mental health and SUD S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John -preexisting conditions S. 934 - A bill to amend title XVIII of the Social Security Act to improve rural health clinic payments - Sen. Warner, Mark - rural health clinic payments S. 942 - A bill to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect - Sen. Baldwin, Tammy - Short-Term, Limited Duration Insurance Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
RUSH Protection Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Rural Hospital Support Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Improving Access to Indian Health Services Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 205 - Accelerating Broadband Connectivity Act of 2021 - Rep. Kelly, Trent [R-MS-1] - broadband H.R. 341 - Ensuring Telehealth Expansion Act of 2021 - Rep. Williams, Roger [R-TX-25] - telehealth H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 - Rep. Thompson, Mike [D-CA-5] - telehealth H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - SDOH H.R. 434 - Preventing Mental Health and Substance Use Crises During Emergencies Act - Rep. Trone, David J. [D-MD-6] - mental health and SUD H.R. 596 - ACCESS Act - Rep. Schakowsky, Janice D. [D-IL-9] - telehealth H.R. 675 - COVID-19 Price Gouging Prevention Act - Rep. Schakowsky, Janice D. [D-IL-9] - price gouging H.R. 747 - Access to TESTs Act - Rep. DeGette, Diana [D-CO-1] - COVID-19 H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - maternal health H.R. 925 - Data to Save Moms Act - Rep. Davids, Sharice [D-KS-3] - maternal health H.R. 937 - Tech To Save Moms Act - Rep. Johnson, Eddie Bernice [D-TX-30] - maternal health H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy [D-GA-6] - maternal health H.R. 951 - Maternal Vaccination Act - Rep. Sewell, Terri A. [D-AL-7] - maternal health H.R. 959 - To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes - Rep. Underwood, Lauren [D-IL-14] - maternal health H.R. 1046 - Federal Broadband Deployment in Unserved Areas Act - Rep. Curtis, John R. [R-UT-3] - broadband H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. [D-NC-1] - maternal health H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John A. [D-KY-3] - COVID-19 relief H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl L. "Buddy" [R-GA-1] - telehealth H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes - Rep. Veasey, Marc A. [D-TX-33] - broadband and telehealth H.R. 1872 - MORE Health Education Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - health education H.R. 1888 - Improving Access to Indian Health Services Act- Rep. Ruiz, Raul [D-CA-36] - FMAP for Indian health services H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter A. [D-OR-4] - public option H.R. 3063 - MOMMIES Act - Rep. Pressley, Ayanna [D-MA-7] - maternal health H.R. 3126 - Healthy MOM Act - Rep. Watson Coleman, Bonnie [D-NJ-12] - maternal health H.R. 3407 - MOMMAs Act - Rep. Kelly, Robin L. [D-IL-2] - maternal health H.R. 3688 - To address maternal mortality and morbidity - Rep. Adams, Alma S. [D-NC-12] - maternal health H.R. 3753 - Parity Implementation Assistance Act - Rep. Cardenas, Tony [D-CA-29] - mental health and SUD H.R. 4026 - To require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health - Rep. Burgess, Michael C. [R-TX-26] - SDOH S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina [D-MN] - SDOH S. 168 - TREAT Act - Sen. Murphy, Christopher [D-CT] - telehealth S. 287 - A bill to direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes - Sen. Baldwin, Tammy [D-WI] - maternal health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert P., Jr. [D-PA] - maternal health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim [D-VA] - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory A. [D-NJ] - maternal health S. 347 - Data to Save Moms Act - Sen. Smith, Tina [D-MN] - maternal health S. 368 - Telehealth Modernization Act - Sen. Scott, Tim [R-SC] - telehealth S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat [R-PA] - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard J. [D-IL] - maternal health S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard [D-CT] - SDOH S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon [D-RI] - public option S. 1333 - A bill to address maternal mortality and morbidity - Sen. Gillibrand, Kirsten E. [D-NY] - maternal health S. 1542 - MOMMIES Act - Sen. Booker, Cory A. [D-NJ] - maternal health S. 1622 - HEALTH for MOM Act of 2021 - Sen. Portman, Rob [R-OH] - maternal health S. 1704 - Telehealth Expansion Act of 2021 - Sen. Daines, Steve [R-MT] - telehealth S. 1804 - Mothers and Newborns Success Act - Sen. Kaine, Tim [D-VA] - maternal health S. 1833 - Ensuring Access to Primary Care for Women & Children Act - Sen. Brown, Sherrod [D-OH] - maternal health S. 1962 - Parity Implementation Assistance Act - Sen. Murphy, Christopher [D-CT] - mental health and SUD S. 1988 - Protecting Rural Telehealth Access Act - Sen. Manchin, Joe, III [D-WV] - telehealth S. 2061 - Telemental Health Care Access Act of 2021 - Sen. Cassidy, Bill [R-LA] - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Health Insurance Consumer Protection Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Lower Costs, More Cures Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
CAHOOTS Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Medicare Advantage Integrity Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Medicare Advantage Integrity Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Medicare for All Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Medicare for All Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Protecting Seniors Through Immunization Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Nursing Home Reform Modernization Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Protect Seniors and Cut Waste Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Public Option Deficit Reduction Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Public Option Deficit Reduction Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 205 - Accelerating Broadband Connectivity Act of 2021 - Rep. Kelly, Trent [R-MS-1] - broadband H.R. 341 - Ensuring Telehealth Expansion Act of 2021 - Rep. Williams, Roger [R-TX-25] - telehealth H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 - Rep. Thompson, Mike [D-CA-5] - telehealth H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - SDOH H.R. 434 - Preventing Mental Health and Substance Use Crises During Emergencies Act - Rep. Trone, David J. [D-MD-6] - mental health and SUD H.R. 596 - ACCESS Act - Rep. Schakowsky, Janice D. [D-IL-9] - telehealth H.R. 675 - COVID-19 Price Gouging Prevention Act - Rep. Schakowsky, Janice D. [D-IL-9] - price gouging H.R. 747 - Access to TESTs Act - Rep. DeGette, Diana [D-CO-1] - COVID-19 H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - maternal health H.R. 925 - Data to Save Moms Act - Rep. Davids, Sharice [D-KS-3] - maternal health H.R. 937 - Tech To Save Moms Act - Rep. Johnson, Eddie Bernice [D-TX-30] - maternal health H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy [D-GA-6] - maternal health H.R. 951 - Maternal Vaccination Act - Rep. Sewell, Terri A. [D-AL-7] - maternal health H.R. 959 - To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes - Rep. Underwood, Lauren [D-IL-14] - maternal health H.R. 1046 - Federal Broadband Deployment in Unserved Areas Act - Rep. Curtis, John R. [R-UT-3] - broadband H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. [D-NC-1] - maternal health H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John A. [D-KY-3] - COVID-19 relief H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl L. "Buddy" [R-GA-1] - telehealth H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes - Rep. Veasey, Marc A. [D-TX-33] - broadband and telehealth H.R. 1872 - MORE Health Education Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - health education H.R. 1888 - Improving Access to Indian Health Services Act- Rep. Ruiz, Raul [D-CA-36] - FMAP for Indian health services H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter A. [D-OR-4] - public option H.R. 3063 - MOMMIES Act - Rep. Pressley, Ayanna [D-MA-7] - maternal health H.R. 3126 - Healthy MOM Act - Rep. Watson Coleman, Bonnie [D-NJ-12] - maternal health H.R. 3407 - MOMMAs Act - Rep. Kelly, Robin L. [D-IL-2] - maternal health H.R. 3688 - To address maternal mortality and morbidity - Rep. Adams, Alma S. [D-NC-12] - maternal health H.R. 3753 - Parity Implementation Assistance Act - Rep. Cardenas, Tony [D-CA-29] - mental health and SUD H.R. 4026 - To require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health - Rep. Burgess, Michael C. [R-TX-26] - SDOH S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina [D-MN] - SDOH S. 168 - TREAT Act - Sen. Murphy, Christopher [D-CT] - telehealth S. 287 - A bill to direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes - Sen. Baldwin, Tammy [D-WI] - maternal health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert P., Jr. [D-PA] - maternal health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim [D-VA] - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory A. [D-NJ] - maternal health S. 347 - Data to Save Moms Act - Sen. Smith, Tina [D-MN] - maternal health S. 368 - Telehealth Modernization Act - Sen. Scott, Tim [R-SC] - telehealth S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat [R-PA] - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard J. [D-IL] - maternal health S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard [D-CT] - SDOH S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon [D-RI] - public option S. 1333 - A bill to address maternal mortality and morbidity - Sen. Gillibrand, Kirsten E. [D-NY] - maternal health S. 1542 - MOMMIES Act - Sen. Booker, Cory A. [D-NJ] - maternal health S. 1622 - HEALTH for MOM Act of 2021 - Sen. Portman, Rob [R-OH] - maternal health S. 1704 - Telehealth Expansion Act of 2021 - Sen. Daines, Steve [R-MT] - telehealth S. 1804 - Mothers and Newborns Success Act - Sen. Kaine, Tim [D-VA] - maternal health S. 1833 - Ensuring Access to Primary Care for Women & Children Act - Sen. Brown, Sherrod [D-OH] - maternal health S. 1962 - Parity Implementation Assistance Act - Sen. Murphy, Christopher [D-CT] - mental health and SUD S. 1988 - Protecting Rural Telehealth Access Act - Sen. Manchin, Joe, III [D-WV] - telehealth S. 2061 - Telemental Health Care Access Act of 2021 - Sen. Cassidy, Bill [R-LA] - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Improving Access to Mental Health Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Accelerating Broadband Connectivity Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 205 - Accelerating Broadband Connectivity Act of 2021 - Rep. Kelly, Trent [R-MS-1] - broadband H.R. 341 - Ensuring Telehealth Expansion Act of 2021 - Rep. Williams, Roger [R-TX-25] - telehealth H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 - Rep. Thompson, Mike [D-CA-5] - telehealth H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - SDOH H.R. 434 - Preventing Mental Health and Substance Use Crises During Emergencies Act - Rep. Trone, David J. [D-MD-6] - mental health and SUD H.R. 596 - ACCESS Act - Rep. Schakowsky, Janice D. [D-IL-9] - telehealth H.R. 675 - COVID-19 Price Gouging Prevention Act - Rep. Schakowsky, Janice D. [D-IL-9] - price gouging H.R. 747 - Access to TESTs Act - Rep. DeGette, Diana [D-CO-1] - COVID-19 H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - maternal health H.R. 925 - Data to Save Moms Act - Rep. Davids, Sharice [D-KS-3] - maternal health H.R. 937 - Tech To Save Moms Act - Rep. Johnson, Eddie Bernice [D-TX-30] - maternal health H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy [D-GA-6] - maternal health H.R. 951 - Maternal Vaccination Act - Rep. Sewell, Terri A. [D-AL-7] - maternal health H.R. 959 - To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes - Rep. Underwood, Lauren [D-IL-14] - maternal health H.R. 1046 - Federal Broadband Deployment in Unserved Areas Act - Rep. Curtis, John R. [R-UT-3] - broadband H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. [D-NC-1] - maternal health H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John A. [D-KY-3] - COVID-19 relief H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl L. "Buddy" [R-GA-1] - telehealth H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes - Rep. Veasey, Marc A. [D-TX-33] - broadband and telehealth H.R. 1872 - MORE Health Education Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - health education H.R. 1888 - Improving Access to Indian Health Services Act- Rep. Ruiz, Raul [D-CA-36] - FMAP for Indian health services H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter A. [D-OR-4] - public option H.R. 3063 - MOMMIES Act - Rep. Pressley, Ayanna [D-MA-7] - maternal health H.R. 3126 - Healthy MOM Act - Rep. Watson Coleman, Bonnie [D-NJ-12] - maternal health H.R. 3407 - MOMMAs Act - Rep. Kelly, Robin L. [D-IL-2] - maternal health H.R. 3688 - To address maternal mortality and morbidity - Rep. Adams, Alma S. [D-NC-12] - maternal health H.R. 3753 - Parity Implementation Assistance Act - Rep. Cardenas, Tony [D-CA-29] - mental health and SUD H.R. 4026 - To require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health - Rep. Burgess, Michael C. [R-TX-26] - SDOH S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina [D-MN] - SDOH S. 168 - TREAT Act - Sen. Murphy, Christopher [D-CT] - telehealth S. 287 - A bill to direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes - Sen. Baldwin, Tammy [D-WI] - maternal health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert P., Jr. [D-PA] - maternal health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim [D-VA] - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory A. [D-NJ] - maternal health S. 347 - Data to Save Moms Act - Sen. Smith, Tina [D-MN] - maternal health S. 368 - Telehealth Modernization Act - Sen. Scott, Tim [R-SC] - telehealth S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat [R-PA] - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard J. [D-IL] - maternal health S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard [D-CT] - SDOH S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon [D-RI] - public option S. 1333 - A bill to address maternal mortality and morbidity - Sen. Gillibrand, Kirsten E. [D-NY] - maternal health S. 1542 - MOMMIES Act - Sen. Booker, Cory A. [D-NJ] - maternal health S. 1622 - HEALTH for MOM Act of 2021 - Sen. Portman, Rob [R-OH] - maternal health S. 1704 - Telehealth Expansion Act of 2021 - Sen. Daines, Steve [R-MT] - telehealth S. 1804 - Mothers and Newborns Success Act - Sen. Kaine, Tim [D-VA] - maternal health S. 1833 - Ensuring Access to Primary Care for Women & Children Act - Sen. Brown, Sherrod [D-OH] - maternal health S. 1962 - Parity Implementation Assistance Act - Sen. Murphy, Christopher [D-CT] - mental health and SUD S. 1988 - Protecting Rural Telehealth Access Act - Sen. Manchin, Joe, III [D-WV] - telehealth S. 2061 - Telemental Health Care Access Act of 2021 - Sen. Cassidy, Bill [R-LA] - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Medicare Prescription Drug Price Negotiation Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act - Rep. Pallone, Frank, Jr. [D-NJ-6] - drug pricing H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021 - Rep. Rush, Bobby L. [D-IL-1] - generic drugs H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana [R-TN-1] - PBMs H.R. 1873 - To educate health care providers and the public on biosimilar biological products, and for other purposes - Rep. Bucshon, Larry [R-IN-8] - drug education H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require the Secretary of Health and Human Services to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter [D-VT-At Large] - Part D price negotiation H.R. 2139 - Medicare Drug Price Negotiation Act - Rep. Doggett, Lloyd [D-TX-35] - Part D price negotiation H.R. 2148 - Prescription Drug Price Relief Act of 2021 - Rep. Khanna, Ro [D-CA-17] - excessive drug pricing H.R. 2608 - Ensuring Seniors Access to Local Pharmacies Act of 2021 - Rep. Welch, Peter [D-VT-At Large] - rural health H.R. 2829 - To require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Rep. Welch, Peter [D-VT-At Large] - reference prices H.R. 2846 - Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021 - Rep. McKinley, David B. [R-WV-1] - biosimilar drugs H.R. 2855 - Star Rating for Biosimilars Act - Rep. Tonko, Paul [D-NY-20] - biosimilar drugs H.R. 2891 - Preserve Access to Affordable Generics and Biosimilars Act - Rep. Nadler, Jerrold [D-NY-10] - biosimilar drugs H.R. 3831 - Seniors Securing Access to Vital and Essential Prescription Drugs Act - Rep. Lee, Susie [D-NV-3] - Part D H.R. 4121 - To codify a final rule issued by the Secretary of Health and Human Services relating to fraud and abuse and the removal of safe harbor protection for certain drug rebates - Rep. Arrington, Jodey C. [R-TX-19] - drug rebates S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha [R-TN] - PBMs S. 833 - A bill to amend XVIII of the Social Security Act to allow the Secretary of Health and Human Services to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy [D-MN] - Part D price negotiation S. 898 - Fair Accountability and Innovative Research Drug Pricing Act of 2021 - Sen. Baldwin, Tammy [D-WI] - reporting price increases S. 908 - Medicare Drug Price Negotiation Act - Sen. Sanders, Bernard [I-VT] - Part D price negotiation S. 1123 - PING Act - Sen. Blackburn, Marsha [R-TN] - Part D non-interference S. 1132 - A bill to establish a cap on out-of-pocket costs for insulin - Sen. Kennedy, John [R-LA] - out-of-pocket costs S. 1323 - A bill to require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Sen. Merkley, Jeff [D-OR] - reference prices S. 1428 - Preserve Access to Affordable Generics and Biosimilars Act - Sen. Klobuchar, Amy [D-MN] - biosimilar drugs S. 2257 - A bill to provide Federal support for nonprofit generic and essential medicine and device manufacturers to increase the availability of drugs and devices in order to reduce drug or device shortages and drug and device costs - Sen. Rosen, Jacky [D-NV] - drug shortages and costs S. 2304 - A bill to amend title XI of the Social Security Act to require that direct-to-consumer advertisements for prescription drugs and biological products include an appropriate disclosure of pricing information - Sen. Durbin, Richard J. [D-IL] - drug pricing Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Medicare Prescription Drug Price Negotiation Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021- Rep. Rush, Bobby - patent infringement settlements H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana - PBMs H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require HHS to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter - drug prices H.R. 2139 - To amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by HHS under Medicare part D, and for other purposes - Rep. Doggett, Lloyd - drug prices S. 250 - Fairness in Orphan Drug Exclusivity Act - Sen. Cassidy, Bill - orphan drugs S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha - PBMs and pharmaceutical supply chain S. 833 - A bill to amend XVIII of the Social Security Act to allow HHS to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy -drug prices S. 908 - A bill to amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D, and for other purposes - Sen. Sanders, Bernard - drug prices Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
SAVE Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Medicare Drug Price Negotiation Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act - Rep. Pallone, Frank, Jr. [D-NJ-6] - drug pricing H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021 - Rep. Rush, Bobby L. [D-IL-1] - generic drugs H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana [R-TN-1] - PBMs H.R. 1873 - To educate health care providers and the public on biosimilar biological products, and for other purposes - Rep. Bucshon, Larry [R-IN-8] - drug education H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require the Secretary of Health and Human Services to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter [D-VT-At Large] - Part D price negotiation H.R. 2139 - Medicare Drug Price Negotiation Act - Rep. Doggett, Lloyd [D-TX-35] - Part D price negotiation H.R. 2148 - Prescription Drug Price Relief Act of 2021 - Rep. Khanna, Ro [D-CA-17] - excessive drug pricing H.R. 2608 - Ensuring Seniors Access to Local Pharmacies Act of 2021 - Rep. Welch, Peter [D-VT-At Large] - rural health H.R. 2829 - To require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Rep. Welch, Peter [D-VT-At Large] - reference prices H.R. 2846 - Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021 - Rep. McKinley, David B. [R-WV-1] - biosimilar drugs H.R. 2855 - Star Rating for Biosimilars Act - Rep. Tonko, Paul [D-NY-20] - biosimilar drugs H.R. 2891 - Preserve Access to Affordable Generics and Biosimilars Act - Rep. Nadler, Jerrold [D-NY-10] - biosimilar drugs H.R. 3831 - Seniors Securing Access to Vital and Essential Prescription Drugs Act - Rep. Lee, Susie [D-NV-3] - Part D H.R. 4121 - To codify a final rule issued by the Secretary of Health and Human Services relating to fraud and abuse and the removal of safe harbor protection for certain drug rebates - Rep. Arrington, Jodey C. [R-TX-19] - drug rebates S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha [R-TN] - PBMs S. 833 - A bill to amend XVIII of the Social Security Act to allow the Secretary of Health and Human Services to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy [D-MN] - Part D price negotiation S. 898 - Fair Accountability and Innovative Research Drug Pricing Act of 2021 - Sen. Baldwin, Tammy [D-WI] - reporting price increases S. 908 - Medicare Drug Price Negotiation Act - Sen. Sanders, Bernard [I-VT] - Part D price negotiation S. 1123 - PING Act - Sen. Blackburn, Marsha [R-TN] - Part D non-interference S. 1132 - A bill to establish a cap on out-of-pocket costs for insulin - Sen. Kennedy, John [R-LA] - out-of-pocket costs S. 1323 - A bill to require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Sen. Merkley, Jeff [D-OR] - reference prices S. 1428 - Preserve Access to Affordable Generics and Biosimilars Act - Sen. Klobuchar, Amy [D-MN] - biosimilar drugs S. 2257 - A bill to provide Federal support for nonprofit generic and essential medicine and device manufacturers to increase the availability of drugs and devices in order to reduce drug or device shortages and drug and device costs - Sen. Rosen, Jacky [D-NV] - drug shortages and costs S. 2304 - A bill to amend title XI of the Social Security Act to require that direct-to-consumer advertisements for prescription drugs and biological products include an appropriate disclosure of pricing information - Sen. Durbin, Richard J. [D-IL] - drug pricing Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Medicare Drug Price Negotiation Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021- Rep. Rush, Bobby - patent infringement settlements H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana - PBMs H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require HHS to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter - drug prices H.R. 2139 - To amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by HHS under Medicare part D, and for other purposes - Rep. Doggett, Lloyd - drug prices S. 250 - Fairness in Orphan Drug Exclusivity Act - Sen. Cassidy, Bill - orphan drugs S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha - PBMs and pharmaceutical supply chain S. 833 - A bill to amend XVIII of the Social Security Act to allow HHS to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy -drug prices S. 908 - A bill to amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D, and for other purposes - Sen. Sanders, Bernard - drug prices Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Prescription Drug Price Relief Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act - Rep. Pallone, Frank, Jr. [D-NJ-6] - drug pricing H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021 - Rep. Rush, Bobby L. [D-IL-1] - generic drugs H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana [R-TN-1] - PBMs H.R. 1873 - To educate health care providers and the public on biosimilar biological products, and for other purposes - Rep. Bucshon, Larry [R-IN-8] - drug education H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require the Secretary of Health and Human Services to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter [D-VT-At Large] - Part D price negotiation H.R. 2139 - Medicare Drug Price Negotiation Act - Rep. Doggett, Lloyd [D-TX-35] - Part D price negotiation H.R. 2148 - Prescription Drug Price Relief Act of 2021 - Rep. Khanna, Ro [D-CA-17] - excessive drug pricing H.R. 2608 - Ensuring Seniors Access to Local Pharmacies Act of 2021 - Rep. Welch, Peter [D-VT-At Large] - rural health H.R. 2829 - To require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Rep. Welch, Peter [D-VT-At Large] - reference prices H.R. 2846 - Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021 - Rep. McKinley, David B. [R-WV-1] - biosimilar drugs H.R. 2855 - Star Rating for Biosimilars Act - Rep. Tonko, Paul [D-NY-20] - biosimilar drugs H.R. 2891 - Preserve Access to Affordable Generics and Biosimilars Act - Rep. Nadler, Jerrold [D-NY-10] - biosimilar drugs H.R. 3831 - Seniors Securing Access to Vital and Essential Prescription Drugs Act - Rep. Lee, Susie [D-NV-3] - Part D H.R. 4121 - To codify a final rule issued by the Secretary of Health and Human Services relating to fraud and abuse and the removal of safe harbor protection for certain drug rebates - Rep. Arrington, Jodey C. [R-TX-19] - drug rebates S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha [R-TN] - PBMs S. 833 - A bill to amend XVIII of the Social Security Act to allow the Secretary of Health and Human Services to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy [D-MN] - Part D price negotiation S. 898 - Fair Accountability and Innovative Research Drug Pricing Act of 2021 - Sen. Baldwin, Tammy [D-WI] - reporting price increases S. 908 - Medicare Drug Price Negotiation Act - Sen. Sanders, Bernard [I-VT] - Part D price negotiation S. 1123 - PING Act - Sen. Blackburn, Marsha [R-TN] - Part D non-interference S. 1132 - A bill to establish a cap on out-of-pocket costs for insulin - Sen. Kennedy, John [R-LA] - out-of-pocket costs S. 1323 - A bill to require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Sen. Merkley, Jeff [D-OR] - reference prices S. 1428 - Preserve Access to Affordable Generics and Biosimilars Act - Sen. Klobuchar, Amy [D-MN] - biosimilar drugs S. 2257 - A bill to provide Federal support for nonprofit generic and essential medicine and device manufacturers to increase the availability of drugs and devices in order to reduce drug or device shortages and drug and device costs - Sen. Rosen, Jacky [D-NV] - drug shortages and costs S. 2304 - A bill to amend title XI of the Social Security Act to require that direct-to-consumer advertisements for prescription drugs and biological products include an appropriate disclosure of pricing information - Sen. Durbin, Richard J. [D-IL] - drug pricing Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Expanded Telehealth Access Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
HAPI Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Affordable Insulin for the COVID–19 Emergency Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Territory Federal Matching Requirement Equity Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Territory Federal Matching Requirement Equity Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Rural Behavioral Health Access Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Tele-Mental Health Improvement Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 31 - Health Coverage Choice Act - Rep. Biggs, Andy [R-AZ-5] - short-term, limited-duration health insurance plans H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. [R-OH-14] - pre-existing conditions H.R. 317 - To amend the Public Health Service Act to establish a health insurance Federal Invisible Risk Sharing Program - Rep. Schweikert, David [R-AZ-6] - federal risk sharing program H.R. 477 - To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and the Patient Protection and Affordable Care Act to require coverage of hearing devices and systems in certain private health insurance plans, and for other purposes - Rep. Neguse, Joe [D-CO-2] - coverage for hearing devices H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie [D-TX-7] - surprise medical bills H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael C. [R-TX-26] - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa [D-DE-At Large] - coverage for COVID-19 drugs H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - pre-existing conditions H.R. 1255 - Living Donor Protection Act of 2021 - Rep. Nadler, Jerrold [D-NY-10] - coverage for organ donors H.R. 1790 - To amend the Patient Protection and Affordable Care Act to require the Secretary of Health and Human Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia [D-IA-3] - maximum out of pocket costs and premium tax credits H.R. 2264 - Tele-Mental Health Improvement Act - Rep. Trone, David J. [D-MD-6] - telehealth H.R. 2808 - To amend the Internal Revenue Code of 1986 to make improvements to Health Savings Accounts - Rep. Rosendale Sr., Matthew M. [R-MT-At Large] - HSAs H.R. 3029 - Health Care PRICE Transparency Act - Rep. Davidson, Warren [R-OH-8] - price transparency H.R. 3783 - Medical Nutrition Equity Act of 2021 - Rep. McGovern, James P. [D-MA-2] - coverage of medical foods H.R. 3947 - To prohibit the inclusion of mandatory predispute arbitration clauses and clauses limiting class action lawsuits in health insurance contracts - Rep. Porter, Katie [D-CA-45] - health insurance contracts H.R. 3969 - To amend title XXVII of the Public Health Service Act to include activities to address social determinants of health in the calculation of medical loss ratios - Rep. Curtis, John R. [R-UT-3] - SDOH and MLRs H.R. 4123 - To codify certain rules related to health reimbursement arrangements and other account-based group health plans - Rep. Bishop, Dan [R-NC-9] - health reimbursement arrangements H.R. 4289 - To amend title II of the Social Security Act to provide for long-term care insurance benefits - Rep. Suozzi, Thomas R. [D-NY-3] - long-term care insurance benefits S. 125 - Protecting Life in Health Savings Accounts Act - Sen. Lee, Mike [R-UT] - HSAs S. 377 - Living Donor Protection Act of 2021 - Sen. Gillibrand, Kirsten E. [D-NY] - coverage for organ donors S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco [R-FL] - HSAs S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina [D-MN] - SUD and mental health S. 754 - A bill to provide health insurance benefits for outpatient and inpatient items and services related to the diagnosis and treatment of a congenital anomaly or birth defect - Sen. Baldwin, Tammy [D-WI] - insurance benefits S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John [R-LA] - pre-existing conditions S. 1524 - Health Care PRICE Transparency Act- Sen. Braun, Mike [R-IN] - price transparency S. 2097 - A bill to amend the Internal Revenue Code of 1986 to make permanent the permissible first-dollar coverage of telehealth services for purposes of health savings accounts - Sen. Kennedy, John [R-LA] - HSAs S. 2099 - A bill to amend the Internal Revenue Code of 1986 to allow individuals who are not enrolled in a high deductible health plan to have access to health savings accounts - Sen. Sasse, Ben [R-NE] - HSAs Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020, including disclosure of agent broker compensation (Section 202c); issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
Tele-Mental Health Improvement Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. - preexisting conditions H.R. 526 - Ensuring Coverage in Public Health Emergencies Act of 2021 - Rep. Doggett, Lloyd - SEP H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie - COVID-19 diagnostic testing H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa - COVID-19 H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy - preexisting conditions H.R. 898 - Care for COVID-19 Act of 2021 - Rep. Ruiz, Raul - COVID-19 H.R. 1790 - To amend the Patient Protection and ACA to require HHS Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia - MOOP & premium tax credit eligibility H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen - coverage for foster youth H.R. 1796 - To direct HHS to award grants to eligible State agencies to promote State innovations to expand health insurance coverage - Rep. Bera, Ami - state innovations and insurance coverage H.R. 1806 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program - Rep. Castor, Kathy - navigator program H.R. 1874 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program, and for other purposes - Rep. Castor, Kathy - navigator program H.R. 1875 - To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage - Rep. Castor, Kathy - short-term limited duration insurance H.R. 1878 - To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund - Rep. Craig, Angie - affordability H.R. 2264 - To require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Rep. Trone, David - mental health and SUD S. 263 - Worker Health Coverage Protection Act - Sen. Durbin, Richard - coverage continuity & COBRA S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco - HSAs S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne - cost-sharing subsidies S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina - mental health and SUD S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John -preexisting conditions S. 934 - A bill to amend title XVIII of the Social Security Act to improve rural health clinic payments - Sen. Warner, Mark - rural health clinic payments S. 942 - A bill to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect - Sen. Baldwin, Tammy - Short-Term, Limited Duration Insurance Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
MIND Act
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
More Help for Seniors Act of 2021
Client: AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · Firm: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris [D-NH-1] - Medicare prescription drug benefit H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services for the treatment of psychiatric or substance use disorders furnished to certain individuals in an institution for mental diseases, and for other purposes - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - To amend title XVIII of the Social Security Act to provide information regarding vaccines for seniors as part of the Medicare & You handbook and to ensure that the treatment of cost sharing for vaccines under Medicare part D is consistent with the treatment of vaccines under Medicare part B, and for other purposes - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - To delay and offset the sequester under the Statutory Pay-As-You-Go Act of 2010 as a result of the enactment of the American Rescue Plan Act of 2021, and for other purpose - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - To amend title XVIII of the Social Security Act to expand accessibility to certain telehealth services under the Medicare program - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children's Health Insurance Program - Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 - To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program - Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - To amend title XVIII of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare program - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - To amend titles XVIII and XIX of the Social Security Act to eliminate cost sharing with respect to coverage of insulin as a covered part D drug under the Medicare program or as a covered outpatient drug under the Medicaid program - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - To amend title XVIII of the Social Security Act to provide coverage for certain vision items and services under part B of the Medicare program - Rep. Schrier, Kim [D-WA] - Medicare vision coverage H.R. 4263 - To amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - A bill to amend title XVIII of the Social Security Act to provide for the waiver of certain telehealth requirements to permit reimbursement for audio-only telehealth services under the Medicare program during emergency declarations - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - A bill to amend title XVIII of the Social Security Act and the SUPPORT for Patients and Communities Act to provide for Medicare and Medicaid mental and behavioral health treatment through telehealth - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - A bill to amend title XIX of the Social Security Act to increase the Federal medical assistance percentage for States that provide Medicaid coverage for telehealth services - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - A bill to amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - A bill to amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare - Sen. Brown, Sherrod [D-OH] - Medicare buy-in Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
H.R. 31 - Health Coverage Choice Act - Rep. Biggs, Andy [R-AZ-5] - short-term, limited-duration health insurance plans H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. [R-OH-14] - pre-existing conditions H.R. 317 - To amend the Public Health Service Act to establish a health insurance Federal Invisible Risk Sharing Program - Rep. Schweikert, David [R-AZ-6] - federal risk sharing program H.R. 477 - To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and the Patient Protection and Affordable Care Act to require coverage of hearing devices and systems in certain private health insurance plans, and for other purposes - Rep. Neguse, Joe [D-CO-2] - coverage for hearing devices H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie [D-TX-7] - surprise medical bills H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael C. [R-TX-26] - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa [D-DE-At Large] - coverage for COVID-19 drugs H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - pre-existing conditions H.R. 1255 - Living Donor Protection Act of 2021 - Rep. Nadler, Jerrold [D-NY-10] - coverage for organ donors H.R. 1790 - To amend the Patient Protection and Affordable Care Act to require the Secretary of Health and Human Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia [D-IA-3] - maximum out of pocket costs and premium tax credits H.R. 2264 - Tele-Mental Health Improvement Act - Rep. Trone, David J. [D-MD-6] - telehealth H.R. 2808 - To amend the Internal Revenue Code of 1986 to make improvements to Health Savings Accounts - Rep. Rosendale Sr., Matthew M. [R-MT-At Large] - HSAs H.R. 3029 - Health Care PRICE Transparency Act - Rep. Davidson, Warren [R-OH-8] - price transparency H.R. 3783 - Medical Nutrition Equity Act of 2021 - Rep. McGovern, James P. [D-MA-2] - coverage of medical foods H.R. 3947 - To prohibit the inclusion of mandatory predispute arbitration clauses and clauses limiting class action lawsuits in health insurance contracts - Rep. Porter, Katie [D-CA-45] - health insurance contracts H.R. 3969 - To amend title XXVII of the Public Health Service Act to include activities to address social determinants of health in the calculation of medical loss ratios - Rep. Curtis, John R. [R-UT-3] - SDOH and MLRs H.R. 4123 - To codify certain rules related to health reimbursement arrangements and other account-based group health plans - Rep. Bishop, Dan [R-NC-9] - health reimbursement arrangements H.R. 4289 - To amend title II of the Social Security Act to provide for long-term care insurance benefits - Rep. Suozzi, Thomas R. [D-NY-3] - long-term care insurance benefits S. 125 - Protecting Life in Health Savings Accounts Act - Sen. Lee, Mike [R-UT] - HSAs S. 377 - Living Donor Protection Act of 2021 - Sen. Gillibrand, Kirsten E. [D-NY] - coverage for organ donors S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco [R-FL] - HSAs S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina [D-MN] - SUD and mental health S. 754 - A bill to provide health insurance benefits for outpatient and inpatient items and services related to the diagnosis and treatment of a congenital anomaly or birth defect - Sen. Baldwin, Tammy [D-WI] - insurance benefits S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John [R-LA] - pre-existing conditions S. 1524 - Health Care PRICE Transparency Act- Sen. Braun, Mike [R-IN] - price transparency S. 2097 - A bill to amend the Internal Revenue Code of 1986 to make permanent the permissible first-dollar coverage of telehealth services for purposes of health savings accounts - Sen. Kennedy, John [R-LA] - HSAs S. 2099 - A bill to amend the Internal Revenue Code of 1986 to allow individuals who are not enrolled in a high deductible health plan to have access to health savings accounts - Sen. Sasse, Ben [R-NE] - HSAs Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020, including disclosure of agent broker compensation (Section 202c); issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act - Rep. Pallone, Frank, Jr. [D-NJ-6] - drug pricing H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021 - Rep. Rush, Bobby L. [D-IL-1] - generic drugs H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana [R-TN-1] - PBMs H.R. 1873 - To educate health care providers and the public on biosimilar biological products, and for other purposes - Rep. Bucshon, Larry [R-IN-8] - drug education H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require the Secretary of Health and Human Services to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter [D-VT-At Large] - Part D price negotiation H.R. 2139 - Medicare Drug Price Negotiation Act - Rep. Doggett, Lloyd [D-TX-35] - Part D price negotiation H.R. 2148 - Prescription Drug Price Relief Act of 2021 - Rep. Khanna, Ro [D-CA-17] - excessive drug pricing H.R. 2608 - Ensuring Seniors Access to Local Pharmacies Act of 2021 - Rep. Welch, Peter [D-VT-At Large] - rural health H.R. 2829 - To require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Rep. Welch, Peter [D-VT-At Large] - reference prices H.R. 2846 - Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021 - Rep. McKinley, David B. [R-WV-1] - biosimilar drugs H.R. 2855 - Star Rating for Biosimilars Act - Rep. Tonko, Paul [D-NY-20] - biosimilar drugs H.R. 2891 - Preserve Access to Affordable Generics and Biosimilars Act - Rep. Nadler, Jerrold [D-NY-10] - biosimilar drugs H.R. 3831 - Seniors Securing Access to Vital and Essential Prescription Drugs Act - Rep. Lee, Susie [D-NV-3] - Part D H.R. 4121 - To codify a final rule issued by the Secretary of Health and Human Services relating to fraud and abuse and the removal of safe harbor protection for certain drug rebates - Rep. Arrington, Jodey C. [R-TX-19] - drug rebates S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha [R-TN] - PBMs S. 833 - A bill to amend XVIII of the Social Security Act to allow the Secretary of Health and Human Services to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy [D-MN] - Part D price negotiation S. 898 - Fair Accountability and Innovative Research Drug Pricing Act of 2021 - Sen. Baldwin, Tammy [D-WI] - reporting price increases S. 908 - Medicare Drug Price Negotiation Act - Sen. Sanders, Bernard [I-VT] - Part D price negotiation S. 1123 - PING Act - Sen. Blackburn, Marsha [R-TN] - Part D non-interference S. 1132 - A bill to establish a cap on out-of-pocket costs for insulin - Sen. Kennedy, John [R-LA] - out-of-pocket costs S. 1323 - A bill to require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs - Sen. Merkley, Jeff [D-OR] - reference prices S. 1428 - Preserve Access to Affordable Generics and Biosimilars Act - Sen. Klobuchar, Amy [D-MN] - biosimilar drugs S. 2257 - A bill to provide Federal support for nonprofit generic and essential medicine and device manufacturers to increase the availability of drugs and devices in order to reduce drug or device shortages and drug and device costs - Sen. Rosen, Jacky [D-NV] - drug shortages and costs S. 2304 - A bill to amend title XI of the Social Security Act to require that direct-to-consumer advertisements for prescription drugs and biological products include an appropriate disclosure of pricing information - Sen. Durbin, Richard J. [D-IL] - drug pricing Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 369 - Health Care Affordability Act of 2021 - Rep. Underwood, Lauren [D-IL-14] - premium tax credits H.R. 3563 - To amend the Internal Revenue Code of 1986 to permit high deductible health plans to provide chronic disease prevention services to plan enrollees prior to satisfying their plan deductible - Rep. Blumenauer, Earl [D-OR-3] - plan deductibles S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne [D-NH] - premium tax credits Regulatory Issues: Issues concerning the patient-centered outcomes research fee; employer coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; issues relating to COVID-19; health insurer and employer reporting of health coverage; issues related to health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); and other issues relating to health care reform implementation.
H.R. 205 - Accelerating Broadband Connectivity Act of 2021 - Rep. Kelly, Trent [R-MS-1] - broadband H.R. 341 - Ensuring Telehealth Expansion Act of 2021 - Rep. Williams, Roger [R-TX-25] - telehealth H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 - Rep. Thompson, Mike [D-CA-5] - telehealth H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - SDOH H.R. 434 - Preventing Mental Health and Substance Use Crises During Emergencies Act - Rep. Trone, David J. [D-MD-6] - mental health and SUD H.R. 596 - ACCESS Act - Rep. Schakowsky, Janice D. [D-IL-9] - telehealth H.R. 675 - COVID-19 Price Gouging Prevention Act - Rep. Schakowsky, Janice D. [D-IL-9] - price gouging H.R. 747 - Access to TESTs Act - Rep. DeGette, Diana [D-CO-1] - COVID-19 H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - maternal health H.R. 925 - Data to Save Moms Act - Rep. Davids, Sharice [D-KS-3] - maternal health H.R. 937 - Tech To Save Moms Act - Rep. Johnson, Eddie Bernice [D-TX-30] - maternal health H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy [D-GA-6] - maternal health H.R. 951 - Maternal Vaccination Act - Rep. Sewell, Terri A. [D-AL-7] - maternal health H.R. 959 - To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes - Rep. Underwood, Lauren [D-IL-14] - maternal health H.R. 1046 - Federal Broadband Deployment in Unserved Areas Act - Rep. Curtis, John R. [R-UT-3] - broadband H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. [D-NC-1] - maternal health H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John A. [D-KY-3] - COVID-19 relief H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl L. "Buddy" [R-GA-1] - telehealth H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse, and for other purposes - Rep. Veasey, Marc A. [D-TX-33] - broadband and telehealth H.R. 1872 - MORE Health Education Act - Rep. Blunt Rochester, Lisa [D-DE-At Large] - health education H.R. 1888 - Improving Access to Indian Health Services Act- Rep. Ruiz, Raul [D-CA-36] - FMAP for Indian health services H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter A. [D-OR-4] - public option H.R. 3063 - MOMMIES Act - Rep. Pressley, Ayanna [D-MA-7] - maternal health H.R. 3126 - Healthy MOM Act - Rep. Watson Coleman, Bonnie [D-NJ-12] - maternal health H.R. 3407 - MOMMAs Act - Rep. Kelly, Robin L. [D-IL-2] - maternal health H.R. 3688 - To address maternal mortality and morbidity - Rep. Adams, Alma S. [D-NC-12] - maternal health H.R. 3753 - Parity Implementation Assistance Act - Rep. Cardenas, Tony [D-CA-29] - mental health and SUD H.R. 4026 - To require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health - Rep. Burgess, Michael C. [R-TX-26] - SDOH S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina [D-MN] - SDOH S. 168 - TREAT Act - Sen. Murphy, Christopher [D-CT] - telehealth S. 287 - A bill to direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes - Sen. Baldwin, Tammy [D-WI] - maternal health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert P., Jr. [D-PA] - maternal health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim [D-VA] - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory A. [D-NJ] - maternal health S. 347 - Data to Save Moms Act - Sen. Smith, Tina [D-MN] - maternal health S. 368 - Telehealth Modernization Act - Sen. Scott, Tim [R-SC] - telehealth S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat [R-PA] - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard J. [D-IL] - maternal health S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard [D-CT] - SDOH S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon [D-RI] - public option S. 1333 - A bill to address maternal mortality and morbidity - Sen. Gillibrand, Kirsten E. [D-NY] - maternal health S. 1542 - MOMMIES Act - Sen. Booker, Cory A. [D-NJ] - maternal health S. 1622 - HEALTH for MOM Act of 2021 - Sen. Portman, Rob [R-OH] - maternal health S. 1704 - Telehealth Expansion Act of 2021 - Sen. Daines, Steve [R-MT] - telehealth S. 1804 - Mothers and Newborns Success Act - Sen. Kaine, Tim [D-VA] - maternal health S. 1833 - Ensuring Access to Primary Care for Women & Children Act - Sen. Brown, Sherrod [D-OH] - maternal health S. 1962 - Parity Implementation Assistance Act - Sen. Murphy, Christopher [D-CT] - mental health and SUD S. 1988 - Protecting Rural Telehealth Access Act - Sen. Manchin, Joe, III [D-WV] - telehealth S. 2061 - Telemental Health Care Access Act of 2021 - Sen. Cassidy, Bill [R-LA] - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2021 · first_quarter · Q1
H.R. 145 - Continuing Coverage for Preexisting Conditions Act of 2021 - Rep. Joyce, David P. - preexisting conditions H.R. 526 - Ensuring Coverage in Public Health Emergencies Act of 2021 - Rep. Doggett, Lloyd - SEP H.R. 533 - Stop COVID-19 Test Surprise Medical Bills Act of 2021 - Rep. Fletcher, Lizzie - COVID-19 diagnostic testing H.R. 689 - Premium Relief Act of 2021 - Rep. Burgess, Michael - Patient and State Stability Fund H.R. 796 - Coverage for COVID-19 Treatment Act of 2021 - Rep. Blunt Rochester, Lisa - COVID-19 H.R. 892 - Pre-existing Conditions Protection Act of 2021 - Rep. McMorris Rodgers, Cathy - preexisting conditions H.R. 898 - Care for COVID-19 Act of 2021 - Rep. Ruiz, Raul - COVID-19 H.R. 1790 - To amend the Patient Protection and ACA to require HHS Services to set forth a method of determining maximum out-of-pocket limits and annual updates to premium tax credit eligibility - Rep. Axne, Cynthia - MOOP & premium tax credit eligibility H.R. 1795 - To amend title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth - Rep. Bass, Karen - coverage for foster youth H.R. 1796 - To direct HHS to award grants to eligible State agencies to promote State innovations to expand health insurance coverage - Rep. Bera, Ami - state innovations and insurance coverage H.R. 1806 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program - Rep. Castor, Kathy - navigator program H.R. 1874 - To amend the Patient Protection and ACA to provide for additional requirements with respect to the navigator program, and for other purposes - Rep. Castor, Kathy - navigator program H.R. 1875 - To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage - Rep. Castor, Kathy - short-term limited duration insurance H.R. 1878 - To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund - Rep. Craig, Angie - affordability H.R. 2264 - To require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Rep. Trone, David - mental health and SUD S. 263 - Worker Health Coverage Protection Act - Sen. Durbin, Richard - coverage continuity & COBRA S. 380 - Health Savings Act of 2021 - Sen. Rubio, Marco - HSAs S. 499 - Improving Health Insurance Affordability Act of 2021 - Sen. Shaheen, Jeanne - cost-sharing subsidies S. 660 - A bill to require parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth - Sen. Smith, Tina - mental health and SUD S. 756 - A bill to amend the Patient Protection and Affordable Care Act to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited - Sen. Kennedy, John -preexisting conditions S. 934 - A bill to amend title XVIII of the Social Security Act to improve rural health clinic payments - Sen. Warner, Mark - rural health clinic payments S. 942 - A bill to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect - Sen. Baldwin, Tammy - Short-Term, Limited Duration Insurance Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to the No Surprises Act, enacted as part of the Consolidated Appropriations Act in December 2020; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
H.R. 369 - Health Care Affordability Act of 2021 - Rep. Underwood, Lauren - tax credits H.R. 1860 - To amend the Internal Revenue Code of 1986 to provide the opportunity for responsible health savings to all American families - Rep. Stivers, Steve - health savings accounts Regulatory Issues: Issues concerning the patient-centered outcomes research fee; employer coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; issues relating to COVID-19; health insurer and employer reporting of health coverage; issues related to health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); and other issues relating to health care reform implementation.
H.R. 379 - Improving Social Determinants of Health Act of 2021 - Rep. Barragan, Nanette Diaz - SDOH H.R. 778 - Secure Data and Privacy for Contact Tracing Act of 2021 - Rep. Speier, Jackie - digital contact tracing for COVID-19 H.R. 908 - MORE Health Education Act - Rep. Blunt Rochester, Lisa - federally facilitated exchanges H.R. 909 - Moms Matter Act - Rep. Blunt Rochester, Lisa - maternal mental health conditions and SUD H.R. 943 - Social Determinants for Moms Act - Rep. McBath, Lucy -SDOH and maternal health H.R. 1212 - Kira Johnson Act - Rep. Adams, Alma - maternal health outcomes H.R. 1218 - Data Mapping to Save Moms Lives Act - Rep. Butterfield, G. K. -maternal health data H.R. 1268 - Building COVID-19 Vaccine Confidence Act of 2021 - Rep. Velazquez, Nydia - COVID-19 H.R. 1319 - American Rescue Plan Act of 2021 - Rep. Yarmuth, John - COVID-19 relief H.R. 1350 - Supporting Best Practices for Healthy Moms Act - Rep. Kelly, Robin - maternal health outcomes H.R. 1364 - Parity Enforcement Act of 2021 - Rep. Norcross, Donald - mental health and SUD H.R. 1400 - COVID-19 Health Disparities Action Act of 2021 - Rep. Cardenas, Tony -COVID-19 and health disparities H.R. 1406 - COVID-19 Emergency Telehealth Impact Reporting Act of 2021 - Rep. Curtis, John - telehealth and COVID-19 H.R. 1544 - To authorize the HHS to award grants to facilitate the funding of community-based mental health and substance use disorder services and peer support programs - Rep. Cardenas, Tony - mental health and SUD H.R. 1647 - To amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment and mental health services - Rep. McKinley, David - telehealth and SUD H.R. 1721 - To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse - Rep. Veasey, Marc - broadband H.R. 1835 - COVID Community Care Act - Rep. Lee, Barbara - COVID-19 response H.R. 1848 - To rebuild and modernize the Nation's infrastructure to expand access to broadband and Next Generation 9-1-1, rehabilitate drinking water infrastructure, modernize the electric grid and energy supply infrastructure, redevelop brownfields, strengthen health care infrastructure, create jobs, and protect public health and the environment, and for other purposes - Rep. Pallone, Frank, Jr. - broadband and public health infrastructure H.R. 1872 - To amend the Patient Protection and ACA to provide for Federal Exchange outreach and educational activities, and for other purposes - Rep. Blunt Rochester, Lisa - Federal Exchange outreach and educational activities H.R. 1976 - To establish an improved Medicare for All national health insurance program - Rep. Jayapal, Pramila - public option H.R. 1985 - To amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Rep. Pascrell, Bill, Jr. - quality and transparency H.R. 2010 - To amend the Patient Protection and Affordable Care Act to establish a public health insurance option - Rep. DeFazio, Peter - public option S. 24 - Protecting Personal Health Data Act - Sen. Klobuchar, Amy - privacy S. 104 - Improving Social Determinants of Health Act of 2021- Sen. Smith, Tina - health disparities S. 199 - Secure Data and Privacy for Contact Tracing Act of 2021 - Sen. Schatz, Brian - digital contact tracing for COVID-19 S. 201 - Improving Access to Health Care in Rural and Underserved Areas Act - Sen. Rosen, Jacky - rural health S. 334 - IMPACT to Save Moms Act - Sen. Casey, Robert - maternal health S. 340 - TREATS Act - Sen. Portman, Rob - telehealth, SUD and mental health S. 345 - Maternal Vaccinations Act - Sen. Kaine, Tim - maternal health S. 346 - Black Maternal Health Momnibus Act of 2021 - Sen. Booker, Cory - maternal health and health disparities S. 347 - Data to Save Moms Act - Sen. Smith, Tina - maternal health data S. 352 - Health Care Improvement Act of 2021 - Sen. Warner, Mark - health care costs and coverage S. 408 - Supporting Best Practices for Healthy Moms Act - Sen. Toomey, Pat - maternal health S. 411 - MOMMAs Act - Sen. Durbin, Richard - maternal health S. 512 - A bill to require the Centers for Disease Control and Prevention to collect and report certain data concerning COVID-19 - Sen. Warren, Elizabeth - COVID-19 S. 586 - A bill to amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting - Sen. Capito, Shelley Moore - SUD S. 674 - A bill to support public health infrastructure - Sen. Murray, Patty - public health infrastructure S. 708 - A bill to direct HHS to convene a task force to advise the Assistant Secretary for Mental Health and Substance Use on a national strategy for preventing mental health and substance use crises during a public health emergency - Sen. Kelly, Mark - mental health and SUD national strategy S. 745 - A bill to make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Sen. Klobuchar, Amy - broadband S. 779 - A bill to provide that certain rules and guidance related to waivers for State innovation under the Patient Protection and ACA shall have no force or effect - Sen. Warner, Mark R. - state innovation waivers S. 782 - A bill to amend titles XVIII and XIX of the Social Security Act to modernize Federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families - Sen. Casey, Robert P., Jr. - quality and transparency S. 783 - COVID Community Care Act - Sen. Warren, Elizabeth - COVID-19 response S. 851 - A bill to address social determinants of maternal health - Sen. Blumenthal, Richard - SDOH and maternal health S. 893 - A bill to support the use of technology in maternal health care - Sen. Menendez, Robert - maternal health S. 983 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes - Sen. Whitehouse, Sheldon - public option S. 987 - A bill to provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder - Sen. Portman, Rob - SUD S. 1010 - A bill to provide funding for programs and activities under the SUPPORT for Patients and Communities Act - Sen. Shaheen, Jeanne - SUD S. 1042 - A bill to prevent maternal mortality and serve maternal morbidity among Black pregnant and postpartum individuals and other underserved populations, to provide training in respectful maternity care, to reduce and prevent bias, racism, and discrimination in maternity care settings, and for other purposes - Sen. Warnock, Raphael - maternal health Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues related to repeal of the antitrust-related portions of the McCarran-Ferguson Act; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
H.R. 153 - Protecting Consumer Access to Generic Drugs Act of 2021- Rep. Rush, Bobby - patent infringement settlements H.R. 1829 - To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes - Rep. Harshbarger, Diana - PBMs H.R. 2071 - To amend part D of title XVIII of the Social Security Act to require HHS to negotiate covered part D drug prices on behalf of Medicare beneficiaries - Rep. Welch, Peter - drug prices H.R. 2139 - To amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by HHS under Medicare part D, and for other purposes - Rep. Doggett, Lloyd - drug prices S. 250 - Fairness in Orphan Drug Exclusivity Act - Sen. Cassidy, Bill - orphan drugs S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 - Sen. Blackburn, Marsha - PBMs and pharmaceutical supply chain S. 833 - A bill to amend XVIII of the Social Security Act to allow HHS to negotiate fair prescription drug prices under part D of the Medicare program - Sen. Klobuchar, Amy -drug prices S. 908 - A bill to amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D, and for other purposes - Sen. Sanders, Bernard - drug prices Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to health equity; issues related to vaccination; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2020 · fourth_quarter · Q4
H.R. 748 - CARES Act -Courtney - COVID-19 coverage H.R. 1418 - Competitive Health Insurance Reform Act of 2020 - DeFazio - antitrust laws, health insurance, McCarran-Ferguson H.R. 3630 - No Surprises Act - Pallone - surprise medical billing H.R. 3784 - Air Ambulance Affordability Act of 2019 - Neguse - air ambulances H.R. 4223 - Protecting Patients from Surprise Medical Bills Act - Spano - surprise medical billing H.R. 5121 - Healthcare Cost Transparency Act - Beyer - provider price comparison tool H.R. 5239 - Prescription Drug Price Reporting Act - Joyce - reporting on drug expenditures and price changes under group health plans H.R. 5575 - Primary and Behavioral Health Care Access Act of 2020 -Underwood - coverage of primary care and behavioral health visits H.R. 6005 - Know the Price Act - Malinowski - health plan transparency H.R. 6173 - Covering Coronavirus Test Act of 2020 - DeGette - COVID-19 testing coverage H.R. 6193 - Medication Access in Emergencies Act of 2020 - Pappas - coverage of prescription drugs during emergency periods H.R. 6201 - Families First Coronavirus Response Act - Lowey - includes several provisions related to COVID-19 testing coverage H.R. 6213 - No Cost for COVID-19 Testing Act - Wilson - COVID-19 testing coverage H.R. 6214 - To amend title XVIII of the Social Security Act to provide for coverage of testing for COVID-19 at no cost sharing under the Medicare Advantage program - Kind - Medicare Advantage coverage of COVID-19 related visits and testing H.R. 6222 - Ensuring Affordable COVID-19 Preventive Care Act of 2020 - Schakowsky - coverage of certain new preventative services related to COVID-19 H.R. 6231 - Ensuring Access to COVID-19 Preventive Care Act of 2020 - Bucshon - coverage of certain vaccines and testing services during the COVID-19 emergency H.R. 6299 - Rapid Coverage of COVID-19 Vaccine Act of 2020 - Courtney - COVID-19 coverage H.R. 6317 - To provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes - Doggett - special enrollment periods in public health emergency H.R. 6338 - To waive high deductible health plan requirements for health savings accounts -Budd - HDHP coverage during COVID H.R. 6486- Care for COVID-19 Act 2.0 -Ruiz - COVID H.R. 6514 - Worker Health Coverage Protection Act - Scott - COVID H.R. 6518 - Stop Health Premium Spikes Act of 2020 - Peters - risk corridors H.R. 6532 - COVID Special Enrollment Act of 2020 - Doggett - COVID H.R. 6568 - Coverage for COVID-19 Treatment Act of 2020 - Rochester - COVID H.R. 6644 - To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person during the COVID-19 emergency. -Schrier - COVID H.R. 6674 - Medicare Crisis Program Act of 2020 -Jayapal - COVID H.R. 6712 - American Healthshare Plans Act of 2020 - Curtis - health share pools H.R. 6810 - Health Care Protection Act -Davis - COVID H.R. 7006 - Improving Care in Home Health Agencies Act - Velazquez - home health services H.R. 7267 - To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to prohibit a group health plan and a health insurance issuer offering group or individual health insurance coverage from reducing contracted rates, or terminating contracts, with health care providers during a public health emergency. - Porter - ERISA H.R. 7475 - Ensuring FEHBP Coverage During Pandemic Act - Vela - special enrollment period H.R. 7539 - Strengthening Behavioral Health Parity Act - Kennedy - strengthen mental health and SUD benefits H.R. 7647 - To provide for a COVID-19-related delay regarding annual limitation on cost-sharing for group health plans and individual and small group health insurance coverage - McEachin - drug manufacturer support applied to patient out-of-pocket limit H.R. 7659 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2020 - Sewell - inclusion of certain audio-only diagnoses in the determination of risk adjustment for MA plans H.R. 7676 - Health Care Prices Revealed and Information to Consumers Explained Transparency Act - Flores - hospital and insurer price transparency H.R. 7722 - Matts Act - Fortenberry - limit price of insulin drugs accessible for those enrolled in group or indiv. health insurance coverage, group health plans, uninsured H.R. 7921 - Connecting Communities to Grant Opportunities Act of 2020 - Velazquez - navigator programs H.R. 7942 - Public Health Emergency COBRA Extension Act -Sanchez - COBRA extension H.R. 8060 - Tele-Mental Health Improvement Act - Trone - parity in mental health and SUD service under private insurance H.R. 8181 - Jack Reynolds Memory MediGap Expansion - Axne - Medigap coverage for Medicare ESRD H.R. 8308 - Telehealth Coverage and Payment Parity Act - Phillips - coverage for services furnished through telehealth H.R. 8330 - No Surprise Bills for New Moms Act - Porter - health coverage of newborns H.R. 8527 - Fair Care Act of 2020 - Westerman - health care costs and coverage H.R. 8573 - Helping Families Access Pediatric Care Act of 2020 - Schrier - deductibles and outpatient pediatric services H.R. 8615 - ARC Act of 2020 -Payne, Jr. - coverage of peripheral artery disease screening tests H.R. 8875 - Health Insurance Lemon Law Act - Kennedy - special enrollment period for non-compliant health plans S. 350 - Competitive Health Insurance Reform Act of 2019 - Daines - McCarran-Ferguson Act S. 1531 - STOP Surprise Medical Bills Act - Cassidy-Bennet - surprise medical billing S. 1948 - Chronic Disease Management Act - Thune - pre-deductible coverage of chronic disease prevention services S. 2546 - Safe Step Act - Murkowski - Step therapy exceptions S. 3200 - Chronic Disease Management Act of 2020 - Thune - coverage of chronic disease prevention services S. 3383 - Continuing Coverage for Preexisting Conditions Act of 2020 -Kennedy - preexisting conditions S. 3499 - A bill to amend coverage requirements to ensure that no person incurs cost sharing when receiving a test to confirm a COVID-19 infection - Smith - COVID-19 cost -sharing S. 3505 - A bill to require private health insurance to rapidly cover preventive services and vaccines related to the coronavirus - Jones - rapid COVID-19 coverage S. 3536 - A bill to provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes - Casey - COVID-19 coverage S. 3610 - American Healthshare Plans Act of 2020 - Paul - health share pools S. 3631 - Relief for Rural Providers During Emergencies Act - Sasse - COVID S. 3741 - Health Care at Home Act of 2020 - Smith - COVID S. 3792 - Tele-Mental Health Improvement Act - Smith - parity S. 3821 - Affordable Health Care Options Act of 2020 - Loeffler - affordability S. 3991 - Coronavirus 2019 Special Enrollment Period Act - Duckworth - SEP S. 4106 - A bill to amend the Public Health Service Act to provide for hospital and insurer price transparency - Braun - price transparency S. 4185 - End Surprise Medical Bills for Air Ambulances Act of 2020 - Wicker - establish an IDR for air ambulance S. 4198 - Affordable Coronavirus Testing Act - Scott - coverage for COVID serology testing S. 4255 - Katherines Lung Cancer Early Detection and Survival Act of 2020 - Smith - group health plans, group and indiv coverage benefits for lung cancer screenings S. 4329 - Continuous Health Coverage for Workers Act - McSally - COBRA continuation coverage S. 4469 - COVID-19 Treatment Coverage Act - Smith - COVID treatment Medicaid/MA/Private/Medicare coverage S. 4506 - Pre-Existing Conditions Protection Act of 2020 - Gardner - coverage of pre-ex conditions under private insurance S. 4521 - Health Care Improvement Act of 2020 - Warner - expand ACA coverage S. 4557 - COVid Enrollment Response Act - Baldwin - assistance enrolling in health care coverage S. 4609 - Vaccine And Coverage Certainty Act - Wyden - coverage of COVID vaccine under Medicare/Medicaid, CHIP S. 4653 - A bill to prevent efforts of the Department of Justice to advocate courts to strike down the Patient Protection and Affordable Care Act - Schumer - ACA S. 4761 - Primary and Behavioral Health Care Access Act of 2020 - King - coverage and cost-sharing S. 4796 - Fair Care Act of 2020 - Braun - health care costs and coverage S. 4820 - Long-Term Care Affordability Act - Pat Toomey - long term care insurance S. 4894 - DOC Access Act of 2019 - Manchin - vision and dental insurance S. 4959 - A bill to increase transparency and access to group health plan and health insurance issuer reporting - Braun - Transparency on pharmacy benefits and drug costs S. 5084 - A bill to increase transparency and access to group health plan and health insurance issuer reporting - Braun - Transparency Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
H.R. 3709 - Chronic Disease Management Act of 2019 - Blumenauer - HSAs and HDHPs H.R. 4651 - American Future Healthcare Act of 2019 - King - amends the Internal Revenue Code to expand health savings accounts H.R. 4652 - Individual Health Insurance Marketplace Improvement Act - Langevin - Individual Market Reinsurance fund H.R. 5807 - Know Your Provider Act of 2020 - Larson - provider directory information H.R. 5809 - Better Information Act of 2020 - Beyer - health insurance membership card H.R. 5816 - Continuing Care for Patients Act of 2020 - Moore - coverage and provider network status H.R. 5817 - Fair and Honest Advance Cost Estimate for Patients Act of 2020 - Nunes - health plan transparency H.R. 5825 - To amend the Internal Revenue Code of 1986 to provide for reporting by certain investors with respect to certain specified medical care providers - Neal - investment in medicine H.R. 6286 - Health Savings Act of 2020 - Burgess - health savings account H.R. 6545 - Health Insurance Marketplace Affordability Act of 2020 - Murphy - age rating adjustment H.R. 7008 - Family Savings Flexibility Act - Wenstrup - HSA arrangements H.R. 7825 - Pandemic Eradication and Enhanced Prevention through Savings Act - Buck - increase opportunities for savings to HSA, MSA, FSA plans H.R. 8032 - Health Savings Accounts For All Act of 2020 - Biggs - eliminate limitations on contributions to HSAs H.R. 8473 - To amend the Internal Revenue Code of 1986 to consolidate health accounts into Medisave Accounts - Gonzales - creates tax exempt Medisave accounts for qualified medical expenses H.R. 9051 - Caring for Americans with Supplemental Help Act of 2020 - Neal - increase COVID-19 recovery rebates S. 3439 - Lower Health Insurance Deductibles Act - Scott - health savings accounts S. 3539 - A bill to amend the Internal Revenue Code of 1986 to exempt telehealth services from certain high deductible health plan rules - Daines - telehealth S. 3546 - A bill to waive high deductible health plan requirements for health savings accounts - Cruz - health savings accounts S. 3924 - A bill to provide tax credits to low- to moderate-income individuals for certain computer and education costs, to direct the Federal Communications Commission to modify the requirements for the Lifeline program to provide increased support, and for other purposes. - Durbin - Lifeline/Medicaid S. 4267 - Health Savings Accounts For All Act of 2020 - Paul - eliminate limitations on contributions to HSAs S. 5085 - A bill to amend the Internal Revenue Code of 1986 to increase the additional 2020 recovery rebates, to repeal section 230 of the Communications Act of 1934 - McConnell - increase COVID-19 recovery rebates Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; issues relating to COVID-19; health insurer and employer reporting of health coverage; issues related to health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 14 - Commitment to Defeat the Virus and Keep America Healthy Act - Hudson - fighting COVID-19 H.R. 133 - Consolidated Appropriations Act, 2021 - Cuellar - year-end Congressional package H.R. 925 - amended version of The Heroes Act (H.R.8406)- Lowey - Coronavirus Relief package H.R. 1897 - Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) - Kelly - maternal health H.R. 4004 - Social Determinants Accelerator Act of 2019 - Bustos - social determinants of health H.R. 4215 - Excellence in Maternal Health Act of 2019 - Bucshon - maternal health H.R. 4768 - Home Visiting to Reduce Maternal Mortality and Morbidity Act - David - maternal health H.R. 4900 - Telehealth Across State Lines Act of 2019 - Roe - telehealth H.R. 4932 - Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019 - Thompson - telehealth H.R. 4995 - Maternal Health Quality Improvement Act of 2019 - Engel - maternal health outcomes H.R. 5190 - STAR Act - Harder - telemedicine assistance for rural health clinics and health centers H.R. 5257 - Telehealth Expansion Act of 2019 - Cox - establish FCC telehealth program H.R. 5473 - Enhance Access to Support Essential Behavioral Health Services Act - Bilirakis - telehealth H.R. 5640 - Data Mapping to Save Moms' Lives Act - Butterfield - maternal health H.R. 5681 - Protecting Communities from Hospital Closures Act of 2020 - Boyle - rural health H.R. 5754 - Rural ER Access Act - Green - rural health H.R. 5763 - National Telehealth Strategy and Data Advancement Act - Gianforte - telehealth H.R. 5800 - Ban Surprise Billing Act - Scott - surprise medical bills H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act of 2020 - Neal - surprise medical bills H.R. 5916 - Transparent Health Care Pricing Act of 2020 - Gallagher - provider transparency in health care services H.R. 5924 - To amend the Public Health Service Act to authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty medicine physicians - McKinley - rural health, loan program H.R. 6074 - Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 - Lowey - COVID-19 H.R. 6132 - Social Determinants for Moms Act of 2020 - McBath - maternal health and social determinants of health H.R. 6138 - Tech to Save Moms Act - Johnson - maternal health H.R. 6142 - Black Maternal Health Momnibus Act of 2020 - Underwood - maternal health H.R. 6143 - Moms MATTER Act of 2020 - Kennedy - maternal health H.R. 6144 - Kira Johnson Act - Adams - maternal health H.R. 6165 - Data to Save Moms Act of 2020 - Davids - maternal health H.R. 6232 - To require the Secretary of Health and Human Services, through the National Disaster Medical System, to provide for certain laboratory reimbursement for diagnostic testing for COVID-19 in uninsured individuals - Cardenas - Federal coverage of COVID-19 related visits and testing for uninsured individuals H.R. 6261 - To provide for coverage of testing for COVID-19 at no cost sharing for Indians receiving health services through the Indian Health Service - Ruiz - Federal coverage of COVID-19 related visits and testing for Native Americans H.R. 6351 - Universal Coronavirus Vaccine Act - Harder - COVID-19 H.R. 6379 - Take Responsibility for Workers and Families Act - Lowey - COVID-19 H.R. 6426 - To direct the Secretary of Health and Human Services to establish a program under which loans shall be made to certain health care organizations to assist such organizations with anticipated revenue loss or higher operating costs as a result of the COVID-19 emergency, and for other purposes - Max Rose - costs H.R. 6437 - Coronavirus Immigrant Families Protection Act - Chu - COVID19 H.R. 6467 -Coronavirus Community Relief Act - Neguse - COVID H.R. 6468 -To provide for an enhanced Coronavirus relief fund, and for other purposes. - Perlmutter - COVID H.R. 6474 - Healthcare Broadband Expansion During COVID-19 Act - Eshoo - rural health H.R. 6487 - ACCESS Act - Schakowsky - telehealth H.R. 6620 - To authorize grants to address substance use during COVID-19.- Kuster - COVID H.R. 6634 - Emergency COVID Telehealth Response Act - Axne - telehealth H.R. 6654 - Emergency COVID Telehealth Response Act -Axne - telehealth H.R. 6666 - COVID-19 Testing, Reaching, And Contacting Everyone (TRACE) Act - Rush - COVID H.R. 6719 - Emergency Medical Supplies Procurement Act - Khanna- COVID H.R. 6763 - COVID-19 Racial and Ethnic Disparities Task Force Act of 2020 - Kelley - COVID H.R. 6800 - HEROES Act - Lowey - COVID H.R. 6881 - Emergency Broadband Connections Act of 2020 - COVID H.R. 6926 - MIND Act -Boyle - COVID H.R. 6999 - Coronavirus Mental Health and Addiction Assistance Act of 2020 -Ryan - COVID H.R. 7017 - Right to Test Act - McHenry - Testing H.R. 7077 - Community Solutions for COVID-19 Act - Kelley - COVID H.R. 7190 - Increasing Rural Health Access During the COVID-19 Public Health Emergency Act of 2020 - Torres Small - COVID H.R. 7205 - Nationwide Dig Once Act of 2020 - Eshoo - broadband H.R. 7302 - To make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Clyburn - Broadband H.R. 7359 - Accelerating Broadband Connectivity Act of 2020 - Kelley - Broadband H.R. 7534 - RURAL HELP Act of 2020 - Keller - study on cost disparities between rural and urban hospitals H.R. 7546 - Minority Community Public Health Emergency Response Act of 2020 - Lewis - minority, underserved communities access to public health and health care services during COVID-19 H.R. 7557 - To amend title VI of the Social Security Act to extend the coverage of Coronavirus Relief Fund payments to Tribal Governments - OHalleran - COVID-19 relief funds H.R. 7571 -Facilitating Reforms that Offer Necessary Telehealth In Every Rural (FRONTIER) Community Act - Young - expand telehealth mental health services to frontier states H.R. 7593 - TREATS Act - McKinley - Increase telehealth for SUD H.R. 7614 - Depts. of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act - DeLauro - Appropriations H.R. 7618 - COVID-19 Bias and Anti-Racism Training Act of 2020 - Adams - improve bias and anti-racism training for health entities H.R. 7649 - Jobs to Fight COVID-19 Act of 2020 - Morelle - initiative for national testing, contact tracing, pandemic response H.R. 7701 - Addiction Prevention and Responsible Opioid Practices Act- Cartwright - program for prevention of opioid misuse H.R. 7732 - How Awareness and Prevention Protect You Act - Wasserman Schultz - CDC campaign to increase awareness and knowledge of COVID-19 virus H.R. 7758 - Assistance for Rural Health, Safety and Educational Facilities Act - Scott - assistance to rural health facilities affected by COVID H.R. 7780 - Virtual Community Support Act of 2020 - Kennedy - community-based mental health and SUD services H.R. 7783 - Plasma Donation Awareness Act of 2020 - Peters - national awareness and outreach on plasma donation H.R. 7972 - Rural Connectivity Advancement Program Act of 2020 - Latta - rural communications infrastructure H.R. 7992 - Telehealth Act - Wagner - telehealth expansion H.R. 8027 - Maternal Health Pandemic Response Act of 2020 - Underwood - maternal health H.R. 8061 - Community Immunity During COVID-19 Act of 2020 - Underwood - fund health depts to increase recommended immunizations H.R. 8086 - To provide additional appropriations for the public health and social services emergency fund - Burgess - appropriations for public health and social services fund H.R. 8098 - Hospital Competition Act of 2020- Banks - hospital price transparency H.R. 8141 - Strengthening Mental Health Supports for BIPOC Communities Act - Cardenas - reduce health inequities for racial and ethnic minority H.R. 8156 - Ensuring Telehealth Expansion Act of 2020 - Williams - extend telehealth provisions H.R. 8192 - COVID Community Care Act - Lee - health appropriations H.R. 8200 - To improve the health of minority individuals during the COVID-19 pandemic - Kelly - health disparities in communities of color H.R. 8203 - COVID-19 Health Disparities Action Act of 2020 - Cardenas - action plan, grants, awareness campaign for COVID health disparities H.R. 8337 - Continuing Appropriations Act, 2021 - Lowey - Health appropriations H.R. 8351 - Community Health Center Mental Health Screening Act - Dean - mental and behavioral health screenings H.R. 8368 - To amend title VI of the Social Security Act to permit the use of amounts under the Coronavirus Relief Fund for rural broadband expansion and improvement - Barr - COVID-19, broadband H.R. 8406- The Heroes Act - Lowey - Coronavirus Relief package H.R. 8417 - To facilitate direct primary care arrangements - Crenshaw - direct primary care H.R. 8419 - To prevent surprise medical bills with respect to COVID-19 testing - Fletcher - COVID-19, surprise medical billing H.R. 8463 - To prohibit discrimination in health care and require the provision of equitable health care, and for other purposes - Schiff - equity in health care H.R. 8496 - SPEEDY COVID-19 Tests Act - Sherrill - COVID-19 testing H.R. 8528 - Ensuring Telehealth Expansion Act of 2020 -Williams - telehealth expansion H.R. 8642 - Safe Testing at Residence Telehealth Act of 2020 - Schweikert -telehealth coverage during COVID-19 H.R. 8677 - HEAT Act - Marshall - payments for home health services furnished via telehealth H.R. 8742 - To extend the availability of amounts under the Coronavirus Relief Fund - Keating - COVID funding availability H.R. 8892 - Rural-Urban Physician Workforce Act of 2020 - Wenstrup - funding for rural residency training H.R. 8900 - Further Continuing Appropriations Act, 2021, and Other Extensions Act - Lowey - End of year extenders and appropriations H.R. 8921 - COVID-19 Cold Storage Expansion Act of 2020 - Espaillat - COVID-19 vaccine admin funding H.R. 8966 - COVID-19 Vaccine Awareness Support Act of 2020 - Wenstrup - public awareness campaign S. 116 - Modernizing Obstetric Medicine Standards Act of 2019 (MOMS Act) - Gillibrand - maternal health S. 916 - Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) - Durbin - maternal health S. 2741 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 - Schatz - telehealth S. 2885 - Stop Marketing and Revealing the Wearables and Trackers Consumer Health Data Act - Cassidy - consumer health information S. 2986 - Social Determinants Accelerator Act of 2019 - Young - Social Determinants of Health S. 3152 - Data Mapping to Save Moms' Lives Act - Rosen - maternal health S. 3318 - Transparent Health Care Pricing Act of 2020 - Cassidy - disclosure of point-of-sale cash prices S. 3380 - Patient Safety Improvement Act of 2020 - Whitehouse - data collection and quality improvement S. 3424 - Black Maternal Health Momnibus Act of 2020 - Harris - maternal health S. 3437 - Improving Care in Rural America Reauthorization Act of 2020 - Loeffler - rural health S. 3438 - R-DOCS Reauthorization Act of 2020 - Loeffler - telehealth S. 3517 - ACCESS Act - Klobuchar - telehealth S. 3568 - Medical Supply Chain Emergency Act of 2020 - Murphy - expedite acquisition of PPE S. 3570 - To provide for the expedited procurement of equipment needed to combat COVID-19 under the Defense Production Act of 1950 - Baldwin - expedite acquisition of PPE S. 3721 - COVID-19 Racial and Ethnic Disparities Task Force Act of 2020 - Harris - COVID S. 3769- Right to Test Act - Cruz - Testing S. 3825 - Coronavirus Mental Health and Addiction Assistance Act of 2020 - Klobuchar - COVID S. 3828 - Jobs to Fight COVID-19 Act of 2020 - Schatz - COVID S. 3838 - Health Care Broadband Expansion During COVID-19 Act -Schatz - broadband S. 3877 - Community Solutions for COVID-19 Act - Booker - COVID S. 3921 - Emergency Medical Supplies Procurement Act - Sanders - COVID S. 3951 - Increasing Rural Health Access During the COVID-19 Public Health Emergency Act of 2020 - McSally - COVID S. 3988 - Enhancing Preparedness through Telehealth Act - Cassidy - Telehealth S. 4015 - Rural Connectivity Advancement Program Act of 2020 - Thune - Rural S. 4021 - Accelerating Broadband Connectivity Act of 2020 - Wicker - Broadband S. 4058 - A bill to authorize grants to address substance use during COVID-19 - Smith - SUD S. 4059 - A bill to direct the Secretary of Health and Human Services to award grants to States, political subdivisions of States, Indian Tribes and Tribal organizations, community-based entities, and primary care and behavioral health organizations to address behavioral health needs caused by the public health emergency declared with respect to COVID-19 - Smith - Mental Health S. 4095 - A bill to provide emergency benefits for broadband service during periods relating to COVID-19, and for other purposes - Wyden - Broadband S. 4103 - A bill to amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment - Portman - telehealth S. 4113 - A bill to amend the Communications Act of 1934 to provide grants to States and Indian Tribes to deploy affordable, high-speed broadband to unserved and underserved areas - Bennett - broadband S. 4131 - Accessible, Affordable Internet for All Act - Klobuchar - broadband access S. 4163 - Timely and Effective Systematic Testing (TEST) Act - Gardner - Biosurveillance of COVID through testing S. 4211 - Facilitating Reforms that Offer Necessary Telehealth In Every Rural (FRONTIER) Community Act - Sullivan - expand mental health services through telehealth S. 4242 - Addiction Prevention and Responsible Opioid Practices Act- Durbin - program for prevention of opioid misuse S. 4248 - COVID-19 Bias and Anti-Racism Training Act of 2020 - Harris - improve bias and anti-racism training for health care entities S. 4262 - COVID-19 Health Disparities Action Act of 2020 - Menendez - HHS action plan, grants, public awareness campaign for COVID-19 and racial and ethnic minorities S. 4269 - Mothers and Newborns Success Act - Kaine - maternal health S. 4291 - DEPLOY Broadband Act - Gardner - rural broadband appropriations S. 4315 - COVID-19 Testing, Reaching, And Contacting Everyone Act - King - grants for testing and contact tracing, supported isolation at individuals residences S. 4317 -SAFE TO WORK Act - Cornyn - GOP COVID-19 relief package S. 4318 -American Workers, Families, and Employers Assistance Act - Grassley - GOP COVID-19 relief package S. 4319 -Supporting America's Restaurant Workers Act - Scott - GOP COVID-19 relief package S. 4320 -Coronavirus Response Additional Supplemental Appropriations Act, 2020 - Shelby - GOP COVID-19 relief package S. 4322 -Safely Back to School and Back to Work Act - Alexander - GOP COVID-19 relief package S. 4323 -TRUST Act of 2020 - Romney - GOP COVID-19 relief package S. 4388 - Mental Health Equity Act of 2020 - Menendez - mental health S. 4427 - Safe Authorization for Vaccines during Emergencies Act - Hassan - transparency in EUA of vaccines S. 4477 - Strengthening Social Connections Act of 2020 - Smith - Appropriations for social isolation services for older Americans S. 4507 - Getting Early Treatment and Comprehensive Assessments Reduces Emergencies Act of 2020 - Warner - campaign for awareness on preventive health services S. 4737 - Community Immunity During COVID-19 Act of 2020 - Smith - immunizations S. 4745 - Stop COVID-19 Test Surprise Medical Bills Act of 2020 - Smith - Surprise Medical Billing S. 4769 - Maternal Health Pandemic Response Act of 2020 - Warren - maternal health S. 4775 - Delivering Immediate Relief to America's Families, Schools and Small Businesses Act - McConnell - COVID-19 relief S. 4789 - Eliminate the Digital Divide Act of 2020 - Cornyn - broadband access S. 4792 - RISER Act -Moran - Coronavirus Relief Fund payment funds S. 4794 - A bill making emergency supplemental appropriations for the COVID-19 Telehealth Program of the Federal Communications Commission for the fiscal year ending September 30, 2020 -Smith - telehealth funds S. 4800 - The Heroes Act - Schumer - COVID-19 relief S. 4819 - Health Equity and Accountability Act of 2020 - Hirono - to improve minority health outcomes S. 4898 - A bill to amend title VI of the Social Security Act to extend the period during which States, Indian Tribes, and local governments may use Coronavirus Relief Fund payments -Murkowski - extension of COVID-19 relief payments S. 4941- Making emergency supplemental appropriations for the fiscal year ending September 30, 2020- Warren - Emergency fund supplemental appropriations S. 4958 - COVID-19 Vaccine Awareness Support Act of 2020 - Portman - public awareness campaign S. 5000 - CARA 2.0 Act of 2020 - Portman - substance use disorder S. 5034 - Behavioral Health Crisis Services Expansion Act - Cortez Masto - mental health S. 5073 - A bill to establish a program to support county and municipal government entities in reducing the spread of COVID-19 through standardized testing and evaluation measures - Scott - COVID-19 testing S. 5082 - A bill to provide Federal support for COVID-19 testing - Warren - COVID-19 testing Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage H.R. 3925 - Reducing Barriers to Substance Use Treatment Act - Tonko - Opioids H.R. 3935 - Protecting Patients Transportation to Care Act - Carter - Medicaid coverage for transportation H.R. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud H.R. 4529 - Promoting Access to Broadband Act of 2019 - Maloney - Medicaid H.R. 4583 - Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Schneider - prescription drug affordability H.R. 4620 - More Help for Seniors Act of 2019 - Rose - expand eligibility for low-income subsidies under part D of the Medicare program H.R. 4621 - Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 - Blunt Rochester - best practices re social determinants of health H.R. 4629 - Star Rating for Biosimilars Act - Tonko - biosimilars H.R. 4632 - Better Transparency in Information for Medicare Beneficiaries Act of 2019 - Kind - provides consumers information regarding premiums under LIS benchmark plans H.R. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 4996 - Helping Medicaid Offer Maternity Services Act of 2020 - Kelly - extend Medicaid coverage post-partum H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized H.R. 5201 - Telemental Health Expansion Act of 2019 - Matsui - Medicare coverage of mental telehealth H.R. 5232 - Road to Recovery Act - Fitzpatrick - Medicaid and CHIP SUD treatment H.R. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program -Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - Increasing Hospital Capacity to Fight the Coronavirus Act of 2020 - Bishop - Medicare and Medicaid payments during COVID-19 emergency H.R. 6462 - Emergency Medicaid for Coronavirus Treatment Act - Gallego - Medicaid coverage H.R. 6511 - Ensuring Vaccination and Treatment Affordability Act - Pappas - COVID H.R. 6521 - To prohibit the Secretary of Health and Human Services from taking certain actions with respect to Medicaid supplemental payments reporting requirements, and for other purposes - Diaz Barragan - Medicaid, delays implementation of MFAR H.R. 6538 - Modernized Medicine Act - Kennedy - Medicaid, Telehealth H.R. 6539 - Coronavirus Medicaid Response Act - Lee - FMAP H.R. 6572 - To direct the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, to carry out a national campaign to increase awareness and knowledge of COVID-19. -Bilirakis - COVID H.R. 6583 - To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes. - Houlahan - COVID H.R. 6616 - Stronger Medicaid Response to the COVID-19 Pandemic Act -Cardenas - COVID H.R. 6640 - Medicare Advantage COVID Treatment Act - Mucarsel-Powell - COVID H.R. 6658 - Insular Area Medicaid Coronavirus Recovery Act - Sablan - FMAP H.R. 6727 - To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program - Schrier - COVID H.R. 6744 - Computer and Internet Equity Act - Davis - internet access for Lifeline program H.R. 6753 - Save Rural Hospitals Act of 2020 - Finkenauer - Medicare hospital payments H.R. 6792 - Improving Telehealth for Underserved Communities Act of 2020 - Smith - telehealth H.R. 6797 - CHIPPER Act - Wild - CHIP, COVID H.R. 6837 - Medicare Accelerated and Advance Payments Improvement Act of 2020 -Schneider - COVID H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act -Boyle - outpatient therapy services H.R. 7187 - HEALTH Act of 2020 -Thompson -Smith - telehealth H.R. 7292 - To amend title XVIII of the Social Security Act to provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. - Kaptur - advance payments H.R. 7338 - To amend title XVIII of the Social Security Act to permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program, and for other purposes. - Cheney - Telehealth H.R. 7391 - To amend title XVIII of the Social Security Act to remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program - Sherrill- Telehealth H.R. 7606 - MFAR Transparency Act - Williams - report on impact of MFAR to Congress H.R. 7627 - MORE Savings Act - Dean - Medicare access to opioid treatment and MAT H.R. 7663 - Protecting Access to Post-COVID-19 Telehealth Act of 2020 - Thompson - waive or modify application of Medicare requirements with respect to telehealth during PHE H.R. 7791 - Value in Health Care Act of 2020 - Welch - Medicare shared savings program and alternative payment arrangements H.R. 7877 - Lowering Drug Costs for Seniors Act of 2020 - Katko - Medicare Part D costs H.R. 7892 - Medicaid Expansion During Crisis Act - Coleman - extend eligibility period for Medicaid enrollment application H.R. 8177 - Renal Anemia Innovation Support and Expansion Act - OHalleran - Medicare prescription drug coverage for chronic kidney disease H.R. 8218 - Rural Ambulance Reimbursement Fairness Act - Gianforte - Medicare payment for rural ambulance services H.R. 8254 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Blumenauer - integrated care for Medicare beneficiaries with ESRD H.R. 8427 - To provide for certain reports on enrollment in the Lifeline program, and for other purposes - Luria - Lifeline program H.R. 8476 - TIKES Act -Blunt Rochester - telehealth coverage in Medicaid H.R. 8505 - To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule - Burgess - Medicare physician fee schedule H.R. 8525 - Expanded Genetic Screening Act of 2020 - Speier - Medicaid coverage of non-invasive prenatal genetic screening H.R. 8529 - Protecting Access to Affordable Medicines Act of 2020 - Butterfield - rebates under the Medicaid program for certain noninnovator multiple source drugs H.R. 8546 - Fair Drug Prices for Kids Act -Wild - Medicaid drug rebate program in CHIP H.R. 8558 - Comprehensive Breast Reconstruction Act of 2020 - Hastings - extends coverage of certain breast reconstructive services following mastectomy under the Medicare and Medicaid programs H.R. 8561 - Restoring Fairness to Medicaid Reimbursement Act of 2020 - Johnson - FMAP H.R. 8574 - PROTECT Long Term Care Facilities Act -Sherrill - long term care in COVID-19 H.R. 8586 - Medicaid Coverage for Addiction Recovery Expansion Act -Foster - Substance Use Disorder H.R. 8623 - SAVE for Seniors Act - Spanberger - Medicare coverage of COVID-19 vaccines H.R. 8624 - Protecting Access to Innovation During COVID-19 Act - Wenstrup - extension of pass-through status under the Medicare program H.R. 8702 - Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 -Bera - part B Medicare payments during COVID H.R. 8725 - HAPI Act - Soto - Medicaid Coverage of adult vaccines H.R. 8727 - Telehealth Modernization Act - Carter - Medicare telehealth payments H.R. 8755 - Expanded Telehealth Access Act -Sherrill - Medicare telehealth coverage H.R. 8756 - COVID Health Care Provider Assurance Act of 2020 - Riggleman - Medicare Part B payments during COVID-19 H.R. 8826 - The Resetting the Impact Act (TRIA) of 2020 - Sewell - amends the IMPACT Act of 2014 H.R. 8840 - Medicare Sequester COVID Moratorium Act - Schneider - extend temporary Medicare sequestration H.R. 8871 - COVID HCBS Relief Act of 2020 - Dingell - funding for state Medicaid programs HCBS H.R. 8934 - Community Integration Act of 2020 - Cartwright - Medicaid HCBS H.R. 8958 - Supporting Best Practices for Healthy Moms Act - Kelly - guidance for state Medicaid programs on maternal health H.R. 9002 - To amend title XIX of the Social Security Act to provide States an option to cover a children's program of all-inclusive coordinated care (ChiPACC) under Medicaid program - DeGette - Childrens health under Medicaid H.R. 9006 - To amend title XIX of the Social Security Act to provide for coverage under the Medicaid program under such title of routine patient costs associated with participation in certain clinical trials - Garcia - Medicaid coverage of clinical trials H.R. 9035 - Permanency for Audio-Only Telehealth Act - Smith - Audio only telehealth in Medicare S. 2846 - Protecting Patients Transportation to Care Act - Isakson - Medicaid coverage of transportation S. 2911 - Seniors Prescription Drug Relief Act of 2019 - Cassidy - Part D smoothing S. 3013 - Encouraging Innovative Benefit Design to Lower Costs for Seniors Act - Crapo - offer additional prescription drugs under Part D S. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program S. 3615 - Rural Community Hospital Demonstration Extension Act of 2020 - Murkowski - rural community hospital demonstration program S. 3665 - Save Rural Hospitals Act of 2020 - Alexander - Medicare hospital payments S. 3750 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Shaheen - COVID S. 3881 - CHIPPER Act - Casey - CHIP, COVID S. 3998 - HEALTH Act of 2020 - Hyde-Smith - telehealth S. 3999 - Mental and Behavioral Health Connectivity Act - King - Mental Health S. 4108 - A bill to amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns - Casey - FMAP S. 4151 - SOS: Sustaining Outpatient Services Act - Hoeven - Medicare OPPS coverage S. 4230 - Telehealth Expansion Act of 2020 - Wyden - Telehealth mental health services in Medicare S. 4274 - Legalizing Drug Discounts for Seniors Act of 2020 - Paul - exclude discounts for covered part D drugs from the anti-kickback prohibition S. 4295 - Public Health Emergency Pass-Through Payment Fairness Act of 2020 - Paul - access to drugs and devices under Medicare S. 4358 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Bennet - Medicaid coverage for vaccines and treatment for COVID-19 for uninsured without cost-sharing S. 4375 - Telehealth Modernization Act - Alexander - make permanent Medicare telehealth flexibilities S. 4423 - COVID-19 Hospice Respite Care Relief Act of 2020 - Brown - Medicare hospice care S. 4448- Fair Drug Prices for Kids Act - Warner - extend Medicaid drug rebate program to CHIP S. 4574 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Young - integrated care for Medicare beneficiaries with ESRD S. 4690 - Maternal Immunization Enhancement Act - Hassan - Medicaid and maternal health S. 4705 - Maternal Immunization Coverage Act - Cassidy - Medicaid coverage S. 4717 - Accelerating Kids Access to Care Act - Grassley - Medicaid enrollment S. 4742 - CLINICAL TREATMENT Act - Burr - Medicaid coverage S. 4825 - Ensuring Access to COVID-19 Vaccines for Seniors Act - Reed - Medicare coverage of COVID-19 vaccines S. 4840 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2020 -Roberts - audio-only risk adjustment in Medicare Advantage S. 4859 - Connected MOM Act - Cassidy - expanded coverage of remote physiologic devices and related services under Medicaid S. 4864 - HAPI Act - Brown - Medicaid coverage of adult vaccines S. 4944 - Equality in Medicare and Medicaid Treatment Act of 2020 - Booker - CMMI models for SDOH in Medicare/Medicaid S. 4949 - Supporting Best Practices for Healthy Moms Act - Toomey - guidance for state Medicaid programs on maternal health S. 4957 - COVID HCBS Relief Act of 2020 - Casey - funding for state Medicaid programs HCBS S. 5007 - Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 - Boozman - increase in Medicare part B payment S. 5044 - Bill to amend title XVIII of the SSA to establish requirement with respect to the use of prior authorization under the Medicare Advantage plans - Brown - Prior authorization S. 5077 - A bill to amend title XIX of the Social Security Act to adjust the limitations on Medicaid disproportionate share hospital payments - Cornyn - Medicaid DSH payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; issues related to health insurance tax for MA and Part D plans; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's health plan models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
H.R. 3 - Lower Drug Costs Now Act of 2019 - Pallone - drug pricing H.R. 4398 - Affordable Prescriptions for Patients Through Promoting Competition Act of 2019 - Cicilline - drug pricing H.R. 4906 - Insulin Price Reduction Act - DeGette - insulin costs H.R. 5444 - Lower Insulin Costs Now Act - Underwood - lowering insulin costs H.R. 5749 - Affordable Insulin for All Act - Crist - insulin costs H.R. 6155 - To amend the Biologics Price Competition and Innovation Act of 2009 to make improvements with respect to the transition of biological products - Grothman - biological products H.R. 6411 - To require group health plans and health insurance issuers offering group or individual coverage to provide notices relating to prescription drug refills to individuals covered under such plans or coverage who reside in emergency areas during emergency periods - McBath - prescription drug refill notices H.R. 6649 - Lower Drug Costs for Seniors During COVID-19 Act of 2020 -Schakowsky - COVID H.R. 6739- Ensuring Seniors' Access to COVID Treatments Act - Casten - COVID H.R. 7062 - Affordable Insulin for the COVID-19 Emergency Act - Waters - Insulin/COVID H.R. 8190 - Biosimilar Insulin Access Act of 2020 - Grothman - insulin biosimilar S. 2543 - Prescription Drug Pricing Reduction Act of 2019 - Grassley - Drug pricing S. 3092 - Expanding Access to Low-Cost Generics Act of 2019 - Smith - 180-day exclusivity period S. 3166 - Prescription Drug Affordability and Access Act - Booker - prescription drug costs S. 3781 - PART Act - Peters - transparency S. 4134 - Increasing Access to Biosimilars Act of 2020 - Cornyn - CMS demonstration project; provider payments for providing biosimilars S. 4199 - Prescription Drug Pricing Reduction Act of 2020 - Grassley - lower drug prices in Medicare and Medicaid/ transparency S. 4439 - Make Medications Affordable by Preventing Pandemic Price-gouging Act of 2020 - Smith - COVID-19 drug be affordable and accessible Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; issues relating to prescription drug price blueprint; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Council of Economic Advisers (CEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of the Vice President of the United States, SENATE, Treasury, Dept of, White House Office
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2020 · third_quarter · Q3
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage H.R. 3925 - Reducing Barriers to Substance Use Treatment Act - Tonko - Opioids H.R. 3935 - Protecting Patients Transportation to Care Act - Carter - Medicaid coverage for transportation H.R. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud H.R. 4529 - Promoting Access to Broadband Act of 2019 - Maloney - Medicaid H.R. 4583 - Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Schneider - prescription drug affordability H.R. 4620 - More Help for Seniors Act of 2019 - Rose - expand eligibility for low-income subsidies under part D of the Medicare program H.R. 4621 - Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 - Blunt Rochester - best practices re social determinants of health H.R. 4629 - Star Rating for Biosimilars Act - Tonko - biosimilars H.R. 4632 - Better Transparency in Information for Medicare Beneficiaries Act of 2019 - Kind - provides consumers information regarding premiums under LIS benchmark plans H.R. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 4996 - Helping Medicaid Offer Maternity Services Act of 2020 - Kelly - extend Medicaid coverage post-partum H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized H.R. 5201 - Telemental Health Expansion Act of 2019 - Matsui - Medicare coverage of mental telehealth H.R. 5232 - Road to Recovery Act - Fitzpatrick - Medicaid and CHIP SUD treatment H.R. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program -Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - Increasing Hospital Capacity to Fight the Coronavirus Act of 2020 - Bishop - Medicare and Medicaid payments during COVID-19 emergency H.R. 6462 - Emergency Medicaid for Coronavirus Treatment Act - Gallego - Medicaid coverage H.R. 6511 - Ensuring Vaccination and Treatment Affordability Act - Pappas - COVID H.R. 6521 - To prohibit the Secretary of Health and Human Services from taking certain actions with respect to Medicaid supplemental payments reporting requirements, and for other purposes - Diaz Barragan - Medicaid, delays implementation of MFAR H.R. 6538 - Modernized Medicine Act - Kennedy - Medicaid, Telehealth H.R. 6539 - Coronavirus Medicaid Response Act - Lee - FMAP H.R. 6572 - To direct the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, to carry out a national campaign to increase awareness and knowledge of COVID-19. -Bilirakis - COVID H.R. 6583 - To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes. - Houlahan - COVID H.R. 6616 - Stronger Medicaid Response to the COVID-19 Pandemic Act -Cardenas - COVID H.R. 6640 - Medicare Advantage COVID Treatment Act - Mucarsel-Powell - COVID H.R. 6658 - Insular Area Medicaid Coronavirus Recovery Act - Sablan - FMAP H.R. 6727 - To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program - Schrier - COVID H.R. 6744 - Computer and Internet Equity Act - Davis - internet access for Lifeline program H.R. 6753 - Save Rural Hospitals Act of 2020 - Finkenauer - Medicare hospital payments H.R. 6792 - Improving Telehealth for Underserved Communities Act of 2020 - Smith - telehealth H.R. 6797 - CHIPPER Act - Wild - CHIP, COVID H.R. 6837 - Medicare Accelerated and Advance Payments Improvement Act of 2020 -Schneider - COVID H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act -Boyle - outpatient therapy services H.R. 7187 - HEALTH Act of 2020 -Thompson -Smith - telehealth H.R. 7292 - To amend title XVIII of the Social Security Act to provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. - Kaptur - advance payments H.R. 7338 - To amend title XVIII of the Social Security Act to permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program, and for other purposes. - Cheney - Telehealth H.R. 7391 - To amend title XVIII of the Social Security Act to remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program - Sherrill- Telehealth H.R. 7606 - MFAR Transparency Act - Williams - report on impact of MFAR to Congress H.R. 7627 - MORE Savings Act - Dean - Medicare access to opioid treatment and MAT H.R. 7663 - Protecting Access to Post-COVID-19 Telehealth Act of 2020 - Thompson - waive or modify application of Medicare requirements with respect to telehealth during PHE H.R. 7791 - Value in Health Care Act of 2020 - Welch - Medicare shared savings program and alternative payment arrangements H.R. 7877 - Lowering Drug Costs for Seniors Act of 2020 - Katko - Medicare Part D costs H.R. 7892 - Medicaid Expansion During Crisis Act - Coleman - extend eligibility period for Medicaid enrollment application H.R. 8177 - Renal Anemia Innovation Support and Expansion Act - OHalleran - Medicare prescription drug coverage for chronic kidney disease H.R. 8218 - Rural Ambulance Reimbursement Fairness Act - Gianforte - Medicare payment for rural ambulance services H.R. 8254 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Blumenauer - integrated care for Medicare beneficiaries with ESRD H.R. 8427 - To provide for certain reports on enrollment in the Lifeline program, and for other purposes - Luria - Lifeline program S. 2846 - Protecting Patients Transportation to Care Act - Isakson - Medicaid coverage of transportation S. 2911 - Seniors Prescription Drug Relief Act of 2019 - Cassidy - Part D smoothing S. 3013 - Encouraging Innovative Benefit Design to Lower Costs for Seniors Act - Crapo - offer additional prescription drugs under Part D S. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program S. 3615 - Rural Community Hospital Demonstration Extension Act of 2020 - Murkowski - rural community hospital demonstration program S. 3665 - Save Rural Hospitals Act of 2020 - Alexander - Medicare hospital payments S. 3750 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Shaheen - COVID S. 3881 - CHIPPER Act - Casey - CHIP, COVID S. 3998 - HEALTH Act of 2020 - Hyde-Smith - telehealth S. 3999 - Mental and Behavioral Health Connectivity Act - King - Mental Health S. 4108 - A bill to amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns - Casey - FMAP S. 4151 - SOS: Sustaining Outpatient Services Act - Hoeven - Medicare OPPS coverage S. 4230 - Telehealth Expansion Act of 2020 - Wyden - Telehealth mental health services in Medicare S. 4274 - Legalizing Drug Discounts for Seniors Act of 2020 - Paul - exclude discounts for covered part D drugs from the anti-kickback prohibition S. 4295 - Public Health Emergency Pass-Through Payment Fairness Act of 2020 - Paul - access to drugs and devices under Medicare S. 4358 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Bennet - Medicaid coverage for vaccines and treatment for COVID-19 for uninsured without cost-sharing S. 4375 - Telehealth Modernization Act - Alexander - make permanent Medicare telehealth flexibilities S. 4423 - COVID-19 Hospice Respite Care Relief Act of 2020 - Brown - Medicare hospice care S. 4448 - Fair Drug Prices for Kids Act - Warner - extend Medicaid drug rebate program to CHIP S. 4574 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Young - integrated care for Medicare beneficiaries with ESRD S. 4690 - A bill to increase vaccination rates among pregnant women enrolled in Medicaid or CHIP, and for other purposes - Hassan - Medicaid and maternal health S. 4705 - A bill to amend title XIX requiring coverage under Medicaid of vaccines for pregnant women - Cassidy - Medicaid coverage S. 4717 - A bill to amend title XIX of the Social Security Act to streamline enrollment of certain Medicaid providers across State lines, and for other purposes - Grassley - Medicaid enrollment S. 4742 - A bill to amend title XIX of the Social Security Act to promote access to life-saving therapies for Medicaid enrollees by ensuring coverage of routine patient costs for items and services furnished in connection with participation in qualifying clinical trials, and for other purposes - Burr - Medicaid coverage Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to COVID-19, including testing; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
H.R. 925 - amended version of The Heroes Act (H.R.8406)- Lowey - Coronavirus Relief package H.R. 1897 - Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) - Kelly - maternal health H.R. 4004 - Social Determinants Accelerator Act of 2019 - Bustos - social determinants of health H.R. 4215 - Excellence in Maternal Health Act of 2019 - Bucshon - maternal health H.R. 4768 - Home Visiting to Reduce Maternal Mortality and Morbidity Act - David - maternal health H.R. 4900 - Telehealth Across State Lines Act of 2019 - Roe - telehealth H.R. 4932 - Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019 - Thompson - telehealth H.R. 4995 - Maternal Health Quality Improvement Act of 2019 - Engel - maternal health outcomes H.R. 5190 - STAR Act - Harder - telemedicine assistance for rural health clinics and health centers H.R. 5257 - Telehealth Expansion Act of 2019 - Cox - establish FCC telehealth program H.R. 5473 - Enhance Access to Support Essential Behavioral Health Services Act - Bilirakis - telehealth H.R. 5640 - Data Mapping to Save Moms' Lives Act - Butterfield - maternal health H.R. 5681 - Protecting Communities from Hospital Closures Act of 2020 - Boyle - rural health H.R. 5754 - Rural ER Access Act - Green - rural health H.R. 5763 - National Telehealth Strategy and Data Advancement Act - Gianforte - telehealth H.R. 5800 - Ban Surprise Billing Act - Scott - surprise medical bills H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act of 2020 - Neal - surprise medical bills H.R. 5916 - Transparent Health Care Pricing Act of 2020 - Gallagher - provider transparency in health care services H.R. 5924 - To amend the Public Health Service Act to authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty medicine physicians - McKinley - rural health, loan program H.R. 6074 - Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 - Lowey - COVID-19 H.R. 6132 - Social Determinants for Moms Act of 2020 - McBath - maternal health and social determinants of health H.R. 6138 - Tech to Save Moms Act - Johnson - maternal health H.R. 6142 - Black Maternal Health Momnibus Act of 2020 - Underwood - maternal health H.R. 6143 - Moms MATTER Act of 2020 - Kennedy - maternal health H.R. 6144 - Kira Johnson Act - Adams - maternal health H.R. 6165 - Data to Save Moms Act of 2020 - Davids - maternal health H.R. 6232 - To require the Secretary of Health and Human Services, through the National Disaster Medical System, to provide for certain laboratory reimbursement for diagnostic testing for COVID-19 in uninsured individuals - Cardenas - Federal coverage of COVID-19 related visits and testing for uninsured individuals H.R. 6261 - To provide for coverage of testing for COVID-19 at no cost sharing for Indians receiving health services through the Indian Health Service - Ruiz - Federal coverage of COVID-19 related visits and testing for Native Americans H.R. 6351 - Universal Coronavirus Vaccine Act - Harder - COVID-19 H.R. 6379 - Take Responsibility for Workers and Families Act - Lowey - COVID-19 H.R. 6426 - To direct the Secretary of Health and Human Services to establish a program under which loans shall be made to certain health care organizations to assist such organizations with anticipated revenue loss or higher operating costs as a result of the COVID-19 emergency, and for other purposes - Max Rose - costs H.R. 6437 - Coronavirus Immigrant Families Protection Act - Chu - COVID19 H.R. 6467 -Coronavirus Community Relief Act - Neguse - COVID H.R. 6468 -To provide for an enhanced Coronavirus relief fund, and for other purposes. - Perlmutter - COVID H.R. 6474 - Healthcare Broadband Expansion During COVID-19 Act - Eshoo - rural health H.R. 6487 - ACCESS Act - Schakowsky - telehealth H.R. 6620 - To authorize grants to address substance use during COVID-19.- Kuster - COVID H.R. 6634 - Emergency COVID Telehealth Response Act - Axne - telehealth H.R. 6654 - Emergency COVID Telehealth Response Act -Axne - telehealth H.R. 6666 - COVID-19 Testing, Reaching, And Contacting Everyone (TRACE) Act - Rush - COVID H.R. 6719 - Emergency Medical Supplies Procurement Act - Khanna- COVID H.R. 6763 - COVID-19 Racial and Ethnic Disparities Task Force Act of 2020 - Kelley - COVID H.R. 6800 - HEROES Act - Lowey - COVID H.R. 6881 - Emergency Broadband Connections Act of 2020 - COVID H.R. 6926 - MIND Act -Boyle - COVID H.R. 6999 - Coronavirus Mental Health and Addiction Assistance Act of 2020 -Ryan - COVID H.R. 7017 - Right to Test Act - McHenry - Testing H.R. 7077 - Community Solutions for COVID-19 Act - Kelley - COVID H.R. 7190 - Increasing Rural Health Access During the COVID-19 Public Health Emergency Act of 2020 - Torres Small - COVID H.R. 7205 - Nationwide Dig Once Act of 2020 - Eshoo - broadband H.R. 7302 - To make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Clyburn - Broadband H.R. 7359 - Accelerating Broadband Connectivity Act of 2020 - Kelley - Broadband H.R. 7534 - RURAL HELP Act of 2020 - Keller - study on cost disparities between rural and urban hospitals H.R. 7546 - Minority Community Public Health Emergency Response Act of 2020 - Lewis - minority, underserved communities access to public health and health care services during COVID-19 H.R. 7557 - To amend title VI of the Social Security Act to extend the coverage of Coronavirus Relief Fund payments to Tribal Governments - OHalleran - COVID-19 relief funds H.R. 7571 - Facilitating Reforms that Offer Necessary Telehealth In Every Rural (FRONTIER) Community Act - Young - expand telehealth mental health services to frontier states H.R. 7593 - TREATS Act - McKinley - Increase telehealth for SUD H.R. 7614 - Depts. of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act - DeLauro - Appropriations H.R. 7618 - COVID-19 Bias and Anti-Racism Training Act of 2020 - Adams - improve bias and anti-racism training for health entities H.R. 7649 - Jobs to Fight COVID-19 Act of 2020 - Morelle - initiative for national testing, contact tracing, pandemic response H.R. 7701 - Addiction Prevention and Responsible Opioid Practices Act- Cartwright - program for prevention of opioid misuse H.R. 7732 - How Awareness and Prevention Protect You Act - Wasserman Schultz - CDC campaign to increase awareness and knowledge of COVID-19 virus H.R. 7758 - Assistance for Rural Health, Safety and Educational Facilities Act - Scott - assistance to rural health facilities affected by COVID H.R. 7780 - Virtual Community Support Act of 2020 - Kennedy - community-based mental health and SUD services H.R. 7783 - Plasma Donation Awareness Act of 2020 - Peters - national awareness and outreach on plasma donation H.R. 7972 - Rural Connectivity Advancement Program Act of 2020 - Latta - rural communications infrastructure H.R. 7992 - Telehealth Act - Wagner - telehealth expansion H.R. 8027 - Maternal Health Pandemic Response Act of 2020 - Underwood - maternal health H.R. 8061 - Community Immunity During COVID-19 Act of 2020 - Underwood - fund health depts to increase recommended immunizations H.R. 8086 - To provide additional appropriations for the public health and social services emergency fund - Burgess - appropriations for public health and social services fund H.R. 8098 - Hospital Competition Act of 2020- Banks - hospital price transparency H.R. 8141 - Strengthening Mental Health Supports for BIPOC Communities Act - Cardenas - reduce health inequities for racial and ethnic minority H.R. 8156 - Ensuring Telehealth Expansion Act of 2020 - Williams - extend telehealth provisions H.R. 8192 - COVID Community Care Act - Lee - health appropriations H.R. 8200 - To improve the health of minority individuals during the COVID-19 pandemic - Kelly - health disparities in communities of color H.R. 8203 - COVID-19 Health Disparities Action Act of 2020 - Cardenas - action plan, grants, awareness campaign for COVID health disparities H.R. 8337 - Continuing Appropriations Act, 2021 - Lowey - Health appropriations H.R. 8351 - Community Health Center Mental Health Screening Act - Dean - mental and behavioral health screenings H.R. 8368 - To amend title VI of the Social Security Act to permit the use of amounts under the Coronavirus Relief Fund for rural broadband expansion and improvement - Barr - COVID-19, broadband H.R. 8406- The Heroes Act - Lowey - Coronavirus Relief package H.R. 8417 - To facilitate direct primary care arrangements - Crenshaw - direct primary care H.R. 8419 - To prevent surprise medical bills with respect to COVID-19 testing - Fletcher - COVID-19, surprise medical billing H.R. 8463 - To prohibit discrimination in health care and require the provision of equitable health care, and for other purposes - Schiff - equity in health care S. 116 - Modernizing Obstetric Medicine Standards Act of 2019 (MOMS Act) - Gillibrand - maternal health S. 916 - Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) - Durbin - maternal health S. 2741 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 - Schatz - telehealth S. 2885 - Stop Marketing and Revealing the Wearables and Trackers Consumer Health Data Act - Cassidy - consumer health information S. 2986 - Social Determinants Accelerator Act of 2019 - Young - Social Determinants of Health S. 3152 - Data Mapping to Save Moms' Lives Act - Rosen - maternal health S. 3318 - Transparent Health Care Pricing Act of 2020 - Cassidy - disclosure of point-of-sale cash prices S. 3380 - Patient Safety Improvement Act of 2020 - Whitehouse - data collection and quality improvement S. 3424 - Black Maternal Health Momnibus Act of 2020 - Harris - maternal health S. 3437 - Improving Care in Rural America Reauthorization Act of 2020 - Loeffler - rural health S. 3438 - R-DOCS Reauthorization Act of 2020 - Loeffler - telehealth S. 3517 - ACCESS Act - Klobuchar - telehealth S. 3568 - Medical Supply Chain Emergency Act of 2020 - Murphy - expedite acquisition of PPE S. 3570 - To provide for the expedited procurement of equipment needed to combat COVID-19 under the Defense Production Act of 1950 - Baldwin - expedite acquisition of PPE S. 3721 - COVID-19 Racial and Ethnic Disparities Task Force Act of 2020 - Harris - COVID S. 3769 - Right to Test Act - Cruz - Testing S. 3825 - Coronavirus Mental Health and Addiction Assistance Act of 2020 - Klobuchar - COVID S. 3828 - Jobs to Fight COVID-19 Act of 2020 - Schatz - COVID S. 3838 - Health Care Broadband Expansion During COVID-19 Act -Schatz - broadband S. 3877 - Community Solutions for COVID-19 Act - Booker - COVID S. 3921 - Emergency Medical Supplies Procurement Act - Sanders - COVID S. 3951 - Increasing Rural Health Access During the COVID-19 Public Health Emergency Act of 2020 - McSally - COVID S. 3988 - Enhancing Preparedness through Telehealth Act - Cassidy - Telehealth S. 4015 - Rural Connectivity Advancement Program Act of 2020 - Thune - Rural S. 4021 - Accelerating Broadband Connectivity Act of 2020 - Wicker - Broadband S. 4058 - A bill to authorize grants to address substance use during COVID-19 - Smith - SUD S. 4059 - A bill to direct the Secretary of Health and Human Services to award grants to States, political subdivisions of States, Indian Tribes and Tribal organizations, community-based entities, and primary care and behavioral health organizations to address behavioral health needs caused by the public health emergency declared with respect to COVID-19 - Smith - Mental Health S. 4095 - A bill to provide emergency benefits for broadband service during periods relating to COVID-19, and for other purposes - Wyden - Broadband S. 4103 - A bill to amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment - Portman - telehealth S. 4113 - A bill to amend the Communications Act of 1934 to provide grants to States and Indian Tribes to deploy affordable, high-speed broadband to unserved and underserved areas - Bennett - broadband S. 4131 - Accessible, Affordable Internet for All Act - Klobuchar - broadband access S. 4163 - Timely and Effective Systematic Testing (TEST) Act - Gardner - Biosurveillance of COVID through testing S. 4211 - Facilitating Reforms that Offer Necessary Telehealth In Every Rural (FRONTIER) Community Act - Sullivan - expand mental health services through telehealth S. 4242 - Addiction Prevention and Responsible Opioid Practices Act- Durbin - program for prevention of opioid misuse S. 4248 - COVID-19 Bias and Anti-Racism Training Act of 2020 - Harris - improve bias and anti-racism training for health care entities S. 4262 - COVID-19 Health Disparities Action Act of 2020 - Menendez - HHS action plan, grants, public awareness campaign for COVID-19 and racial and ethnic minorities S. 4269 - Mothers and Newborns Success Act - Kaine - maternal health S. 4291 - DEPLOY Broadband Act - Gardner - rural broadband appropriations S. 4315 - COVID-19 Testing, Reaching, And Contacting Everyone Act - King - grants for testing and contact tracing, supported isolation at individuals residences S. 4317 - SAFE TO WORK Act - Cornyn - GOP COVID-19 relief package S. 4318 - American Workers, Families, and Employers Assistance Act - Grassley - GOP COVID-19 relief package S. 4319 - Supporting America's Restaurant Workers Act - Scott - GOP COVID-19 relief package S. 4320 - Coronavirus Response Additional Supplemental Appropriations Act, 2020 - Shelby - GOP COVID-19 relief package S. 4322 - Safely Back to School and Back to Work Act - Alexander - GOP COVID-19 relief package S. 4323 - TRUST Act of 2020 - Romney - GOP COVID-19 relief package S. 4388 - Mental Health Equity Act of 2020 - Menendez - mental health S. 4427 - Safe Authorization for Vaccines during Emergencies Act - Hassan - transparency in EUA of vaccines S. 4477 - Strengthening Social Connections Act of 2020 - Smith - Appropriations for social isolation services for older Americans S. 4507 - Getting Early Treatment and Comprehensive Assessments Reduces Emergencies Act of 2020 - Warner - campaign for awareness on preventive health services S. 4737 - A bill to amend the Public Health Service Act to direct the Secretary of Health and Human Services to make grants to covered health departments to increase the rate of recommended immunizations, and for other purposes - Smith - immunizations S. 4745 - A bill to prevent surprise medical bills with respect to COVID-19 testing - Smith - Surprise Medical Billing S. 4769 - A bill to improve the public health response to addressing maternal mortality and morbidity during the COVID-19 public health emergency - Warren - maternal health S. 4775 - A bill to provide continued emergency assistance, educational support, and health care response for individuals, families, and businesses affected by the 2020 coronavirus pandemic - McConnell - COVID-19 relief Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
H.R. 748 - CARES Act - Courtney - COVID-19 coverage H.R. 1418 - Competitive Health Insurance Reform Act of 2020 - DeFazio - antitrust laws, health insurance H.R. 3630 - No Surprises Act - Pallone - surprise medical billing H.R. 3784 - Air Ambulance Affordability Act of 2019 - Neguse - air ambulances H.R. 4223 - Protecting Patients from Surprise Medical Bills Act - Spano - surprise medical billing H.R. 5121 - Healthcare Cost Transparency Act - Beyer - provider price comparison tool H.R. 5239 - Prescription Drug Price Reporting Act - Joyce - reporting on drug expenditures and price changes under group health plans H.R. 5575 - Primary and Behavioral Health Care Access Act of 2020 -Underwood - coverage of primary care and behavioral health visits H.R. 6005 - Know the Price Act - Malinowski - health plan transparency H.R. 6173 - Covering Coronavirus Test Act of 2020 - DeGette - COVID-19 testing coverage H.R. 6193 - Medication Access in Emergencies Act of 2020 - Pappas - coverage of prescription drugs during emergency periods H.R. 6201 - Families First Coronavirus Response Act - Lowey - includes several provisions related to COVID-19 testing coverage H.R. 6213 - No Cost for COVID-19 Testing Act - Wilson - COVID-19 testing coverage H.R. 6214 - To amend title XVIII of the Social Security Act to provide for coverage of testing for COVID-19 at no cost sharing under the Medicare Advantage program - Kind - Medicare Advantage coverage of COVID-19 related visits and testing H.R. 6222 - Ensuring Affordable COVID-19 Preventive Care Act of 2020 - Schakowsky - coverage of certain new preventative services related to COVID-19 H.R. 6231 - Ensuring Access to COVID-19 Preventive Care Act of 2020 - Bucshon - coverage of certain vaccines and testing services during the COVID-19 emergency H.R. 6299 - Rapid Coverage of COVID-19 Vaccine Act of 2020 - Courtney - COVID-19 coverage H.R. 6317 - To provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes - Doggett - special enrollment periods in public health emergency H.R. 6338 - To waive high deductible health plan requirements for health savings accounts -Budd - HDHP coverage during COVID H.R. 6486 - Care for COVID-19 Act 2.0 -Ruiz - COVID H.R. 6514 - Worker Health Coverage Protection Act - Scott - COVID H.R. 6518 - Stop Health Premium Spikes Act of 2020 - Peters - risk corridors H.R. 6532 - COVID Special Enrollment Act of 2020 - Doggett - COVID H.R. 6568 - Coverage for COVID-19 Treatment Act of 2020 - Rochester - COVID H.R. 6644 - To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person during the COVID-19 emergency. -Schrier - COVID H.R. 6674 - Medicare Crisis Program Act of 2020 -Jayapal - COVID H.R. 6712 - American Healthshare Plans Act of 2020 - Curtis - health share pools H.R. 6810 - Health Care Protection Act -Davis - COVID H.R. 7006 - Improving Care in Home Health Agencies Act - Velazquez - home health services H.R. 7267 - To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to prohibit a group health plan and a health insurance issuer offering group or individual health insurance coverage from reducing contracted rates, or terminating contracts, with health care providers during a public health emergency. - Porter - ERISA H.R. 7475 - Ensuring FEHBP Coverage During Pandemic Act - Vela - special enrollment period H.R. 7539 - Strengthening Behavioral Health Parity Act - Kennedy - strengthen mental health and SUD benefits H.R. 7647 - To provide for a COVID-19-related delay regarding annual limitation on cost-sharing for group health plans and individual and small group health insurance coverage - McEachin - drug manufacturer support applied to patient out-of-pocket limit H.R. 7659 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2020 - Sewell - inclusion of certain audio-only diagnoses in the determination of risk adjustment for MA plans H.R. 7676 - Health Care Prices Revealed and Information to Consumers Explained Transparency Act - Flores - hospital and insurer price transparency H.R. 7722 - Matts Act - Fortenberry - limit price of insulin drugs accessible for those enrolled in group or indiv. health insurance coverage, group health plans, uninsured H.R. 7921 - Connecting Communities to Grant Opportunities Act of 2020 - Velazquez - navigator programs H.R. 7942 - Public Health Emergency COBRA Extension Act -Sanchez - COBRA extension H.R. 8060 - Tele-Mental Health Improvement Act - Trone - parity in mental health and SUD service under private insurance H.R. 8181 - Jack Reynolds Memory MediGap Expansion - Axne - Medigap coverage for Medicare ESRD H.R. 8308 - Telehealth Coverage and Payment Parity Act - Phillips - coverage for services furnished through telehealth H.R. 8330 - No Surprise Bills for New Moms Act - Porter - health coverage of newborns S. 1531 - STOP Surprise Medical Bills Act - Cassidy-Bennet - surprise medical billing S. 1948 - Chronic Disease Management Act - Thune - pre-deductible coverage of chronic disease prevention services S. 2546 - Safe Step Act - Murkowski - Step therapy exceptions S. 3200 - Chronic Disease Management Act of 2020 - Thune - coverage of chronic disease prevention services S. 3383 - Continuing Coverage for Preexisting Conditions Act of 2020 -Kennedy - preexisting conditions S. 3499 - A bill to amend coverage requirements to ensure that no person incurs cost sharing when receiving a test to confirm a COVID-19 infection - Smith - COVID-19 cost -sharing S. 3505 - A bill to require private health insurance to rapidly cover preventive services and vaccines related to the coronavirus - Jones - rapid COVID-19 coverage S. 3536 - A bill to provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes - Casey - COVID-19 coverage S. 3610 - American Healthshare Plans Act of 2020 - Paul - health share pools S. 3631 - Relief for Rural Providers During Emergencies Act - Sasse - COVID S. 3741 - Health Care at Home Act of 2020 - Smith - COVID S. 3792 - Tele-Mental Health Improvement Act - Smith - parity S. 3821 - Affordable Health Care Options Act of 2020 - Loeffler - affordability S. 3991 - Coronavirus 2019 Special Enrollment Period Act - Duckworth - SEP S. 4106 - A bill to amend the Public Health Service Act to provide for hospital and insurer price transparency - Braun - price transparency S. 4185 - End Surprise Medical Bills for Air Ambulances Act of 2020 - Wicker - establish an IDR for air ambulance S. 4198 - Affordable Coronavirus Testing Act - Scott - coverage for COVID serology testing S. 4255 - Katherines Lung Cancer Early Detection and Survival Act of 2020 - Smith - group health plans, group and indiv coverage benefits for lung cancer screenings S. 4329 - Continuous Health Coverage for Workers Act - McSally - COBRA continuation coverage S. 4469 - COVID-19 Treatment Coverage Act - Smith - COVID treatment Medicaid/MA/Private/Medicare coverage S. 4506 - Pre-Existing Conditions Protection Act of 2020 - Gardner - coverage of pre-ex conditions under private insurance S. 4521 - Health Care Improvement Act of 2020 - Warner - expand ACA coverage S. 4557 - COVid Enrollment Response Act - Baldwin - assistance enrolling in health care coverage S. 4609 - Vaccine And Coverage Certainty Act - Wyden - coverage of COVID vaccine under Medicare/Medicaid, CHIP S. 4653 - A bill to prevent efforts of the Department of Justice to advocate courts to strike down the Patient Protection and Affordable Care Act - Schumer - ACA S. 4761 - A bill to amend the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide for 3 primary care visits and 3 behavioral health care visits without application of any cost-sharing requirement - King - coverage and cost-sharing Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
H.R. 3709 - Chronic Disease Management Act of 2019 - Blumenauer - HSAs and HDHPs H.R. 4651 - American Future Healthcare Act of 2019 - King - amends the Internal Revenue Code to expand health savings accounts H.R. 4652 - Individual Health Insurance Marketplace Improvement Act - Langevin - Individual Market Reinsurance fund H.R. 5807 - Know Your Provider Act of 2020 - Larson - provider directory information H.R. 5809 - Better Information Act of 2020 - Beyer - health insurance membership card H.R. 5816 - Continuing Care for Patients Act of 2020 - Moore - coverage and provider network status H.R. 5817 - Fair and Honest Advance Cost Estimate for Patients Act of 2020 - Nunes - health plan transparency H.R. 5825 - To amend the Internal Revenue Code of 1986 to provide for reporting by certain investors with respect to certain specified medical care providers - Neal - investment in medicine H.R. 6286 - Health Savings Act of 2020 - Burgess - health savings account H.R. 6545 - Health Insurance Marketplace Affordability Act of 2020 - Murphy - age rating adjustment H.R. 7008 - Family Savings Flexibility Act - Wenstrup - HSA arrangements H.R. 7825 - Pandemic Eradication and Enhanced Prevention through Savings Act - Buck - increase opportunities for savings to HSA, MSA, FSA plans H.R. 8032 - Health Savings Accounts For All Act of 2020 - Biggs - eliminate limitations on contributions to HSAs S. 3439 - Lower Health Insurance Deductibles Act - Scott - health savings accounts S. 3539 - A bill to amend the Internal Revenue Code of 1986 to exempt telehealth services from certain high deductible health plan rules - Daines - telehealth S. 3546 - A bill to waive high deductible health plan requirements for health savings accounts - Cruz - health savings accounts S. 3924 - A bill to provide tax credits to low- to moderate-income individuals for certain computer and education costs, to direct the Federal Communications Commission to modify the requirements for the Lifeline program to provide increased support, and for other purposes. - Durbin - Lifeline/Medicaid S. 4267 - Health Savings Accounts For All Act of 2020 - Paul - eliminate limitations on contributions to HSAs Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; issues relating to COVID-19; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 3 - Lower Drug Costs Now Act of 2019 - Pallone - drug pricing H.R. 4398 - Affordable Prescriptions for Patients Through Promoting Competition Act of 2019 - Cicilline - drug pricing H.R. 4906 - Insulin Price Reduction Act - DeGette - insulin costs H.R. 5444 - Lower Insulin Costs Now Act - Underwood - lowering insulin costs H.R. 5749 - Affordable Insulin for All Act - Crist - insulin costs H.R. 6155 - To amend the Biologics Price Competition and Innovation Act of 2009 to make improvements with respect to the transition of biological products - Grothman - biological products H.R. 6411 - To require group health plans and health insurance issuers offering group or individual coverage to provide notices relating to prescription drug refills to individuals covered under such plans or coverage who reside in emergency areas during emergency periods - McBath - prescription drug refill notices H.R. 6649 - Lower Drug Costs for Seniors During COVID-19 Act of 2020 -Schakowsky - COVID H.R. 6739- Ensuring Seniors' Access to COVID Treatments Act - Casten - COVID H.R. 7062 - Affordable Insulin for the COVID-19 Emergency Act - Waters - Insulin/COVID H.R. 8190 - Biosimilar Insulin Access Act of 2020 - Grothman - insulin biosimilar S. 2543 - Prescription Drug Pricing Reduction Act of 2019 - Grassley - Drug pricing S. 3092 - Expanding Access to Low-Cost Generics Act of 2019 - Smith - 180-day exclusivity period S. 3166 - Prescription Drug Affordability and Access Act - Booker - prescription drug costs S. 3781 - PART Act - Peters - transparency S. 4134 - Increasing Access to Biosimilars Act of 2020 - Cornyn - CMS demonstration project; provider payments for providing biosimilars S. 4199 - Prescription Drug Pricing Reduction Act of 2020 - Grassley - lower drug prices in Medicare and Medicaid/ transparency S. 4439 - Make Medications Affordable by Preventing Pandemic Price-gouging Act of 2020 - Smith - COVID-19 drug be affordable and accessible Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including vaccines and therapeutics; issues relating to prescription drug rebates; issues relating to prescription drug price blueprint; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Filing targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2020 · second_quarter · Q2
H.R. 3709 - Chronic Disease Management Act of 2019 - Blumenauer - HSAs and HDHPs H.R. 4651 - American Future Healthcare Act of 2019 - King - amends the Internal Revenue Code to expand health savings accounts H.R. 4652 - Individual Health Insurance Marketplace Improvement Act - Langevin - Individual Market Reinsurance fund H.R. 5807 - Know Your Provider Act of 2020 - Larson - provider directory information H.R. 5809 - Better Information Act of 2020 - Beyer - health insurance membership card H.R. 5816 - Continuing Care for Patients Act of 2020 - Moore - coverage and provider network status H.R. 5817 - Fair and Honest Advance Cost Estimate for Patients Act of 2020 - Nunes - health plan transparency H.R. 5825 - To amend the Internal Revenue Code of 1986 to provide for reporting by certain investors with respect to certain specified medical care providers - Neal - investment in medicine H.R. 6286 - Health Savings Act of 2020 - Burgess - health savings account H.R. 6545 - Health Insurance Marketplace Affordability Act of 2020 - Murphy H.R. 7008 - Family Savings Flexibility Act - Wenstrup - HSA arrangements S. 3439 - Lower Health Insurance Deductibles Act - Scott - health savings accounts S. 3539 - A bill to amend the Internal Revenue Code of 1986 to exempt telehealth services from certain high deductible health plan rules - Daines - telehealth S. 3546 - A bill to waive high deductible health plan requirements for health savings accounts - Cruz - health savings accounts S. 3924 - A bill to provide tax credits to low- to moderate-income individuals for certain computer and education costs, to direct the Federal Communications Commission to modify the requirements for the Lifeline program to provide increased support, and for other purposes. - Durbin - Lifeline/Medicaid Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; issues relating to COVID-19; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 748 - CARES Act -Courtney - COVID-19 coverage H.R. 3630 - No Surprises Act - Pallone - surprise medical billing H.R. 3784 - Air Ambulance Affordability Act of 2019 - Neguse - air ambulances H.R. 4223 - Protecting Patients from Surprise Medical Bills Act - Spano - surprise medical billing H.R. 5121 - Healthcare Cost Transparency Act - Beyer - provider price comparison tool H.R. 5239 - Prescription Drug Price Reporting Act - Joyce - reporting on drug expenditures and price changes under group health plans H.R. 5575 - Primary and Behavioral Health Care Access Act of 2020 -Underwood - coverage of primary care and behavioral health visits H.R. 6005 - Know the Price Act - Malinowski - health plan transparency H.R. 6173 - Covering Coronavirus Test Act of 2020 - DeGette - COVID-19 testing coverage H.R. 6193 - Medication Access in Emergencies Act of 2020 - Pappas - coverage of prescription drugs during emergency periods H.R. 6201 - Families First Coronavirus Response Act - Lowey - includes several provisions related to COVID-19 testing coverage H.R. 6213 - No Cost for COVID-19 Testing Act - Wilson - COVID-19 testing coverage H.R. 6214 - To amend title XVIII of the Social Security Act to provide for coverage of testing for COVID-19 at no cost sharing under the Medicare Advantage program - Kind - Medicare Advantage coverage of COVID-19 related visits and testing H.R. 6222 - Ensuring Affordable COVID-19 Preventive Care Act of 2020 - Schakowsky - coverage of certain new preventative services related to COVID-19 H.R. 6231 - Ensuring Access to COVID-19 Preventive Care Act of 2020 - Bucshon - coverage of certain vaccines and testing services during the COVID-19 emergency H.R. 6299 - Rapid Coverage of COVID-19 Vaccine Act of 2020 - Courtney - COVID-19 coverage H.R. 6317 - To provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes - Doggett - special enrollment periods in public health emergency H.R. 6338 - To waive high deductible health plan requirements for health savings accounts -Budd - HDHP coverage during COVID H.R. 6486 - Care for COVID-19 Act 2.0 -Ruiz - COVID H.R. 6514 - Worker Health Coverage Protection Act - Scott - COVID H.R. 6518 - Stop Health Premium Spikes Act of 2020 - Peters - risk corridors H.R. 6532 - COVID Special Enrollment Act of 2020 - Doggett - COVID H.R. 6568 - Coverage for COVID-19 Treatment Act of 2020 - Rochester - COVID H.R. 6644 - To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person during the COVID-19 emergency. -Schrier - COVID H.R. 6674 - Medicare Crisis Program Act of 2020 -Jayapal - COVID H.R. 6712 - American Healthshare Plans Act of 2020 - Curtis - health share pools H.R. 6810 - Health Care Protection Act -Davis - COVID H.R. 7006 - Improving Care in Home Health Agencies Act - Velazquez - home health services H.R. 7267 - To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to prohibit a group health plan and a health insurance issuer offering group or individual health insurance coverage from reducing contracted rates, or terminating contracts, with health care providers during a public health emergency. - Porter - ERISA S. 1531 - STOP Surprise Medical Bills Act - Cassidy-Bennet - surprise medical billing S. 1948 - Chronic Disease Management Act - Thune - pre-deductible coverage of chronic disease prevention services S. 2546 - Safe Step Act - Murkowski - Step therapy exceptions S. 3200 - Chronic Disease Management Act of 2020 - Thune - coverage of chronic disease prevention services S. 3383 - Continuing Coverage for Preexisting Conditions Act of 2020 -Kennedy - preexisting conditions S. 3499 - A bill to amend coverage requirements to ensure that no person incurs cost sharing when receiving a test to confirm a COVID-19 infection - Smith - COVID-19 cost -sharing S. 3505 - A bill to require private health insurance to rapidly cover preventive services and vaccines related to the coronavirus - Jones - rapid COVID-19 coverage S. 3536 - A bill to provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes - Casey - COVID-19 coverage S. 3610 - American Healthshare Plans Act of 2020 - Paul - health share pools S. 3631 - Relief for Rural Providers During Emergencies Act - Sasse - COVID S. 3741 - Health Care at Home Act of 2020 - Smith - COVID S. 3792 - Tele-Mental Health Improvement Act - Smith - parity S. 3821 - Affordable Health Care Options Act of 2020 - Loeffler - affordability S. 3991 - Coronavirus 2019 Special Enrollment Period Act - Duckworth - SEP S. 4106 - A bill to amend the Public Health Service Act to provide for hospital and insurer price transparency - Braun - price transparency Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage H.R. 3925 - Reducing Barriers to Substance Use Treatment Act - Tonko - Opioids H.R. 3935 - Protecting Patients Transportation to Care Act - Carter - Medicaid coverage for transportation H.R. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud H.R. 4529 - Promoting Access to Broadband Act of 2019 - Maloney - Medicaid H.R. 4583 - Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Schneider - prescription drug affordability H.R. 4620 - More Help for Seniors Act of 2019 - Rose - expand eligibility for low-income subsidies under part D of the Medicare program H.R. 4621 - Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 - Blunt Rochester - best practices re social determinants of health H.R. 4629 - Star Rating for Biosimilars Act - Tonko - biosimilars H.R. 4632 - Better Transparency in Information for Medicare Beneficiaries Act of 2019 - Kind - provides consumers information regarding premiums under LIS benchmark plans H.R. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized H.R. 5201 - Telemental Health Expansion Act of 2019 - Matsui - Medicare coverage of mental telehealth H.R. 5232 - Road to Recovery Act - Fitzpatrick - Medicaid and CHIP SUD treatment H.R. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Jodey Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program - Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Abby Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - Increasing Hospital Capacity to Fight the Coronavirus Act of 2020 - Bishop - Medicare and Medicaid payments during COVID-19 emergency H.R. 6462 - Emergency Medicaid for Coronavirus Treatment Act - Gallego - Medicaid coverage H.R. 6511 - Ensuring Vaccination and Treatment Affordability Act - Pappas - COVID H.R. 6521 - To prohibit the Secretary of Health and Human Services from taking certain actions with respect to Medicaid supplemental payments reporting requirements, and for other purposes - Diaz Barragan H.R. 6538 - Modernized Medicine Act - Kennedy - Medicaid, Telehealth H.R. 6539 - Coronavirus Medicaid Response Act - Lee - FMAP H.R. 6572 - To direct the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, to carry out a national campaign to increase awareness and knowledge of COVID-19. - Bilirakis - COVID H.R. 6583 - To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes. - Houlahan - COVID H.R. 6616 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Cardenas - COVID H.R. 6640 - Medicare Advantage COVID Treatment Act - Mucarsel-Powell - COVID H.R. 6658 - Insular Area Medicaid Coronavirus Recovery Act - Sablan - FMAP H.R. 6727 - To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program - Schrier - COVID H.R. 6744 - Computer and Internet Equity Act - Davis - internet access for Lifeline program H.R. 6753 - Save Rural Hospitals Act of 2020 - Finkenauer - Medicare hospital payments H.R. 6792 - Improving Telehealth for Underserved Communities Act of 2020 - Smith - telehealth H.R. 6797 - CHIPPER Act - Wild - CHIP, COVID H.R. 6837 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Schneider - COVID H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act - Boyle - outpatient therapy services H.R. 7187 - HEALTH Act of 2020 -Thompson -Smith - telehealth H.R. 7297 - To amend title XVIII of the Social Security Act to provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. - Kaptur H.R. 7338 - To amend title XVIII of the Social Security Act to permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program, and for other purposes. - Cheney - Telehealth H.R. 7391 - To amend title XVIII of the Social Security Act to remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program - Sherrill - Telehealth S. 2846 - Protecting Patients Transportation to Care Act - Isakson - Medicaid coverage of transportation S. 2911 - Seniors Prescription Drug Relief Act of 2019 - Cassidy - Part D smoothing S. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program S. 3615 - Rural Community Hospital Demonstration Extension Act of 2020 - Murkowski - rural community hospital demonstration program S. 3665 - Save Rural Hospitals Act of 2020 - Alexander - Medicare hospital payments S. 3750 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Shaheen - COVID S. 3881 - CHIPPER Act - Casey - CHIP, COVID S. 3998 - HEALTH Act of 2020 - Hyde-Smith - telehealth S. 3999 - Mental and Behavioral Health Connectivity Act - King - Mental Health S. 4108 - A bill to amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns - Casey - FMAP Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2021 Rate Notice and Call Letter; issues related to MLTSS; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to COVID-19; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
H.R. 3 - Lower Drug Costs Now Act of 2019 - Pallone - drug pricing H.R. 4398 - Affordable Prescriptions for Patients Through Promoting Competition Act of 2019 - Cicilline - drug pricing H.R. 4906 - Insulin Price Reduction Act - DeGette - insulin costs H.R. 5444 - Lower Insulin Costs Now Act - Underwood - lowering insulin costs H.R. 5749 - Affordable Insulin for All Act - Crist - insulin costs H.R. 6155 - To amend the Biologics Price Competition and Innovation Act of 2009 to make improvements with respect to the transition of biological products - Grothman - biological products H.R. 6411 - To require group health plans and health insurance issuers offering group or individual coverage to provide notices relating to prescription drug refills to individuals covered under such plans or coverage who reside in emergency areas during emergency periods - McBath - prescription drug refill notices H.R. 6649 - Lower Drug Costs for Seniors During COVID-19 Act of 2020 -Schakowsky - COVID H.R. 6739- Ensuring Seniors' Access to COVID Treatments Act - Casten - COVID H.R. 7062 - Affordable Insulin for the COVID-19 Emergency Act - Waters - Insulin/COVID S. 2543 - Prescription Drug Pricing Reduction Act of 2019 - Grassley - Drug pricing S. 3092 - Expanding Access to Low-Cost Generics Act of 2019 - Smith - 180-day exclusivity period S. 3166 - Prescription Drug Affordability and Access Act - Booker - prescription drug costs S. 3781 - PART Act - Peters - transparency Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; issues relating to vaccines; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19; issues relating to prescription drug rebates; issues relating to prescription drug price blueprint; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 1897 - Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) - Kelly - maternal health H.R. 4004 - Social Determinants Accelerator Act of 2019 - Bustos - social determinants of health H.R. 4215 - Excellence in Maternal Health Act of 2019 - Bucshon - maternal health H.R. 4768 - Home Visiting to Reduce Maternal Mortality and Morbidity Act - David - maternal health H.R. 4900 - Telehealth Across State Lines Act of 2019 - Roe - telehealth H.R. 4932 - Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019 - Thompson - telehealth H.R. 4995 - Maternal Health Quality Improvement Act of 2019 - Engel - maternal health outcomes H.R. 5190 - STAR Act - Harder - telemedicine assistance for rural health clinics and health centers H.R. 5257 - Telehealth Expansion Act of 2019 - Cox - establish FCC telehealth program H.R. 5473 - Enhance Access to Support Essential Behavioral Health Services Act - Bilirakis - telehealth H.R. 5640 - Data Mapping to Save Moms' Lives Act - Butterfield - maternal health H.R. 5681 - Protecting Communities from Hospital Closures Act of 2020 - Boyle - rural health H.R. 5754 - Rural ER Access Act - Green - rural health H.R. 5763 - National Telehealth Strategy and Data Advancement Act - Gianforte - telehealth H.R. 5800 - Ban Surprise Billing Act - Scott - surprise medical bills H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act of 2020 - Neal - surprise medical bills H.R. 5916 - Transparent Health Care Pricing Act of 2020 - Gallagher - provider transparency in health care services H.R. 5924 - To amend the Public Health Service Act to authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty medicine physicians - McKinley - rural health, loan program H.R. 6074 - Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 - Lowey - COVID-19 H.R. 6132 - Social Determinants for Moms Act of 2020 - McBath - maternal health and social determinants of health H.R. 6138 - Tech to Save Moms Act - Johnson - maternal health H.R. 6142 - Black Maternal Health Momnibus Act of 2020 - Underwood - maternal health H.R. 6143 - Moms MATTER Act of 2020 - Kennedy - maternal health H.R. 6144 - Kira Johnson Act - Adams - maternal health H.R. 6165 - Data to Save Moms Act of 2020 - Davids - maternal health H.R. 6232 - To require the Secretary of Health and Human Services, through the National Disaster Medical System, to provide for certain laboratory reimbursement for diagnostic testing for COVID-19 in uninsured individuals - Cardenas - Federal coverage of COVID-19 related visits and testing for uninsured individuals H.R. 6261 - To provide for coverage of testing for COVID-19 at no cost sharing for Indians receiving health services through the Indian Health Service - Ruiz - Federal coverage of COVID-19 related visits and testing for Native Americans H.R. 6351 - Universal Coronavirus Vaccine Act - Harder - COVID-19 H.R. 6379 - Take Responsibility for Workers and Families Act - Lowey - COVID-19 H.R. 6426 - To direct the Secretary of Health and Human Services to establish a program under which loans shall be made to certain health care organizations to assist such organizations with anticipated revenue loss or higher operating costs as a result of the COVID-19 emergency, and for other purposes - Max Rose - costs H.R. 6437 - Coronavirus Immigrant Families Protection Act - Chu - COVID19 H.R. 6467 - Coronavirus Community Relief Act - Neguse - COVID H.R. 6468 - To provide for an enhanced Coronavirus relief fund, and for other purposes. - Perlmutter - COVID H.R. 6474 - Healthcare Broadband Expansion During COVID-19 Act - Eshoo - rural health H.R. 6487 - ACCESS Act - Schakowsky - telehealth H.R. 6620 - To authorize grants to address substance use during COVID-19.- Kuster - COVID H.R. 6634 - Emergency COVID Telehealth Response Act - Axne - telehealth H.R. 6654 - Emergency COVID Telehealth Response Act -Axne - telehealth H.R. 6666 - COVID-19 Testing, Reaching, And Contacting Everyone (TRACE) Act - Rush - COVID H.R. 6719 - Emergency Medical Supplies Procurement Act - Khanna- COVID H.R. 6763 - COVID-19 Racial and Ethnic Disparities Task Force Act of 2020 - Kelley - COVID H.R. 6800 - HEROES Act - Lowey - COVID H.R. 6881 - Emergency Broadband Connections Act of 2020 - COVID H.R. 6926 - MIND Act -Boyle - COVID H.R. 6999 - Coronavirus Mental Health and Addiction Assistance Act of 2020 -Ryan - COVID H.R. 7017 - Right to Test Act - McHenry - Testing H.R. 7077 - Community Solutions for COVID-19 Act - Kelley - COVID H.R. 7190 - Increasing Rural Health Access During the COVID-19 Public Health Emergency Act of 2020 - Torres Small - COVID H.R. 7205 - Nationwide Dig Once Act of 2020 - Eshoo - broadband H.R. 7302 - To make high-speed broadband internet service accessible and affordable to all Americans, and for other purposes - Clyburn - Broadband H.R. 7359 - Accelerating Broadband Connectivity Act of 2020 - Kelley - Broadband S. 116 - Modernizing Obstetric Medicine Standards Act of 2019 (MOMS Act) - Gillibrand - maternal health S. 916 - Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) - Durbin - maternal health S. 2741 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 - Schatz - telehealth S. 2885 - Stop Marketing and Revealing the Wearables and Trackers Consumer Health Data Act - Cassidy - consumer health information S. 2986 - Social Determinants Accelerator Act of 2019 - Young - Social Determinants of Health S. 3152 - Data Mapping to Save Moms' Lives Act - Rosen - maternal health S. 3318 - Transparent Health Care Pricing Act of 2020 - Cassidy - disclosure of point-of-sale cash prices S. 3380 - Patient Safety Improvement Act of 2020 - Whitehouse - data collection and quality improvement S. 3424 - Black Maternal Health Momnibus Act of 2020 - Harris - maternal health S. 3437 - Improving Care in Rural America Reauthorization Act of 2020 - Loeffler - rural health S. 3438 - R-DOCS Reauthorization Act of 2020 - Loeffler - telehealth S. 3517 - ACCESS Act - Klobuchar - telehealth S. 3568 - Medical Supply Chain Emergency Act of 2020 - Murphy - expedite acquisition of PPE S. 3570 - To provide for the expedited procurement of equipment needed to combat COVID-19 under the Defense Production Act of 1950 - Baldwin - expedite acquisition of PPE S. 3721 - COVID-19 Racial and Ethnic Disparities Task Force Act of 2020 - Harris - COVID S. 3769 - Right to Test Act - Cruz - Testing S. 3825 - Coronavirus Mental Health and Addiction Assistance Act of 2020 - Klobuchar - COVID S. 3828 - Jobs to Fight COVID-19 Act of 2020 - Schatz - COVID S. 3838 - Health Care Broadband Expansion During COVID-19 Act -Schatz - broadband S. 3877 - Community Solutions for COVID-19 Act - Booker - COVID S. 3921 - Emergency Medical Supplies Procurement Act - Sanders - COVID S. 3951 - Increasing Rural Health Access During the COVID-19 Public Health Emergency Act of 2020 - McSally - COVID S. 3988 - Enhancing Preparedness through Telehealth Act - Cassidy - Telehealth S. 4015 - Rural Connectivity Advancement Program Act of 2020 - Thune - Rural S. 4021 - Accelerating Broadband Connectivity Act of 2020 - Wicker - Broadband S. 4058 - A bill to authorize grants to address substance use during COVID-19 - Smith - SUD S. 4059 - A bill to direct the Secretary of Health and Human Services to award grants to States, political subdivisions of States, Indian Tribes and Tribal organizations, community-based entities, and primary care and behavioral health organizations to address behavioral health needs caused by the public health emergency declared with respect to COVID-19 - Smith - Mental Health S. 4095 - A bill to provide emergency benefits for broadband service during periods relating to COVID-19, and for other purposes - Wyden - Broadband S. 4103 - A bill to amend title XVIII of the Social Security Act to increase the use of telehealth for substance use disorder treatment - Portman - telehealth S. 4113 - A bill to amend the Communications Act of 1934 to provide grants to States and Indian Tribes to deploy affordable, high-speed broadband to unserved and underserved areas - Bennett - broadband Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non- discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
Filing targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2020 · first_quarter · Q1
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage H.R. 3925 - Reducing Barriers to Substance Use Treatment Act - Tonko - Opioids H.R. 3935 - Protecting Patients Transportation to Care Act - Carter - Medicaid coverage for transportation H.R. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud H.R. 4529 - Promoting Access to Broadband Act of 2019 - Maloney - Medicaid H.R. 4583 - Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Schneider - prescription drug affordability H.R. 4620 - More Help for Seniors Act of 2019 - Rose - expand eligibility for low-income subsidies under part D of the Medicare program H.R. 4621 - Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 - Blunt Rochester - best practices re social determinants of health H.R. 4629 - Star Rating for Biosimilars Act - Tonko - biosimilars H.R. 4632 - Better Transparency in Information for Medicare Beneficiaries Act of 2019 - Kind - provides consumers information regarding premiums under LIS benchmark plans H.R. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized H.R. 5201 - Telemental Health Expansion Act of 2019 - Matsui - Medicare coverage of mental telehealth H.R. 5232 - Road to Recovery Act - Fitzpatrick - Medicaid and CHIP SUD treatment H.R. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Jodey Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program -Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Abby Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - To amend title XI of the Social Security Act to provide for a waiver of payment reductions under the Medicare and Medicaid programs for certain nonapproved capital expenditures undertaken by health care facilities during the COVID-19 emergency - Bishop - Medicare and Medicaid payments during COVID-19 emergency S. 2846 - Protecting Patients Transportation to Care Act - Isakson - Medicaid coverage of transportation S. 2911 - Seniors Prescription Drug Relief Act of 2019 - Cassidy - Part D smoothing S. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2021 Rate Notice and Call Letter; issues related to MLTSS; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to COVID-19; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2019 · fourth_quarter · Q4
S. 350, Competitive Health Insurance Reform Act (Daines) - McCarran-Ferguson Act S. 455, Marketing and Outreach Restoration to Empower Health Education Act (Shaheen) - funding for outreach and education on ACA Exchanges S. 466, Protecting Americans with Preexisting Conditions Act (Warner) - blocking updated Section 1332 guidance S. 560, Ensuring Lasting Smiles Act (Baldwin) - coverage mandate for treatment of congenital anomaly or birth defect S. 741, Cancer Drug Parity Act (Smith) -- cost sharing for oral anticancer drugs S. 913, Disclosure of Price Information to Enrollees (Braun) S. 961, Improving Health Insurance Affordability Act (Shaheen) - premium tax credits S. 964, Marketplace Certainty Act (Shaheen) - cost-sharing subsidies S. 967, Reducing Costs for Out-of-Network Services Act (Shaheen) - caps on out-of-network charges S. 981, Medicare-X Choice Act (Bennet) - public option S. 1033, CHOICE Act (Whitehouse) - public option S. 1125, Protect Act (Tillis) - pre-existing condition protections S. 1129, Medicare for All Act (Sanders) - government health insurance system S. 1170, Association Health Plans Act (Enzi) - codifying final rule for expanding AHPs S. 1266, Protecting Patients from Surprise Medical Bills Act (Scott) - surprise medical billing S. 1531, STOP Surprise Medical Bills Act (Cassidy-Bennet) - surprise medical billing S. 1576, Behavioral Health Coverage Transparency Act (Warren) - mental health parity S. 1577, Know the Price Act (Cassidy-Bennet) - restrictions on provider contracts S. 1737, Mental Health Parity Compliance Act (Murphy) - mental health parity S. 1948, Chronic Disease Management Act (Thune) - pre-deductible coverage of chronic disease prevention services S. 2546, Safe Step Act (Murkowski)-Step therapy exceptions H.R. 692, Pre-existing Conditions Protection Act (Walden) - pre-existing condition protections H.R. 986, Protecting Americans with Preexisting Conditions Act (Kuster) - blocking updated Section 1332 guidance H.R. 987, Marketing and Outreach Restoration to Empower Health Education Act (Blunt Rochester) - funding for outreach and education on ACA Exchanges, Navigator program, and establishment of state-based Health Insurance Exchanges; drug pricing proposals H.R. 1010, Short-Term Plans (Castor) - blocking final rule that expands short-term plans H.R. 1143, Educating Consumers on the Risks of Short-Term Plans Act (Eshoo) - standardized disclosures for short-term plans H.R. 1379, Ensuring Lasting Smiles Act (Peterson) - coverage mandate for treatment of congenital anomaly or birth defect H.R. 1384, Medicare for All Act (Jayapal) - government health insurance system H.R. 1385, State Allowance for a Variety of Exchanges Act (Kim) - funding for establishment of state-based Health Insurance Exchanges H.R. 1386, Expand Navigators Resources for Outreach, Learning, and Longevity Act (Castor) - funding for Navigator Program H.R. 1418, Competitive Health Insurance Reform Act (DeFazio) - McCarran-Ferguson Act H.R. 1425, State Health Care Premium Reduction Act (Craig) - funding for state reinsurance programs H.R. 1510, Premium Relief Act (Burgess) -- Patient and State Stability Fund H.R. 1730, Cancer Drug Parity Act (Higgins) -- cost sharing for oral anticancer drugs H.R. 1884, Protecting Pre-Existing Conditions and Making Health Care More Affordable Act (Pallone) - reinsurance funding, stabilization and affordability proposals H.R. 2000, Medicare-X Choice Act (Delgado) - public option H.R. 2061, Pathway to Universal Coverage Act (Bera) - auto-enrollment H.R. 2085, CHOICE Act (Schakowsky) - public option H.R. 2183, State Flexibility and Patient Choice Act (Marshall) - flexibility in state innovation waivers H.R. 2848, Parity Enforcement Act (Norcross) - mental health parity H.R. 2874, Behavioral Health Coverage Transparency Act (Kennedy) - mental health parity H.R. 3165, Mental Health Parity Compliance Act (Porter) - mental health parity H.R. 3502, Protecting People From Surprise Medical Bills Act (Ruiz) - surprise medical billing H.R. 3630, No Surprises Act (Pallone)-surprise medical billing H.R. 3784, Air Ambulance Affordability Act of 2019 (Neguse)- air ambulances H.R. 4223, Protecting Patients from Surprise Medical Bills Act (Spano)-surprise medical billing H.R. 4379, Under Performing Directories that Affect Treating Emergencies Act (Axne)-provider directories H.R. 4457, Chronic Condition Copay Elimination Act (Underwood)- Eliminating copays for services/drugs for chronic conditions H.R. 4484, Flexibility Through Lower Expenses Health Care Act (Budd)-STLDI plans H.R. 4530, Native American Health Savings Improvement Act (Moolenaar)-HSAs H.R. 4575, Improving Provider Directories Act (Schrier)-provider directories H.R. 5010, State-Based Universal Health Care Act of 2019 (Khanna) - universal health care systems H.R. 5121, Healthcare Cost Transparency Act (Beyer) - provider price comparison tool H.R. 5144, Insurance Accountability and Transparency Act (Davids) - insurance have publicly accessible self-audit information H.R. 5239 Prescription Drug Price Reporting Act (Joyce) - reporting on drug expenditures and price changes under group health plans H. Res. 271 (Allred) - resolution urging DOJ to reverse position in Texas v. United States litigation Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2019 · third_quarter · Q3
S. 61, Safe and Affordable Drugs from Canada Act (Grassley) - drug importation S. 64, Preserve Access to Affordable Generics and Biosimilars Act (Grassley-Klobuchar) - prohibiting pay-for-delay settlements S. 73, End Taxpayer Subsidies for Drug Ads Act (Shaheen) - prohibiting tax deduction for DTC advertising expenses S. 102, Prescription Drug Price Relief Act (Sanders) - reforms linked to international pricing S. 340, CREATES Act (Leahy) - removing barriers to generic drugs S. 344, Hatch-Waxman Integrity Act (Tillis) - inter partes review process S. 366, FLAT Prices Act (Durbin) - reforms for drugs with sudden price spikes S. 378, Stop Price Gouging Act (Durbin) - excise tax for drugs that have price spikes S. 440, Preserving Access to Cost-Effective Drugs Act (Cotton) - sovereign immunity and Inter Partes Review process S. 474, SPIKE Act (Wyden) - justification for drug price increases S. 476, Creating Transparency to Have Drug Rebates Unlocked Act (Wyden) - drug price transparency S. 637, CURE High Drug Prices Act (Blumenthal) - remedies for price gouging S. 657, Point of Sale Rebates (Braun) S. 659, Biologic Patent Transparency Act (Collins) - patent disclosure requirements S. 660, Efficiency and Transparency in Petitions Act (Braun) - FDA citizen petition process S. 844, Short on Competition Act (Klobuchar) - remedies for marginally competitive drug markets S. 977, Transparency Drug Pricing Act (Scott) - transparency and drug pricing reforms S. 1209, Reforming Evergreening and Manipulation that Extends Drug Years Act (Cassidy) - preventing evergreening of patent protections S. 1224, Stop STALLING Act (Klobuchar) - citizen petition process S. 1227, Prescription Pricing for the People Act (Grassley) - FTC report on role of PBMs and allegations of anticompetitive conduct by manufacturers of sole-source drugs S. 1384, Prescription Drug Rebate Reform Act (Romney-Braun) - prescription drug cost sharing S. 1416, Affordable Prescriptions for Patients Act (Cornyn) - product hopping, patent thickets S. 1664, Prescription Drug Price Reporting Act (Scott) - prescription drug price reporting S. 2247, Phair Relief Act of 2019 (Kennedy)-transparency around price concessions for drugs S. 2387, We Protect American Investment in Drugs Act (Van Hollen)-drug pricing S. 2543, Prescription Drug Pricing Reduction Act of 2019 (Grassley)-Drug pricing H.R. 3, Lower Drug Costs Now Act of 2019 (Pallone)-drug pricing H.R. 465, Prescription Drug Price Relief Act (Khanna) - reforms linked to international pricing H.R. 478, Safe and Affordable Drugs from Canada Act (Pingree) - drug importation H.R. 938, BLOCKING Act (Schrader) - changes to 180-day period of market exclusivity for first generic applicant H.R. 965, CREATES Act (Cicilline) - removing barriers to generic drugs H.R. 985, FAST Generics Act (Welch) - removing barriers to generic drugs H.R. 990, Hatch-Waxman Integrity Act (Flores) - inter partes review process H.R. 1093, Stop Price Gouging Act (Pocan) - excise tax for drugs that have price spikes H.R. 1188, FLAT Prices Act (Golden) - reforms for drugs with sudden price spikes H.R. 1344, Competitive DRUGS Act (Doggett) - prohibiting pay-for-delay agreements H.R. 1419, Public Option Deficit Reduction Act (DeFazio) - public option H.R. 1499, Protecting Consumer Access to Generic Drugs Act (Rush) - prohibiting pay-for-delay agreements H.R. 1503, Orange Book Transparency Act (Kelly) - removal of invalidated patents from Orange Book H.R. 1506, FAIR Generics Act (Barragan) - changes to 180-day period of market exclusivity for first generic applicant H.R. 1520, Purple Book Continuity Act (Eshoo) - access to updated information on biologics and biosimilars H.R. 2038, State-Based, Market-Oriented Prescription Drug Negotiations Act (Meadows) - drug price negotiations H.R. 2064, Sunshine for Samples Act (Chu) - reporting requirements on drug samples H.R. 2069, SPIKE Act (Horsford) -justification for drug price increases H.R. 2087, Drug Price Transparency Act (Doggett) - reporting of drug pricing data under Medicare Part B H.R. 2113, Prescription Drug Sunshine, Transparency, Accountability and Reporting Act (Neal) - transparency in drug pricing H.R. 2115, Public Disclosure of Drug Discounts Act (Spanberger) - disclosure of negotiated Rx discounts H.R. 2279, Safe Step Act (Ruiz) - exceptions process for medication step therapy H.R. 2296, FAIR Drug Pricing Act (Schakowsky) - transparency requirements and justification for high list prices and drug price increases H.R. 2374, Stop Significant and Time-wasting Abuse Limiting Legitimate Innovation of New Generics Act (Jeffries) - citizen petition process H.R. 2375, Preserve Access to Affordable Generics and Biosimilars Act (Nadler) - prohibiting pay-for-delay agreements H.R. 2376, Prescription Pricing for the People Act (Collins) - FTC study on role of PBMs and competition and transparency in pharmaceutical supply chain H.R. 3379, Price Relief, Innovation, and Competition for Essential Drugs Act (Schakowsky) - exclusivity period for biological products H.R. 3805, Prescription Drug Rebate Reform Act of 2019 (Gallagher)- drug rebates H.R. 3927, PDMPs Help Patients Act of 2019 (McKinley)-integrating SUDs and behavioral health into PDMPs H.R. 3947, Competition Prescription Act of 2019 (Meadows)- drug pricing H.R. 4010, Emergency Access to Insulin Act of 2019 (Craig)- drug pricing H.R. 4106, Responsibility in Drug Advertising Act of 2019 (DeLauro)-transparency in drug pricing H.R. 4244, MAGIC Act (Kelly)-pathways for insulin approval H.R. 4398, Affordable Prescriptions for Patients Through Promoting Competition Act of 2019 (Cicilline)-drug pricing H.R. 4455, BIOSIM Act (Schrader)-access to biosimilars H.R. 4460, Turn the Tide Act (Kuster)-Opioids H.R. 4538, Closing Loopholes for Orphan Drugs Act (Welch)-Access to drugs H.Con.Res. 55, Expressing the sense of Congress on the need to inform American consumers with more balanced purchasing information for prescription drugs through the disclosure of price information in direct-to-consumer (DTC) advertisements. (Burgess)-drug pricing Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to prescription drug rebates; issues relating to prescription drug price blueprint; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2019 · second_quarter · Q2
S. 1012, The Protecting Jessica Grubbs Legacy Act (Capito) - confidential sharing of substance use disorder information S. 1895, Lower Health Care Costs Act (Alexander-Murray) - surprise medical billing, prescription drug prices, transparency, public health initiatives, exchange of health information, mental health parity, pharmacy benefit manager (PBM) issues, provider directories, disclosure of proprietary information H.R. 525, Strengthening the Health Care Fraud Prevention Task Force Act (Walden) - codification of Healthcare Fraud Prevention Partnership H.R. 506, Hospital Competition Act (Banks) - hospital consolidation H.R. 861, End Surprise Billing Act (Doggett) - surprise medical bills H.R. 1395, Youth Mental Health Services Act (Roe) - mental health for students H.R. 1409, Transparency in All Health Care Pricing Act (Perlmutter) - transparency in health care pricing H.R. 2062, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information H.R. 2740, HHS Appropriations (DeLauro) - funding for HHS programs and agencies H.R. 3030, Patient-Centered Outcomes Research Extension Act (DeGette) - PCORI reauthorization H.R. 3439, Protecting Access to Information for Effective & Necessary Treatment and Services Act (Beyer) - PCORI reauthorization Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2019 · first_quarter · Q1
S. 64, Preserve Access to Affordable Generics and Biosimilars Act (Grassley-Klobuchar) - prohibiting pay-for-delay settlements S. 73, End Taxpayer Subsidies for Drug Ads Act (Shaheen) - prohibiting tax deduction for DTC advertising expenses S. 102, Prescription Drug Price Relief Act (Sanders) - reforms linked to international pricing S. 340, CREATES Act (Leahy) - removing barriers to generic drugs S. 344, Hatch-Waxman Integrity Act (Tillis) - inter partes review process S. 366, FLAT Prices Act (Durbin) - reforms for drugs with sudden price spikes S. 378, Stop Price Gouging Act (Durbin) - excise tax for drugs that have price spikes S. 474, SPIKE Act (Wyden) - justification for drug price increases S. 476, Creating Transparency to Have Drug Rebates Unlocked Act (Wyden) - drug price transparency S. 637, CURE High Drug Prices Act (Blumenthal) - remedies for price gouging S. 657, Point of Sale Rebates (Braun) S. 659, Biologic Patent Transparency Act (Collins) - patent disclosure requirements S. 660, Efficiency and Transparency in Petitions Act (Braun) - FDA citizen petition process S. 844, Short on Competition Act (Klobuchar) - remedies for marginally competitive drug markets S. 977, Transparency Drug Pricing Act (Scott) - transparency and drug pricing reforms H.R. 465, Prescription Drug Price Relief Act (Khanna) - reforms linked to international pricing H.R. 938, BLOCKING Act (Schrader) - changes to 180-day period of market exclusivity for first generic applicant H.R. 965, CREATES Act (Cicilline) - removing barriers to generic drugs H.R. 985, FAST Generics Act (Welch) - removing barriers to generic drugs H.R. 990, Hatch-Waxman Integrity Act (Flores) - inter partes review process H.R. 1093, Stop Price Gouging Act (Pocan) - excise tax for drugs that have price spikes H.R. 1188, FLAT Prices Act (Golden) - reforms for drugs with sudden price spikes H.R. 1344, Competitive DRUGS Act (Doggett) - prohibiting pay-for-delay agreements H.R. 1419, Public Option Deficit Reduction Act (DeFazio) - public option H.R. 1499, Protecting Consumer Access to Generic Drugs Act (Rush) - prohibiting pay-for-delay agreements H.R. 1503, Orange Book Transparency Act (Kelly) - removal of invalidated patents from Orange Book H.R. 1506, FAIR Generics Act (Barragan) - changes to 180-day period of market exclusivity for first generic applicant H.R. 1520, Purple Book Continuity Act (Eshoo) - access to updated information on biologics and biosimilars H.R. 2038, State-Based, Market-Oriented Prescription Drug Negotiations Act (Meadows) - drug price negotiations H.R. 2064, Sunshine for Samples Act (Chu) - reporting requirements on drug samples H.R. 2069, SPIKE Act (Horsford) -justification for drug price increases H.R. 2113, Prescription Drug STAR Act (Neal)-drug price transparency Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to prescription drug rebates; issues relating to prescription drug price blueprint; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2018 · fourth_quarter · 4A
S. 1850, Legacy Act (Manchin-Capito) -- confidentiality of drug and alcohol treatment and prevention records S. 2460, Every Prescription Conveyed Securely Act (Bennet) - opioid issues S. 2680, Opioid Crisis Response Act (Alexander) - opioid initiatives, mental health parity S. 2789, Substance Abuse Prevention Act (Cornyn) - opioid initiatives, restrictions on step therapy S. 2812, Air Ambulance Consumer Protection Act (McCaskill) - air ambulance S. 2828, Sober Home Fraud Detection Act (Rubio) - best practices for identifying fraud in recovery housing S. 2891, Fighting the Opioid Epidemic with Sunshine Act (Grassley) - opioid issues S. 2892, Peer Support Enhancement and Evaluation Review Act (Cardin) - opioid issues S. 2898, Medication-Assisted Treatment Improvement Act (Casey) - opioid issues S. 2899, Caring Recovery for Infants and Babies Act (Brown) - opioid issues S. 2900, Comprehensive Screenings for Seniors Act (Brown) - opioid issues S. 2902, Better Data Sharing to Combat the Opioid Crisis Act (Cassidy) - opioid issues S. 2905, Strengthening Partnerships to Prevent Opioid Abuse Act (Toomey) - opioid issues S. 2910, Telehealth for Childrens Access to Services and Treatment Act (Roberts) - opioid issues S. 2911, Enhancing Patient Access to Non-Opioid Treatment Options (Heller) - opioid issues S. 2912, Opioid Addiction Treatment Programs Enhancement Act (Cassidy) - opioid issues S. 2920, Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act (McCaskill) - opioid issues S. 2922, Help for Moms and Babies Act (Stabenow) - opioid issues S. 2923, Building Capacity for Family-Focused Residential Treatment Act (Grassley) - opioid issues S. 2924, Supporting Family-Focused Residential Treatment Act (Scott) - opioid issues S. 3016, Action for Dental Health Act (Booker) - grants for oral health programs S. 3120, the HEAL Substance Use Disorders Act (Hatch) - opioid initiatives S. 3158, Labor-HHS-Education Appropriations Act (Blunt) - HHS funding S. 3254, Eliminating Kickbacks in Recovery Act (Rubio) - anti-kickback penalties for body brokers Draft Bill: Protecting Patients From Surprise Medical Bills Act (Cassidy) - surprise medical bills H.R. 6, SUPPORT Patients and Families Act (Walden) - opioid initiatives, Medicare and Medicaid issues, budget offsets H.R. 302, FAA Reauthorization Act - air ambulance issues H.R. 1215, Protecting Access to Care Act (King) - medical liability reform H.R. 1313, Preserving Employee Wellness Programs Act (Foxx) - employee wellness programs H.R. 2422, Action for Dental Health Act (Kelly) - oral health services and education for underserved populations H.R. 3331, adoption and use of EHR technology by behavioral health providers (Jenkins) - opioid issues H.R. 3528, Every Prescription Conveyed Securely Act (Clark) - opioid issues H.R. 4684, Ensuring Access to Quality Sober Living Act (Chu) - best practices for recovery housing H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act (Schweikert) - opioid issues H.R. 4998, Health Insurance for Former Foster Youth Act (Bass) - opioid issues H.R. 5100, Recovery Home Certification Act (Knight) -- anti-kickback penalties for body brokers H.R. 5477, Rural DOCS Act (O'Halleran) - opioid issues H.R. 5515, National Defense Authorization Act (Thornberry) H.R. 5562, Protecting NAS Babies Act (Jenkins) - opioid issues H.R. 5582, Abuse Deterrent Access Act (Carter) - opioid issues H.R. 5583, State reporting on certain adult health quality measures (Clarke) - opioid issues H.R. 5590, CMS Action Plan (Kinzinger) - opioid issues H.R. 5714, Education for Disposal of Unused Opioids Act (Black) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - opioid issues H.R. 5716, COMPASS Act (Roskam) - opioid issues H.R. 5723, Expanding Oversight of Opioid Prescribing and Payment Act (Tenney) - opioid issues H.R. 5725, BEST Act (Roskam) - opioid issues H.R. 5774, Combating Opioid Abuse for Care in Hospitals Act (Curbelo) - opioid issues H.R. 5775, Providing Reliable Options for Patients and Educational Resources Act (Paulsen) - opioid issues H.R. 5776, MOST Act (Neal) - opioid issues H.R. 5789, protections for pregnant and post-partum women (Foster) - opioid issues H.R. 5795, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information H.R. 5796, Responsible Education Achieves Care and Healthy Outcomes for Users' Treatment Act (Fitzpatrick) - opioid issues H.R. 5801, PARTNERSHIP Act (Griffith) - opioid issues H.R. 6082, Overdose Prevention and Patient Safety Act (Mullin) - confidential sharing of substance use disorder information H.R. 6147, Interior, Environment, Financial Services, Agriculture, FDA, Transportation, and Housing Appropriations Act (Calvert) - FDA funding H.R. 6157, Defense-Labor-HHS-Education Appropriations Act (Granger) - HHS funding H.R. 6753, Strengthening the Health Care Fraud Prevention Task Force Act (Walden) - codification of Healthcare Fraud Prevention Partnership H.R. 6878, Eliminating Kickbacks in Recovery Act (Deutch) - anti-kickback penalties for body brokers H.R. 6902, Eliminating Kickbacks in Recovery Act (Knight) - anti-kickback penalties for body brokers Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2018 · fourth_quarter · Q4
S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 1016, CONNECT For Health Act (Schatz) - telehealth S. 1169, Medicaid CARE Act (Durbin-Portman) - changes to Medicaid IMD exclusion S. 1688, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 1804, Medicare for All Act (Sanders) - single payer health system S. 1890, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Cardin) - Medigap coverage for beneficiaries with end-stage renal disease S. 1909, BENES Act (Casey) - notifications of Medicare eligibility S. 2027, Medicaid Third Party Liability Act (Portman) - Medicaid third party liability S. 2051, Medicare Care Coordination Improvement Act of 2017 (Portman) - barriers to payment reform models S. 2227, EMPOWER Care Act (Portman-Cantwell) - Medicaid Money Follows the Person Demonstration S. 2707, Informing Seniors About Opioids Act (Nelson) - opioid issues S. 2901, Expanding Telehealth Response to Ensure Addiction Treatment Act (Thune) - opioid issues S. 2904, Medicaid Substance Use Disorder Treatment Via Telehealth Act (Carper) - opioid issues S. 2908, Electronic Prior Authorization in Medicare Part D Act (Roberts) - opioid issues S. 3327, SENIOR Communities Protection Act (Cortez Masto) - preventing fraudulent opioid prescriptions S. 3496, Improving Seniors Access to Quality Benefits Act (Daines-King) - study on MA benchmark cap S. 3497, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap S. 3702, Right Rebate Act (Wyden-Grassley) - Medicaid drug rebate program Draft Bill: Medicare Long-Term Care Services and Supports Act (Pallone) - Long-Term Services and Supports Program H.R. 6, SUPPORT Patients and Families Act (Walden) - opioid initiatives, Medicare and Medicaid issues, budget offsets H.R. 695, Continuing Appropriations Act (Schiff) - Money Follows the Person demonstration, spousal impoverishment protections H.R. 849, Protecting Seniors Access to Medicare Act (Roe) - Independent Payment Advisory Board H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1148, FAST Act (Griffith) - access to telehealth-eligible stroke services under Medicare H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 2556, CONNECT For Health Act (Black) - telehealth H.R. 2575, BENES Act (Ruiz) - notifications of Medicare eligibility H.R. 2644, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Marino) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 2687, Medicaid CARE Act (Foster-Fitzpatrick) - changes to Medicaid IMD exclusion H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) H.R. 3263, Medicare Independence at Home Model of Care (Burgess) - demonstration program H.R. 3325, ACE Kids Act (Barton) - health homes for children with complex medical conditions H.R. 3360, Telehealth Enhancement Act (Harper) - telehealth in Medicare H.R. 3635, Local Coverage Determination Clarification Act (Jenkins) - procedures for Medicare administrative contractors H.R. 3727, Increasing Telehealth Access in Medicare Act (Black) - telehealth in MA plans H.R. 4143, Dialysis PATIENTS Demonstration Act (Smith) - alternative care delivery models and payment methodologies for patients with end-stage renal disease H.R. 4952, Improving Seniors Access to Quality Benefits Act (Kelly) - MA benchmark cap study H.R. 5306, EMPOWER Care Act (Guthrie) - extension of Money Follows the Person demonstration H.R. 5603, Access to Telehealth Services for Substance Use Disorders Act (Matsui) - opioid issues H.R. 5605, Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act (Ruiz) - opioid issues H.R. 5675, drug management programs for at-risk Medicare beneficiaries (Bilirakis) - opioid issues H.R. 5676, SENIOR Communities Protection Act (MacArthur) - preventing fraudulent opioid prescriptions H.R. 5684, Protecting Seniors from Opioid Abuse Act (Kelly) - opioid issues H.R. 5685, Medicare Opioid Safety Education Act (Faso) - opioid issues H.R. 5686, Medicare Clear Health Options in Care for Enrollees Act (Paulsen) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - communication between Medicare plan sponsors and CMS H.R. 5773, Preventing Addiction for Susceptible Seniors Act (Roskam) - opioid issues H.R. 5797, IMD CARE Act (Walters) - Medicaid IMD exclusion H.R. 5798, Opioid Screening and Chronic Pain Management Alternatives for Seniors Act (Bucshon) - opioid issues H.R. 5799, Medicaid Drug Review, Utilization, Good Governance Improvement Act (Blackburn) - opioid issues H.R. 5800, Medicaid IMD ADDITIONAL INFO Act (Upton) - opioid issues H.R. 5804, Post-Surgical Injections as an Opioid Alternative Act (Shimkus) - opioid issues H.R. 5808, Medicaid Pharmaceutical Home Act (Bilirakis) - opioid issues H.R. 5809, Postoperative Opioid Prevention Act (Peters) - opioid issues H.R. 5810, Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act (Lance) - opioid issues H.R. 5812, Improving Medicaid Data Timeliness Act (Griffith) - opioid issues H.R. 6431, Medigap Consumer Protection Act (Levin) - reforms to Medicare supplemental insurance H.R. 6561, Comprehensive Care for Seniors Act (Walorski) -- Program of All-Inclusive Care for the Elderly H.R. 6563, Lower Out-of-Pocket Costs for Seniors Act (Pallone-Neal) - Medicare Part D cliff H.R. 6662, Empowering Seniors Decision Enrollment Act (Paulsen) - special enrollment period for non-deemed Medicare Cost Plan enrollees H.R. 6690, Fighting Fraud to Protect Care for Seniors Act (Roskam) - Medicare pilot program for smart card technology H.R. 7122, Shared Accountability for Improved Patient Outcomes Act (Paulsen) - value-based payment and delivery arrangements H.R. 7217, IMPROVE Act (Barton) - Money Follows the Person demonstration, ACE Kids Act, Medicare drug rebate program, spousal impoverishment protections H.R. 7223, Right Rebate Act (Schrader-Welch) - Medicaid drug rebate program H.R. 7247, Incentivizing Shared Risk in Medicare Advantage Act (Brady) - MA prior authorization H.R. 7249, Better Prior Authorization Notification Act (Reed) - MA prior authorization H.R. 7250, Prior Authorization Improvement Act (Kelly) - MA prior authorization Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2019 Rate Notice and Call Letter; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2018 · third_quarter · Q3
S. 2460, Every Prescription Conveyed Securely Act (Bennet) - opioid issues S. 2680, Opioid Crisis Response Act (Alexander) - opioid initiatives, mental health parity S. 2789, Substance Abuse Prevention Act (Cornyn) - opioid initiatives, restrictions on step therapy S. 2812, Air Ambulance Consumer Protection Act (McCaskill) - air ambulance S. 2828, Sober Home Fraud Detection Act (Rubio) - best practices for identifying fraud in recovery housing S. 2891, Fighting the Opioid Epidemic with Sunshine Act (Grassley) - opioid issues S. 2892, Peer Support Enhancement and Evaluation Review Act (Cardin) - opioid issues S. 2898, Medication-Assisted Treatment Improvement Act (Casey) - opioid issues S. 2899, Caring Recovery for Infants and Babies Act (Brown) - opioid issues S. 2900, Comprehensive Screenings for Seniors Act (Brown) - opioid issues S. 2902, Better Data Sharing to Combat the Opioid Crisis Act (Cassidy) - opioid issues S. 2905, Strengthening Partnerships to Prevent Opioid Abuse Act (Toomey) - opioid issues S. 2910, Telehealth for Childrens Access to Services and Treatment Act (Roberts) - opioid issues S. 2911, Enhancing Patient Access to Non-Opioid Treatment Options (Heller) - opioid issues S. 2912, Opioid Addiction Treatment Programs Enhancement Act (Cassidy) - opioid issues S. 2920, Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act (McCaskill) - opioid issues S. 2922, Help for Moms and Babies Act (Stabenow) - opioid issues S. 2923, Building Capacity for Family-Focused Residential Treatment Act (Grassley) - opioid issues S. 2924, Supporting Family-Focused Residential Treatment Act (Scott) - opioid issues S. 3016, Action for Dental Health Act (Booker) - grants for oral health programs S. 3120, the HEAL Substance Use Disorders Act (Hatch) - opioid initiatives S. 3158, Labor-HHS-Education Appropriations Act (Blunt) - HHS funding S. 3254, Eliminating Kickbacks in Recovery Act (Rubio) - anti-kickback penalties for body brokers Draft Bill: Protecting Patients From Surprise Medical Bills Act (Cassidy) - surprise medical bills H.R. 6, SUPPORT Patients and Families Act (Walden) - opioid initiatives, Medicare and Medicaid issues, budget offsets H.R. 302, FAA Reauthorization Act - air ambulance issues H.R. 1215, Protecting Access to Care Act (King) - medical liability reform H.R. 1313, Preserving Employee Wellness Programs Act (Foxx) - employee wellness programs H.R. 2422, Action for Dental Health Act (Kelly) - oral health services and education for underserved populations H.R. 3331, adoption and use of EHR technology by behavioral health providers (Jenkins) - opioid issues H.R. 3528, Every Prescription Conveyed Securely Act (Clark) - opioid issues H.R. 4684, Ensuring Access to Quality Sober Living Act (Chu) - best practices for recovery housing H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act (Schweikert) - opioid issues H.R. 4998, Health Insurance for Former Foster Youth Act (Bass) - opioid issues H.R. 5100, Recovery Home Certification Act (Knight) -- anti-kickback penalties for body brokers H.R. 5477, Rural DOCS Act (O'Halleran) - opioid issues H.R. 5515, National Defense Authorization Act (Thornberry) H.R. 5562, Protecting NAS Babies Act (Jenkins) - opioid issues H.R. 5582, Abuse Deterrent Access Act (Carter) - opioid issues H.R. 5583, State reporting on certain adult health quality measures (Clarke) - opioid issues H.R. 5590, CMS Action Plan (Kinzinger) - opioid issues H.R. 5714, Education for Disposal of Unused Opioids Act (Black) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - opioid issues H.R. 5716, COMPASS Act (Roskam) - opioid issues H.R. 5723, Expanding Oversight of Opioid Prescribing and Payment Act (Tenney) - opioid issues H.R. 5725, BEST Act (Roskam) - opioid issues H.R. 5774, Combating Opioid Abuse for Care in Hospitals Act (Curbelo) - opioid issues H.R. 5775, Providing Reliable Options for Patients and Educational Resources Act (Paulsen) - opioid issues H.R. 5776, MOST Act (Neal) - opioid issues H.R. 5789, protections for pregnant and post-partum women (Foster) - opioid issues H.R. 5795, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information H.R. 5796, Responsible Education Achieves Care and Healthy Outcomes for Users' Treatment Act (Fitzpatrick) - opioid issues H.R. 5801, PARTNERSHIP Act (Griffith) - opioid issues H.R. 6082, Overdose Prevention and Patient Safety Act (Mullin) - confidential sharing of substance use disorder information H.R. 6147, Interior, Environment, Financial Services, Agriculture, FDA, Transportation, and Housing Appropriations Act (Calvert) - FDA funding H.R. 6157, Defense-Labor-HHS-Education Appropriations Act (Granger) - HHS funding H.R. 6753, Strengthening the Health Care Fraud Prevention Task Force Act (Walden) - codification of Healthcare Fraud Prevention Partnership H.R. 6878, Eliminating Kickbacks in Recovery Act (Deutch) - anti-kickback penalties for body brokers H.R. 6902, Eliminating Kickbacks in Recovery Act (Knight) - anti-kickback penalties for body brokers Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2018 · second_quarter · 2A
S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax S. 2410, Chronic Disease Management Act (Thune) - flexibility for high-deductible health plans S. 3063, Health Insurance Tax Relief Act (Barrasso) - suspension of ACA health insurance tax H.R. 195, Extension of Continuing Appropriations Act - one-year suspension of ACA health insurance tax, two-year delay in ACA excise tax on employer-sponsored health plans H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 4616 (Nunes) - delay in ACA excise tax on employer-provided health coverage H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4620, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax H.R. 4894, Harmful Tax Prevention Act (Noem) - relief from ACA health insurance tax H.R. 4978, Chronic Disease Management Act (Black) - flexibility for high-deductible health plans H.R. 5138, Bipartisan HSA Improvement Act (Kelly) - HSA changes H.R. 5963, Health Insurance Premium Reduction Act (Noem) - suspension of ACA health insurance tax H.R. 6199, Restoring Access to Medication Act (Jenkins) -- OTC medical products as qualified medical expense H.R. 6301, Promoting High-Value Health Care Through Flexibility for High Deductible Health Plans Act (Roskam) - flexibility on first dollar coverage for HSA plans H.R. 6305, Bipartisan HSA Improvement Act (Kelly) - HSA flexibility H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2018 · second_quarter · Q2
Bipartisan Health Care Stabilization Act (Alexander-Murray) - funding for cost sharing reduction benefits, stabilization of individual market Bipartisan Health Care Stabilization Act; updated version (Alexander-Walden-Collins-Costello) - funding for cost sharing reduction benefits and reinsurance, stabilization of individual market S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 581, Jessies Law (Manchin-Capito) - patient history of opioid use disorder S. 1201, Health Care Options for All Act (McCaskill) - coverage options in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1405, FAA Reauthorization Act (Thune) - air ambulance issues S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction benefits S. 1516, Coverage Across State Lines (Heller) S. 1667, Protecting Consumers from Unreasonable Rates Act (Feinstein) - rate review S. 1835, Lower Premiums Through Reinsurance Act (Collins-Nelson) - invisible high risk pool and reinsurance programs S. 1850, Legacy Act (Manchin-Capito) -- confidentiality of drug and alcohol treatment and prevention records S. 1976, Increasing Access to Care Act (Scott) - copper plan S. 1985, Protect Access to Birth Control Act (Murray) - coverage of contraceptive services S. 2052, Healthcare Market Certainty and Mandate Relief Act (Hatch) - funding for cost sharing reduction benefits, HSA improvements, ACA individual mandate S. 2241 (King) - fees on excepted benefits and standalone dental plans S. 2303, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - calculation of medical loss ratios H.R. 2, Agriculture and Nutrition Act (Conaway) - agricultural association health plans H.R. 4, FAA Reauthorization Act (Shuster) - air ambulance issues H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 421, Allowing Greater Access to Safe and Effective Contraception Act (Love) - non-prescription contraceptives, HSA flexibility H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 3450, Protecting Consumers from Unreasonable Rates Act (Schakowsky) - rate review H.R. 3545, Overdose Prevention and Patient Safety Act (Murphy- Blumenauer) -- confidentiality of drug and alcohol treatment and prevention records H.R. 3922, CHAMPION Act (Walden) - extension of federal CHIP funding, ACA grace periods, community health center funding H.R. 3976, Access to Marketplace Insurance Act (Cramer) - third party payments H.R. 4082, Protect Access to Birth Control Act (DeGette) - coverage of contraceptive services H.R. 4200, Healthcare Market Certainty and Mandate Relief Act (Brady) - funding for cost sharing reduction benefits, HSA improvements H.R. 4225 (Hudson) - fees on excepted benefits and standalone dental plans H.R. 4575, Access to Independent Health Insurance Advisors Act (Long-Schrader) - calculation of medical loss ratios H.R. 4666, Premium Relief Act (Costello) - Patient and State Stability Fund H.R. 4695, Bipartisan Market Stabilization and Innovation Act (Schrader) - stabilization of individual market H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2018 · first_quarter · Q1
S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax H.R. 195, Extension of Continuing Appropriations Act - one-year suspension of ACA health insurance tax, two-year delay in ACA excise tax on employer-sponsored health plans H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 4616 (Nunes) - delay in ACA Cadillac tax H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4620, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax H.R. 4894, Harmful Tax Prevention Act (Noem) - relief from ACA health insurance tax H.R. 5138, Bipartisan HSA Improvement Act (Kelly) - HSA changes Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2017 · fourth_quarter · Q4
Better Care Reconciliation Act (Enzi) - ACA repeal and replace issues; tax provisions; Heller amendment on Cadillac tax S. 1, Tax Cuts and Jobs Act (Enzi) - ACA individual mandate S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax H.R. 1, Tax Cuts and Jobs Act (Brady) - ACA individual mandate H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; tax provisions H.R. 4616 (Nunes) - delay in ACA Cadillac tax H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4260, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to the deductibility of employer-sponsored health coverage; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2017 · third_quarter · Q3
Better Care Reconciliation Act (Enzi) - ACA repeal and replace issues; coverage provisions; market stabilization; McConnell Substitute Amendment; Cruz Consumer Freedom Option; Portman Medicaid Option for Cost Sharing; Paul Repeal Only Amendment; Graham-Cassidy-Heller-Johnson Block Grant Amendment S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 191, Patient Freedom Act (Cassidy-Collins) - replacement reforms; state options S. 581, Jessies Law (Manchin-Capito) - patient history of opioid use disorder S. 1201, Health Care Options for All Act (McCaskill) - coverage options in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction (CSR) payments S. 1516, Coverage Across State Lines (Heller) S. 1667, Protecting Consumers from Unreasonable Rates Act (Feinstein) - rate review S. 1749, American Liberty Restoration Act (Hatch) - ACA individual coverage requirement S. 1771, FY 2018 Labor-HHS Appropriations Act (Blunt) - risk corridors and other ACA issues, funding for HHS programs and agencies S. 1835, Lower Premiums Through Reinsurance Act (Collins-Nelson) - invisible high risk pool and reinsurance programs S. 1850, Legacy Act (Manchin-Capito) -- confidentiality of drug and alcohol treatment and prevention records S. 1898 (Daines) - ACA individual coverage requirement H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 421, Allowing Greater Access to Safe and Effective Contraception Act (Love) - non-prescription contraceptives, HSA flexibility H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; coverage provisions; market stabilization H.R. 2086, No Coverage, No Penalty Act (Blackburn) - waiving ACA individual mandate in areas with no QHPs H.R. 2516, Freedom from the ACA Tax Penalty Act (Young) - waiving ACA individual mandate in areas with no QHPs H.R. 3280, Financial Services and General Government Appropriations Act (Graves) - enforcement of ACA individual mandate H.R. 3354, FY 2018 Appropriations Act (Calvert) - risk corridors and other ACA issues, funding for HHS programs and agencies H.R. 3358, FY 2018 Labor-HHS Appropriations Act (Cole) - risk corridors and other ACA issues, funding for HHS programs and agencies H.R. 3450, Protecting Consumers from Unreasonable Rates Act (Schakowsky) - rate review H.R. 3545, Overdose Prevention and Patient Safety Act (Murphy- Blumenauer) -- confidentiality of drug and alcohol treatment and prevention records H.R. 3725, (Tiberi-Burgess) - ACA individual coverage requirement H.R. 3922, CHAMPION Act (Walden) - ACA grace periods, community health center funding FY 2018 Budget Resolution (Black) - Medicaid and Medicare funding Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to all payor claims databases; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2017 · second_quarter · Q2
S. 544, Veterans Choice Program (Tester) - veterans health care S. 1028, RAISE Family Caregivers Act (Collins-Baldwin) - support for family caregivers H.R. 244, Consolidated Appropriations Act - HHS appropriations, funding for cost sharing reduction (CSR) payments H.R. 1215, Protecting Access to Care Act (King) - medical liability reform H.R. 1313, Preserving Employee Wellness Programs Act (Foxx) - employee wellness programs H.R. 2422, Action for Dental Health Act (Kelly) - oral health services and education for underserved populations Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2017 · first_quarter · Q1
S. 297, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug costs H.R. 749, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug costs Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
S.Con.Res. 3, Budget Resolution (Enzi) - ACA repeal and replace issues; tax provisions S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; tax provisions Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2016 · fourth_quarter · Q4
H.R. 34, 21st Century Cures Act (Upton) - Medicare Advantage and Medicaid issues H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 5659, ESRD Choice Act (Smith) - option for ESRD patients to enroll in MA plans H.R. 5942, Dialysis PATIENTS Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 6265, Medigap Reforms (McDermott) S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD S. 3504, Chronic Care Act (Hatch-Wyden-Isakson-Warner) - chronic care reforms, Medicare Advantage provisions Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2016 · third_quarter · Q3
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 815, Access to Independent Health Insurance Advisors Act (Long-Schrader) - treatment of broker compensation in MLR calculation H.R. 954, CO-OP Consumer Protection Act (Smith) - exemption from individual mandate H.R. 1770, Data Security and Breach Notification Act (Blackburn-Welch) - data security H.R. 2205, Data Security Act (Neugebauer) - data security H.R. 2739, Cancer Drug Coverage Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 2868, Small Business Health Fairness Act (Johnson) - association health plans H.R. 3323, Dental and Optometric Care Access Act (Carter) - dental and vision benefits H.R. 3727, Health Insurance Rate Review Act (Schakowsky) - rate review H.R. 4299, Patient Opportunity Protection Act (Blum) - HIPAA excepted benefits H.R. 5410, Health Coverage State Flexibility Act (Flores) - grace period for recipients of advanced premium tax credits H.R. 5485, Financial Services and General Government Appropriations Act (Crenshaw) - risk corridors amendment H.R. 5589, Plan Verification and Fairness Act (Blackburn) - pre-enrollment verification process H.R. 5921, State Age Rating Flexibility Act (Bucshon) - age rating flexibility H.R. 6019, Relief from Obamacare Mandate Act (Young) - exemption from individual mandate H.R. 6049, Protection from Insurance Exchange Monopolies Act (Heck) - exemption from individual mandate H.R. 5926, FY 2017 Labor-HHS-Education Appropriations Bill (Cole) - ACA risk corridors provision, HHS appropriations H. Res. 887, Public Option (DeFazio) S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 1099, Protecting Affordable Coverage for Employees Act (Scott-Shaheen) - ACA definition of small employer S. 1532, Affordability is Access Act (Murray) - coverage of OTC birth control S. 1566, Cancer Drug Coverage Parity Act (Kirk) - coverage of oral anti-cancer drugs S. 1661, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - treatment of broker compensation in MLR calculation S. 2172, Health Insurance Rate Review Act (Feinstein) - rate review S. 2803, Taxpayers Before Insurers Act (Sasse) - ACA reinsurance program S. 3296, Protection from ObamaCare Monopolies Act (McCain) - exemption from individual mandate S. 3297, Relief from Obamacare Mandate Act (Cotton) - exemption from individual mandate S. 3326, State Flexibility to Provide Affordable Health Options Act (Alexander) - ACA subsidies, exemption from individual mandate S. Res. 561, Public Option (Merkley) Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues related to implementation of the Telephone Consumer Protection Act; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2016 · second_quarter · Q2
H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD Draft Bill on Option for ESRD Patients to Enroll in MA Plans (Ways and Means Committee) H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2016 · first_quarter · Q1
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 815, Access to Independent Health Insurance Advisors Act (Long-Schrader) - treatment of broker compensation in MLR calculation H.R. 1624, Protecting Affordable Coverage for Employees Act (Guthrie-Cardenas) - ACA definition of small employer H.R. 1770, Data Security and Breach Notification Act (Blackburn-Welch) - data security H.R. 2205, Data Security Act (Neugebauer) - data security H.R. 2739, Cancer Drug Coverage Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 2868, Small Business Health Fairness Act (Johnson) - association health plans H.R. 3323, Dental and Optometric Care Access Act (Carter) - dental and vision benefits H.R. 3727, Health Insurance Rate Review Act (Schakowsky) - rate review H.R. 3762, Restoring Americans' Healthcare Freedom Reconciliation Act (Price) - ACA premium stabilization programs, individual mandate H.R. 4299, Patient Opportunity Protection Act (Blum) - HIPAA excepted benefits S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 1099, Protecting Affordable Coverage for Employees Act (Scott-Shaheen) - ACA definition of small employer S. 1532, Affordability is Access Act (Murray) - coverage of OTC birth control S. 1566, Cancer Drug Coverage Parity Act (Kirk) - coverage of oral anti-cancer drugs S. 1661, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - treatment of broker compensation in MLR calculation S. 2172, Health Insurance Rate Review Act (Feinstein) - rate review Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues related to implementation of the Telephone Consumer Protection Act; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2015 · third_quarter · 3A
H.R. 9, Innovation Act (Goodlatte) - changes to inter partes review process H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers S. 1137, PATENT Act (Grassley) - changes to inter partes review process S. 2019, Preserve Access to Affordable Generics Act (Klobuchar-Grassley) - pay-for-delay settlements S. 2023, Prescription Drug Affordability Act (Sanders) - pharmaceutical issues Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - rulemaking schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2015 · first_quarter · 1A
H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs Discussion Document for 21st Century Cures (Upton) - new cures and treatments Roadmap for ACA Replacement Legislation (Burr-Hatch-Upton) - health reforms HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP;. implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); financing for infectious disease such as Ebola; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2015 · fourth_quarter · Q4
H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1314, Bipartisan Budget Act - Medicare Part B premium and deductible, Medicare sequestration cuts H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3696, Protecting Medicare Beneficiaries Act (Titus) - Medicare Part B premiums and deductibles H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3831, Securing Fairness in Regulatory Timing Act (Brady) - revised schedule for MA payment rates H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2148, Protecting Medicare Beneficiaries Act (Wyden) - Medicare Part B premiums and deductibles S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2351, Securing Fairness in Regulatory Timing Act (Isakson) - revised schedule for MA payment rates Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; Center for Medicare and Medicaid Innovation demonstrations for MA and PDP plans; and other issues relating to health care reform implementation. *Add MACPAC to Agency List
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2015 · third_quarter · Q3
H.R. 9, Innovation Act (Goodlatte) - changes to inter partes review process H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers S. 1137, PATENT Act (Grassley) - changes to inter partes review process S. 2019, Preserve Access to Affordable Generics Act (Klobuchar-Grassley) - pay-for-delay settlements S. 2023, Prescription Drug Affordability Act (Sanders) - pharmaceutical issues Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 6, 21st Century Cures Act (Upton) - new cures and treatments H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs H.R. 2712, Commonsense Reporting and Verification Act (Black) - employer reporting and eligibility verification for ACA subsidies H.R. 3099, RAISE Family Caregivers Act (Harper) - national strategy to support family caregivers Reconciliation Bill approved by House Ways and Means Committee (Ryan) - ACA issues Reconciliation Bill approved by House Energy and Commerce Committee (Upton) - ACA issues Reconciliation Bill approved by House Education and Workforce Committee (Kline) - ACA issues S. 466, Quality Care for Moms and Babies Act (Stabenow) - pediatric quality measures S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs S. 961, Data Security Act (Carper) - data security S. 1077, Advancing Breakthrough Devices for Patients Act (Burr) - priority review of breakthrough medical devices S. 1427, Quality Measure Alignment Act (Stabenow) - facilitating coordination and alignment between public and private sectors on quality and efficiency measures S. 1719, RAISE Family Caregivers Act (Collins) - national strategy to support family caregivers S. 1996, Commonsense Reporting Act (Warner) - employer reporting and eligibility verification for ACA subsidies S. 2141, TRUST IT Act, (Cassidy) - health IT rating system Roadmap for ACA Replacement Legislation (Burr-Hatch-Upton) - health reforms H.R. 3463, Aligning Childrens Dental Coverage Act (Griffith-DeGette) - rules for stand-alone dental plans Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to nondiscrimination requirements; issues related to issues related to medical loss ratios; reference pricing; payment reform; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to small employer group size; issues related to Certificate of Public Advantage; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2015 · first_quarter · 1A
H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs Discussion Document for 21st Century Cures (Upton) - new cures and treatments Roadmap for ACA Replacement Legislation (Burr-Hatch-Upton) - health reforms HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP;. implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); financing for infectious disease such as Ebola; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2015 · second_quarter · Q2
H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.R. 1295, Trade Preferences Extension Act (Holding) - TAA health coverage tax credits H.R. 1892, Trade Adjustment Assistance Reauthorization Act (Reichert) - TAA health coverage tax credits H.R. 2050, Middle Class Health Benefits Tax Repeal Act (Courtney) - repeal of ACA excise tax on high-cost coverage S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S. 1268, Trade Adjustment Assistance Reauthorization Act (Hatch) - TAA health coverage tax credits H.R. 879 the Ax the Tax on Middle Class Americans Health Plans Act (Guinta) - repeal of the excise tax on high cost employer-sponsored health coverage Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, health insurer and employer reporting of health coverage, and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2015 · first_quarter · Q1
H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.Con.Res. 27, Budget Resolution (Price) - ACA health insurance tax S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S.Con.Res. 11, Budget Resolution (Enzi) - ACA health insurance tax Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, health insurer and employer reporting of health coverage, and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2014 · third_quarter · 3A
H.R. 4, Jobs for America Act (Camp) - ACA provisions H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) - antitrust policy H.R. 544, LIBERTY Act (Gingrey-Matheson) - age rating rules H.R. 743, Health Insurance Industry Fair Competition Act (DeFazio) - antitrust policy H.R. 762, Health Care Choice Act (Blackburn) - national marketplace for individual coverage H.R. 911, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 1019, Health Insurance Rate Review Act (Schakowsky) - rate review H.R. 1188, Preserving Our Hometown Independent Pharmacies Act (Marino) - antitrust policy H.R. 1205, Patients Right to Know Act (Walden) - disclosures on SBC documents H.R. 1558, Small Business Health Relief Act (Collins) - HIT repeal, other ACA changes H.R. 2328, Access to Professional Health Insurance Advisors Act (Rogers-Barrow) - MLR impact on agents and brokers H.R. 2668, Fairness for American Families Act (Young) - delay of ACA individual mandate H.R. 2698, Federal Employee Short-Term Disability Insurance Act (Norton) - short-term disability program for federal employees H.R. 3121, American Health Care Reform Act (Roe) - replacement health reforms H.R. 3350, Keep Your Health Plan Act (Upton) - continuation of existing plans H.R. 3425, Health Care Access Fairness and Penalty Delay Act (Lipinski-Sinema) - delay of open enrollment and individual mandate penalties H.R. 3489, (Tiberi) - repeal of ACA transitional reinsurance fee H.R. 3504, Consumer Protection and Rate Review Act (Schakowsky) - rate review H.R. 3517, Federal and State Insurance Exchange Access Fairness and Penalty Delay Act (Schrader) - individual mandate delay H.R. 3522, Employee Health Care Protection Act (Cassidy) - continuation of current group coverage H.R. 3541, Obamacare Taxpayer Bailout Prevention Act (Griffin) - repeal of ACA risk corridor program H.R. 3598, Catastrophic Plan Bill (Fortenberry) - expanded access to catastrophic plans H.R. 3745, Coverage Protection Act (Kirkpatrick) - continuation of coverage for consumers unable to enroll in QHPs H.R. 3812, No Bailouts for Insurance Industry Act (Coffman) - ACA reinsurance and risk corridor programs H.R. 3851, No Bailouts for Insurance Industry Act (Lance) - ACA reinsurance and risk corridor programs H.R. 3985, Stop ACA's Risky Provisions Act (Westmoreland) - ACAs reinsurance, risk corridor, and risk adjustment programs H.R. 4118, SIMPLE Fairness Act (Jenkins) - delay in ACA individual mandate penalties H.R. 4302, Protecting Access to Medicare Act (Pitts) - ACA Limits on Deductibles for Plans in Small Group Market H.R. 4354, ACA Taxpayer Bailout Protection Act (Griffin) - ACA risk corridor program H.R. 4406, Taxpayer Bailout Protection Act (Lance) - ACA risk corridor program H.R. 4414, Expatriate Health Coverage Clarification Act (Carney) - relief from ACA for expatriate health plans H.R. 4735, Health Care Fairness and Stability Act (Nolan-McKinley) - ACA transitional reinsurance program H.R. 5175, Protecting Americans from Illegal Bailouts Act (Lance) - ACA risk corridor program S. 24, Small Business Health Relief Act (Portman) - HIT repeal, other ACA changes S. 482, Health Insurance Rate Review Act (Feinstein) - rate review S. 650, Access to Independent Health Insurance Advisors Act (Landrieu) - MLR impact on agents and brokers S. 764, Patients Right to Know Act (Cornyn) - disclosures on SBC documents S. 1473, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) - model disclosure forms S. 1481, Long Term Care Insurance Integrity Act (Klobuchar) - third party review of disputed claims S. 1642, Keeping the ACA Promise Act (Landrieu-Manchin) - continuation of existing plans, notification requirements S. 1671, (Manchin-Kirk) - individual mandate delay S. 1693, ACA Enrollment Extension Act (Shaheen) - extending open enrollment, delaying individual mandate penalties S. 1699, Continuous Coverage Act (Mark Udall) - continuation of existing plans S. 1726, Obamacare Taxpayer Bailout Prevention Act (Rubio) - repeal of ACA risk corridor program S. 1729, Expanded Consumer Choice Act (Begich) - adding copper level of coverage to ACA Exchanges S. 1866, Coverage Protection Act (Merkley) - continuation of coverage, retroactive coverage S. 2166, Treating Families Fairly Act (Manchin) - ACA determinations of full-time equivalent employees S. 2168, Small Business Stability Act (Heitkamp) - ACA definition of a large employer S. 2173, Consumers Having Options in Choosing Enrollment Act (Landrieu) - ACA direct enrollment S. 2174, Commonsense Competition and Access to Health Insurance Act (Warner) - offering health insurance coverage across state lines S. 2175, Enhancing Access for Agents and Brokers Act (Landrieu) - access for independent agents and brokers to information about Exchange enrollment S. 2176, Commonsense Reporting Act (Warner) - ACA reporting requirements S. 2214, ACA Taxpayer Bailout Protection Act (Rubio) - ACA risk corridor program S. 2253, Health Care Fairness and Stability Act (Franken-Kirk) - ACA transitional reinsurance program S. 2578, Protect Women's Health From Corporate Interference Act (Murray) - contraceptive coverage S. 2733, Obamacare Opt-Out Act (McCain-Barrasso) - certification process for opting out of ACA individual mandate S. 2801, Health Care Consumer Choices Preservation Act (Enzi) - conditions on automatic renewals Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2014 · fourth_quarter · Q4
H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes H.R. 1024, Medication Therapy Management Empowerment Act (McMorris Rodgers) - medication therapy management programs H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) - MA special needs plans H.R. 4998, MA Participant Bill of Rights Act (DeLauro) - MA plan provider networks H.R. 5113, Protecting Seniors' Medicare Choices from Obamacare Act (Coffman) - MA stabilization program H.R. 5183, Value Based Insurance Design for Better Care Act (Black) - MA demonstration to test VBID methodologies H.R. 5364, CHIP Extension and Improvement Act (Pallone) - federal CHIP funding Draft Bill, Protecting the Integrity of Medicare Act (Brady) - preventing fraud in Medicare and Medicaid S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues S. 25 (Hatch) - extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal S. 2361, Stop SCAMS Act (Nelson-Collins) - reducing Medicare fraud S. 2461, CHIP Extension Act (Rockefeller) --- federal CHIP funding S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) - MA plan provider networks S. 2783, Value Based Insurance Design for Better Care Act (Thune) - MA demonstration to test VBID methodologies Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues;implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease such as Ebola; and other issues relating to health care reform implementation. *AddMACPACtoAgencyList
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2014 · third_quarter · Q3
H.R. 460, Patients' Access to Treatments Act (McKinley) - cost sharing in a specialty drug tier H.R. 1367, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) - FEHBP prescription drugs S. 214, Preserve Access to Affordable Generics Act (Klobuchar) - access to generic drugs Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) - MA special needs plans H.R. 4998, MA Participant Bill of Rights Act (DeLauro) - MA plan provider networks H.R. 5113, Protecting Seniors' Medicare Choices from Obamacare Act (Coffman) - MA stabilization program H.R. 5183, Value Based Insurance Design for Better Care Act (Black) - MA demonstration to test VBID methodologies H.R. 5364, CHIP Extension and Improvement Act (Pallone) - federal CHIP funding Draft Bill, Protecting the Integrity of Medicare Act (Brady) - preventing fraud in Medicare and Medicaid S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues S. 25 (Hatch) - extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal S. 2361, Stop SCAMS Act (Nelson-Collins) - reducing Medicare fraud S. 2461, CHIP Extension Act (Rockefeller) --- federal CHIP funding S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) - MA plan provider networks S. 2783, Value Based Insurance Design for Better Care Act (Thune) - MA demonstration to test VBID methodologies Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2014 · second_quarter · Q2
H.R. 763, Jobs and Premium Protection Act (Boustany-Matheson) repeal of ACA health insurance tax16. Specific Lobbying Issues (continued): H.R. 1248, Family Health Care Flexibility Act (Paulsen) HSA and FSA issues H.R. 1342, Helping Save Americans Health Care Choices Act (Fleming) HSA and FSA issues H.R. 2194, Family and Retirement Health Investment Act (Paulsen) HSA and FSA issues H.R. 2835, Restoring Access to Medication Act (Jenkins) HSA and FSA issues H.R. 3367, HIT Delay Bill (Boustany-Bera) delay of ACA health insurance tax H.R. 4600, Tax Free Health Insurance Act (King) tax treatment of health insurance premiums H.R. 4777, Health Savings Act (Burgess) HSA issues S. 24, Small Business Health Relief Act (Portman) HIT repeal, HSA and FSA changes S. 603, Jobs and Premium Protection Act (Barrasso-Hatch) repeal of ACA health insurance tax S. 610, Family Health Care Flexibility Act (Johanns) HSA and FSA issues S. 1031, Family and Retirement Health Investment Act (Hatch) HSA and FSA issues S. 1485, Americans Giving Care to Elders Act (Klobuchar) tax credits for family caregivers S. 2260, EXPIRE Act (Wyden) tax provisions Hatch-Barrasso Amendment to H.R. 3474, Tax Extenders Bill two-year delay in ACA health insurance tax Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, health insurer and employer reporting of health coverage, and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2014 · first_quarter · Q1
H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits16. Specific Lobbying Issues (continued): H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) MA payment and enrollment issues, wellness incentives H.R. 2810, Medicare Patient Access and Quality Improvement Act (Burgess/Camp) SGR repeal, quality- and value- based payment reforms H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.J.Res. 59, Bipartisan Budget Act (Rogers) MA Special Needs Plans, Cost Plans, Medicare physician payment, QI and TMA programs S. 11, Fiscal Sustainability Act (Corker) Medicare, Medigap, Medicaid issues S. 25 (Hatch) extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Baucus) SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Baucus) SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal U.S. Senate Special Committee on Aging Draft of Stop SCAMS Act (not yet introduced) - anti-fraud activities, including coding, Healthcare Fraud Prevention Partnership, and MEDPAC report16. Regulatory Issues (continued): Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation. 17. Houses of Congress and Federal Agencies (continued): Medicaid and CHIP Payment and Access Commission (MACPAC) 18. Name of Lobbyists (con't): C. Lawrence: Assistant, Legislative Director for Rep. Bill Cassidy (LA-6); May 2008-July 200: Staff Assistant, Legislative Correspondent for Rep. Tom Price (GA-6)
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2013 · fourth_quarter · Q4
H.Con.Res. 25, House Budget Resolution (Ryan) public program issues, deficit reduction proposals16. Specific Lobbying Issues (continued): S.Con.Res. 8, Senate Budget Resolution (Murray) public program issues, deficit reduction proposals H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) MA payment and enrollment issues, wellness incentives H.R. 2810, Medicare Patient Access and Quality Improvement Act (Burgess/Camp) SGR repeal, quality- and value-based payment reforms H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) MA open enrollment period H.J.Res. 59, Bipartisan Budget Act (Rogers) MA Special Needs Plans, Cost Plans, Medicare physician payment, QI and TMA programs S. 11, Fiscal Sustainability Act (Corker) Medicare, Medigap, Medicaid issues S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Baucus) SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative;Regulatory Issues (con't): issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation. 17. Houses of Congress and Federal Agencies (con't): Medicaid and CHIP Payment and Access Commission (MACPAC)
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2013 · third_quarter · Q3
H.R. 1326, Health Care Price Transparency Promotion Act (Burgess) price transparency16. Specific Lobbying Issues (continued): H.R. 1701, Cutting Costly Codes Act (Poe) ICD-10 implementation H.R. 2853, Hospital Price Transparency and Disclosure Act (Lipinski) transparency of hospital prices S. 44, Medical Care Access Protection Act (Portman) medical liability reform S. 972, Cutting Costly Codes Act (Coburn) ICD-10 implementation S. 1284, Labor, HHS, and Education Appropriations Bill (Harkin) funding for HHS programs and agencies; amendment to block implementation of ACA individual mandate Regulatory Issues: Health Insurance Portability and Accountability Act (HIPAA) administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets, identifiers including the health plan identifier, enforcement; Federal Employee Health Benefits Program (FEHBP) enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related Office of Personnel Management (OPM) reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and Medical Loss Ratio (MLR) requirements under the FEHBP; OPM data warehouse for FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; health care reforms related to competition in provider markets; pay-for-delay issues; McCarran Ferguson; accountable care organizations; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges); issues related to the program integrity program; and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2013 · second_quarter · 2A
H.Con.Res. 25, House Budget Resolution (Ryan) public program issues, deficit reduction proposals16. Specific Lobbying Issues (continued): S.Con.Res. 8, Senate Budget Resolution (Murray) public program issues, deficit reduction proposals H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) wellness incentives S. 11, Fiscal Sustainability Act (Corker) Medicare, Medigap, Medicaid issues S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) wellness incentives Discussion Drafts of Medicare Physician Payment Reform Bills (not yet introduced) SGR repeal, quality- and value-based payment reforms Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs;Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.
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2013 · second_quarter · Q2
H.R. 763, Jobs and Premium Protection Act (Boustany-Matheson) HIT repeal16. Specific Lobbying Issues (continued): H.R. 1248, Family Health Care Flexibility Act (Paulsen) HSA and FSA issues H.R. 1342, Helping Save Americans Health Care Choices Act (Fleming) HSA and FSA issues H.R. 2194, Family and Retirement Health Investment Act (Paulsen) HSA and FSA issues S. 24, Small Business Health Relief Act (Portman) HIT repeal, HSA and FSA changes S. 603, Jobs and Premium Protection Act (Barrasso-Hatch) HIT repeal S. 610, Family Health Care Flexibility Act (Johanns) HSA and FSA issues S. 1031, Family and Retirement Health Investment Act (Hatch) HSA and FSA issues Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, and other issues relating to health care reform implementation.
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2013 · first_quarter · Q1
H.Con.Res. 25, House Budget Resolution (Ryan) public program issues, deficit reduction proposals16. Specific Lobbying Issues (continued): S.Con.Res. 8, Senate Budget Resolution (Murray) public program issues, deficit reduction proposals H.R. 8, American Taxpayer Relief Act (Camp) Medicare Advantage, Special Needs Plans, Medicare physician payment, Medicaid and long-term care issues H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations S. 11, Fiscal Sustainability Act (Corker) Medicare, Medigap, Medicaid issues S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) Medicare coverage of skilled nursing care Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation. 17. Federal Agencies (continued) Medicaid and CHIP Payment and Access Commission (MACPAC)
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2012 · fourth_quarter · Q4
H.R. 5, HEALTH Act (Gingrey) IPAB repeal, medical liability reform, McCarran-Ferguson 16. Specific Lobbying Issues (continued): H.R. 452, Medicare Decisions Accountability Act (Roe) IPAB repeal, medical liability reform, McCarran-Ferguson H.R.611 -- BEST PRACTICES Act (Rush) data security H.R. 1173, Fiscal Responsibility and Retirement Security Act (Boustany) National Clearinghouse for LTC Information H.R. 1409, Quality Health Care Coalition Act (Conyers) antitrust exemption for physicians H.R. 1707, Data Accountability and Trust Act (Rush) data security H.R. 1841, Data Accountability and Trust Act (Stearns) data security H.R. 2576, (Black) eligibility for health care assistance H.R. 2577, Secure and Fortify Electronic Data Act (Bono Mack) data security H.R. 2676, Small Business Health Relief Act (Schweikert) repeal of premium tax and other ACA provisions H.R. 4310, National Defense Authorization Act (McKeon) TRICARE provisions H.R. 5800, Health Care Price Transparency Promotion Act (Burgess) price transparency H.R. 5817, Eliminate Privacy Notice Confusion Act (Luetkemeyer) privacy H.R. 5909, Comprehensive Dental Reform Act (Cummings) expanded access to dental services H.R. 6684, Spending Reduction Act (Ryan) ACA provisions, deficit reduction proposals H.J.Res. 17, Continuing Appropriations Resolution (Rogers) temporary appropriations for FY 2013 S. 1049, Small Business Health Relief Act (Kyl) repeal of premium tax and other ACA provisions S. 1099, HEALTH Act (Blunt) medical liability reform S. 1151, Personal Data Privacy and Security Act (Leahy) privacy, data security S. 1207, Data Security and Breach Notification Act (Pryor) data security S. 1223, Location Privacy Protection Act (Franken) privacy S. 1408, Data Breach Notification Act (Feinstein) data security S. 1535, Personal Data Protection and Breach Accountability Act (Blumenthal) data security S. 1789, 21st Century Postal Service Act (Lieberman) -- health benefits for postal employees S. 2111, Cyber Crime Protection Security Act (Leahy) privacy S. 3254, National Defense Authorization Act (Levin) TRICARE provisions S. 3272, Comprehensive Dental Reform Act (Sanders) expanded access to dental services S. 3295, Labor, HHS, Education Appropriations Act (Harkin) funding for HHS programs and agencies, ACA related amendments S. 3333, Data Security and Breach Notification Act (Toomey) data security S. 3351, Protect Our Health Privacy Act (Franken) privacy S. 3414, Cybersecurity Act (Lieberman) privacy, data security S. 3432 Identity Theft and Tax Fraud Prevention Act (Nelson/Coburn) privacy Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets, identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; transition from the similarly sized subscriber group (SSSG) requirement to an MLR; OPM data warehouse; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; health insurance exchanges; preexisting condition insurance plans; accountable care organizations; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal Regulatory Descriptions (con't): requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; and other issues relating to health care reform implementation.
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2012 · third_quarter · Q3
H.R. 5, HEALTH Act (Gingrey) IPAB repeal, medical liability reform, McCarran-Ferguson; 16. Specific Lobbying Issues (continued): H.R. 452, Medicare Decisions Accountability Act (Roe) IPAB repeal, medical liability reform, McCarran-Ferguson H.R.611 -- BEST PRACTICES Act (Rush) data security H.R. 1173, Fiscal Responsibility and Retirement Security Act (Boustany) National Clearinghouse for LTC Information H.R. 1409, Quality Health Care Coalition Act (Conyers) antitrust exemption for physicians H.R. 1707, Data Accountability and Trust Act (Rush) data security H.R. 1841, Data Accountability and Trust Act (Stearns) data security H.R. 2576, (Black) eligibility for health care assistance H.R. 2577, Secure and Fortify Electronic Data Act (Bono Mack) data security H.R. 2676, Small Business Health Relief Act (Schweikert) repeal of premium tax and other ACA provisions H.R. 5800, Health Care Price Transparency Promotion Act (Burgess) price transparency H.R. 5909, Comprehensive Dental Reform Act (Cummings) expanded access to dental services Labor, HHS, Education Appropriations Act (Rehburg) funding for HHS programs and agencies H.J.Res. 17, Continuing Appropriations Resolution (Rogers) temporary appropriations for FY 2013 S. 1049, Small Business Health Relief Act (Kyl) repeal of premium tax and other ACA provisions S. 1099, HEALTH Act (Blunt) medical liability reform S. 1151, Personal Data Privacy and Security Act (Leahy) privacy, data security S. 1207, Data Security and Breach Notification Act (Pryor) data security S. 1408, Data Breach Notification Act (Feinstein) data security S. 1535, Personal Data Protection and Breach Accountability Act (Blumenthal) data security S. 1789, 21st Century Postal Service Act (Lieberman) -- health benefits for postal employees S. 2111, Cyber Crime Protection Security Act (Leahy) privacy S. 3272, Comprehensive Dental Reform Act (Sanders) expanded access to dental services S. 3295, Labor, HHS, Education Appropriations Act (Harkin) funding for HHS programs and agencies, ACA related amendments S. 3333, Data Security and Breach Notification Act (Toomey) data security S. 3351, Protect Our Health Privacy Act (Franken) privacy S. 3414, Cybersecurity Act (Lieberman) privacy, data security S. 3432 Identity Theft and Tax Fraud Prevention Act (Nelson/Coburn) privacy Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets, identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; transition from the similarly sized subscriber group (SSSG) requirement to an MLR; OPM data warehouse; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; health insurance exchanges; preexisting condition insurance plans; accountable care organizations; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to privacy, security, and other regulation of the Internet and electronic commerce; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; dependent coverage; summary of benefits and coverage disclosures; and other issues relating to health care reform implementation.
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2012 · second_quarter · Q2
H.Con.Res. 112, House budget resolution (Ryan) Medicare, Medicaid, ACA issues H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger) H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes 16. Specific Lobbying Issues (continued): H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) Medicare secondary payer rules H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods H.R. 2190, Medicare Drug Savings Act (Waxman) rebates for dual eligibles H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) extension of Medicare cost plans H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney) H.R. 3519 (Towns) exempting Medicare from sequestration H.R. 3691, Senior Medicare Fairness Act (Paulsen) frailty adjuster for certain MA SNPs H.R. 4254, Medicare Advantage Program Integrity Act (Stark) MA payment changes H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) incentives for wellness and prevention Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including; risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to Medigap coverage; and other issues relating to health care reform implementation.
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2012 · first_quarter · Q1
H.R. 979, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) FEHBP prescription drugs H.R.1946, Preserving Hometown Independent Pharmacies Act (Marino) antitrust exemption for independent pharmacies H.R. 3988, Generic Drug and Biosimilar User Fee Act (Murphy/Pitts/Waxman) FDA user fee programs 16. Specific Lobbying Issues (continued): H.R. 3995, Protecting Consumer Access to Generic Drugs Act (Rush) pay-for-delay settlements S. 27, Preserve Access to Affordable Generics Act (Kohl) pay-for-delay settlements S. 2193, Ensuring Safe Medical Devices for Patients (Merkley) FDA oversight of medical devices H.R. 3209, Premarket Predictability Act (Shimkus) changes to the device process H.R. 3208, Patients Come First Act (Shimkus) - changes to the device process H.R. 3205, FDA Renewing Efficiency from Outside Review Management Act of 2011 (Paulsen) changes to the device process Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; and issues relating to access for investigational drugs. 18. Lobbyists (continued): K. Callahan: Ross (March 2005- January 2012); Research Assistant, Senator Tim Johnson (October 2001 March 2005). D. Mott-Bronson: (June 1998 - September 2002); Democratic Professional Staff Member, House International Relations Committee, Representative McKinney (September 2002 December 2002).
H.R. 3709 - Chronic Disease Management Act of 2019 - Blumenauer - HSAs and HDHPs H.R. 4651 - American Future Healthcare Act of 2019 - King - amends the Internal Revenue Code to expand health savings accounts H.R. 4652 - Individual Health Insurance Marketplace Improvement Act - Langevin - Individual Market Reinsurance fund H.R. 5807 - Know Your Provider Act of 2020 - Larson - provider directory information H.R. 5809 - Better Information Act of 2020 - Beyer - health insurance membership card H.R. 5816 - Continuing Care for Patients Act of 2020 - Moore - coverage and provider network status H.R. 5817 - Fair and Honest Advance Cost Estimate for Patients Act of 2020 - Nunes - health plan transparency H.R. 5825 - To amend the Internal Revenue Code of 1986 to provide for reporting by certain investors with respect to certain specified medical care providers - Neal - investment in medicine H.R. 6286 - Health Savings Act of 2020 - Burgess - health savings account S. 3439 - Lower Health Insurance Deductibles Act - Scott - health savings accounts S. 3539 - A bill to amend the Internal Revenue Code of 1986 to exempt telehealth services from certain high deductible health plan rules - Daines - telehealth S. 3546 - A bill to waive high deductible health plan requirements for health savings accounts - Cruz - health savings accounts Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; issues relating to COVID-19; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 1897 - Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) - Kelly - maternal health H.R. 4004 - Social Determinants Accelerator Act of 2019 - Bustos - social determinants of health H.R. 4215 - Excellence in Maternal Health Act of 2019 - Bucshon - maternal health H.R. 4768 - Home Visiting to Reduce Maternal Mortality and Morbidity Act - David - maternal health H.R. 4900 - Telehealth Across State Lines Act of 2019 - Roe - telehealth H.R. 4932 - Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019 - Thompson - telehealth H.R. 4995 - Maternal Health Quality Improvement Act of 2019 - Engel - maternal health outcomes H.R. 5190 - STAR Act - Harder - telemedicine assistance for rural health clinics and health centers H.R. 5257 - Telehealth Expansion Act of 2019 - Cox - establish FCC telehealth program H.R. 5473 - Enhance Access to Support Essential Behavioral Health Services Act - Bilirakis - telehealth H.R. 5640 - Data Mapping to Save Moms' Lives Act - Butterfield - maternal health H.R. 5681 - Protecting Communities from Hospital Closures Act of 2020 - Boyle - rural health H.R. 5754 - Rural ER Access Act - Green - rural health H.R. 5763 - National Telehealth Strategy and Data Advancement Act - Gianforte - telehealth H.R. 5800 - Ban Surprise Billing Act - Scott - surprise medical bills H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act of 2020 - Neal - surprise medical bills H.R. 5916 - Transparent Health Care Pricing Act of 2020 - Gallagher - provider transparency in health care services H.R. 5924 - To amend the Public Health Service Act to authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty medicine physicians - McKinley - rural health, loan program H.R. 6074 - Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 - Lowey - COVID-19 H.R. 6132 - Social Determinants for Moms Act of 2020 - McBath - maternal health and social determinants of health H.R. 6138 - Tech to Save Moms Act - Johnson - maternal health H.R. 6142 - Black Maternal Health Momnibus Act of 2020 - Underwood - maternal health H.R. 6143 - Moms MATTER Act of 2020 - Kennedy - maternal health H.R. 6144 - Kira Johnson Act - Adams - maternal health H.R. 6165 - Data to Save Moms Act of 2020 - Davids - maternal health H.R. 6232 - To require the Secretary of Health and Human Services, through the National Disaster Medical System, to provide for certain laboratory reimbursement for diagnostic testing for COVID-19 in uninsured individuals - Cardenas - Federal coverage of COVID-19 related visits and testing for uninsured individuals H.R. 6261 - To provide for coverage of testing for COVID-19 at no cost sharing for Indians receiving health services through the Indian Health Service - Ruiz - Federal coverage of COVID-19 related visits and testing for Native Americans H.R. 6351 - To authorize the Secretary of Health and Human Services to administer vaccinations for COVID-19, once available, at no cost to the inoculated, in response to the COVID-19 outbreak, and for other purposes - Harder - COVID-19 H.R. 6379 - Take Responsibility for Workers and Families Act - Lowey - COVID-19 S. 116 - Modernizing Obstetric Medicine Standards Act of 2019 (MOMS Act) - Gillibrand - maternal health S. 916 - Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) - Durbin - maternal health S. 2741 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 - Schatz - telehealth S. 2885 - Stop Marketing and Revealing the Wearables and Trackers Consumer Health Data Act - Cassidy - consumer health information S. 2986 - Social Determinants Accelerator Act of 2019 - Young - Social Determinants of Health S. 3152 - Data Mapping to Save Moms' Lives Act - Rosen - maternal health S. 3318 - Transparent Health Care Pricing Act of 2020 - Cassidy - disclosure of point-of-sale cash prices S. 3380 - Patient Safety Improvement Act of 2020 - Whitehouse - data collection and quality improvement S. 3424 - Black Maternal Health Momnibus Act of 2020 - Harris - maternal health S. 3437 - Improving Care in Rural America Reauthorization Act of 2020 - Loeffler - rural health S. 3438 - R-DOCS Reauthorization Act of 2020 - Loeffler - telehealth S. 3517 - A bill to increase the ability of nursing facilities to access to telehealth services and obtain technologies to allow virtual visits during the public health emergency relating to an outbreak of coronavirus disease 2019 (COVID-19) - Klobuchar - telehealth S. 3568 - Require the President to use authorities under the Defense Production Act of 1950 to require emergency production of medical equipment to address the COVID-19 outbreak - Murphy - expedite acquisition of PPE S. 3570 - To provide for the expedited procurement of equipment needed to combat COVID-19 under the Defense Production Act of 1950 - Baldwin - expedite acquisition of PPE Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telemedicine; rural health; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
H.R. 748 - CARES Act -Courtney - COVID-19 coverage H.R. 3630 - No Surprises Act - Pallone - surprise medical billing H.R. 3784 - Air Ambulance Affordability Act of 2019 - Neguse - air ambulances H.R. 4223, Protecting Patients from Surprise Medical Bills Act - Spano - surprise medical billing H.R. 5121 - Healthcare Cost Transparency Act - Beyer - provider price comparison tool H.R. 5239 - Prescription Drug Price Reporting Act - Joyce - reporting on drug expenditures and price changes under group health plans H.R. 5575 - Primary and Behavioral Health Care Access Act of 2020 -Underwood - coverage of primary care and behavioral health visits H.R. 6005 - Know the Price Act - Malinowski - health plan transparency H.R. 6173 - Covering Coronavirus Test Act of 2020 - DeGette - COVID-19 testing coverage H.R. 6193 - Medication Access in Emergencies Act of 2020 - Pappas - coverage of prescription drugs during emergency periods H.R. 6201 - Families First Coronavirus Response Act - Lowey - includes several provisions related to COVID-19 testing coverage H.R. 6213 - No Cost for COVID-19 Testing Act - Wilson - COVID-19 testing coverage H.R. 6214 - To amend title XVIII of the Social Security Act to provide for coverage of testing for COVID-19 at no cost sharing under the Medicare Advantage program - Kind - Medicare Advantage coverage of COVID-19 related visits and testing H.R. 6222 - Ensuring Affordable COVID-19 Preventive Care Act of 2020 - Schakowsky - coverage of certain new preventative services related to COVID-19 H.R. 6231 - Ensuring Access to COVID-19 Preventive Care Act of 2020 - Bucshon - coverage of certain vaccines and testing services during the COVID-19 emergency H.R. 6299 - Rapid Coverage of COVID-19 Vaccine Act of 2020 - Courtney - COVID-19 coverage H.R. 6317 - To provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes - Doggett - special enrollment periods in public health emergency H.R. 6338 - To waive high deductible health plan requirements for health savings accounts -Budd - HDHP coverage during COVID S. 1531 - STOP Surprise Medical Bills Act - Cassidy-Bennet - surprise medical billing S. 1948 - Chronic Disease Management Act - Thune - pre-deductible coverage of chronic disease prevention services S. 2546 - Safe Step Act - Murkowski - Step therapy exceptions S. 3200 - Chronic Disease Management Act of 2020 - Thune - coverage of chronic disease prevention services S. 3383 - Continuing Coverage for Preexisting Conditions Act of 2020 -Kennedy - preexisting conditions S. 3499 - A bill to amend coverage requirements to ensure that no person incurs cost sharing when receiving a test to confirm a COVID-19 infection - Smith - COVID-19 cost -sharing S. 3505 - A bill to require private health insurance to rapidly cover preventive services and vaccines related to the coronavirus - Jones - rapid COVID-19 coverage S. 3536 - A bill to provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes - Casey - COVID-19 coverage Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
H.R. 3 - Lower Drug Costs Now Act of 2019 - Pallone - drug pricing H.R. 4398 - Affordable Prescriptions for Patients Through Promoting Competition Act of 2019 - Cicilline - drug pricing H.R. 4906 - Insulin Price Reduction Act - DeGette - insulin costs H.R. 5444 - Lower Insulin Costs Now Act - Underwood - lowering insulin costs H.R. 5749 - Affordable Insulin for All Act - Crist - insulin costs H.R. 6155 - To amend the Biologics Price Competition and Innovation Act of 2009 to make improvements with respect to the transition of biological products - Grothman - biological products H.R. 6426 - To require group health plans and health insurance issuers offering group or individual coverage to provide notices relating to prescription drug refills to individuals covered under such plans or coverage who reside in emergency areas during emergency periods - McBath - prescription drug refill notices S. 2543 - Prescription Drug Pricing Reduction Act of 2019 - Grassley - Drug pricing S. 3092 - Expanding Access to Low-Cost Generics Act of 2019 - Smith - 180-day exclusivity period S. 3166 - Prescription Drug Affordability and Access Act - Booker - prescription drug costs Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19; issues relating to prescription drug rebates; issues relating to prescription drug price blueprint; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of the Vice President of the United States, SENATE, Treasury, Dept of, White House Office
S. 61, Safe and Affordable Drugs from Canada Act (Grassley) - drug importation S. 64, Preserve Access to Affordable Generics and Biosimilars Act (Grassley-Klobuchar) - prohibiting pay-for-delay settlements S. 73, End Taxpayer Subsidies for Drug Ads Act (Shaheen) - prohibiting tax deduction for DTC advertising expenses S. 102, Prescription Drug Price Relief Act (Sanders) - reforms linked to international pricing S. 340, CREATES Act (Leahy) - removing barriers to generic drugs S. 344, Hatch-Waxman Integrity Act (Tillis) - inter partes review process S. 366, FLAT Prices Act (Durbin) - reforms for drugs with sudden price spikes S. 378, Stop Price Gouging Act (Durbin) - excise tax for drugs that have price spikes S. 440, Preserving Access to Cost-Effective Drugs Act (Cotton) - sovereign immunity and Inter Partes Review process S. 474, SPIKE Act (Wyden) - justification for drug price increases S. 476, Creating Transparency to Have Drug Rebates Unlocked Act (Wyden) - drug price transparency S. 637, CURE High Drug Prices Act (Blumenthal) - remedies for price gouging S. 657, Point of Sale Rebates (Braun) S. 659, Biologic Patent Transparency Act (Collins) - patent disclosure requirements S. 660, Efficiency and Transparency in Petitions Act (Braun) - FDA citizen petition process S. 844, Short on Competition Act (Klobuchar) - remedies for marginally competitive drug markets S. 977, Transparency Drug Pricing Act (Scott) - transparency and drug pricing reforms S. 1209, Reforming Evergreening and Manipulation that Extends Drug Years Act (Cassidy) - preventing evergreening of patent protections S. 1224, Stop STALLING Act (Klobuchar) - citizen petition process S. 1227, Prescription Pricing for the People Act (Grassley) - FTC report on role of PBMs and allegations of anticompetitive conduct by manufacturers of sole-source drugs S. 1384, Prescription Drug Rebate Reform Act (Romney-Braun) - prescription drug cost sharing S. 1416, Affordable Prescriptions for Patients Act (Cornyn) - product hopping, patent thickets S. 1664, Prescription Drug Price Reporting Act (Scott) - prescription drug price reporting S. 2247, Phair Relief Act of 2019 (Kennedy)-transparency around price concessions for drugs S. 2387, We Protect American Investment in Drugs Act (Van Hollen)-drug pricing S. 2543, Prescription Drug Pricing Reduction Act of 2019 (Grassley)-Drug pricing S. 2740, Over-the-Counter Monograph Safety, Innovation, and Reform Act of 2019 (Isakson) - regulations re nonprescription drugs that are marketed without an approved new drug application S. 3052, United States-Mexico-Canada Agreement Implementation Act (Grassley) - drug pricing S. 3067, Non-Opioids Prevent Addiction In the Nation Act (Capito) - non-opioid treatments S. 3092, Expanding Access to Low-Cost Generics Act of 2019 (Smith) - exclusivity period H.R. 3, Lower Drug Costs Now Act of 2019 (Pallone)-drug pricing H.R. 465, Prescription Drug Price Relief Act (Khanna) - reforms linked to international pricing H.R. 478, Safe and Affordable Drugs from Canada Act (Pingree) - drug importation H.R. 938, BLOCKING Act (Schrader) - changes to 180-day period of market exclusivity for first generic applicant H.R. 965, CREATES Act (Cicilline) - removing barriers to generic drugs H.R. 985, FAST Generics Act (Welch) - removing barriers to generic drugs H.R. 990, Hatch-Waxman Integrity Act (Flores) - inter partes review process H.R. 1093, Stop Price Gouging Act (Pocan) - excise tax for drugs that have price spikes H.R. 1188, FLAT Prices Act (Golden) - reforms for drugs with sudden price spikes H.R. 1344, Competitive DRUGS Act (Doggett) - prohibiting pay-for-delay agreements H.R. 1419, Public Option Deficit Reduction Act (DeFazio) - public option H.R. 1499, Protecting Consumer Access to Generic Drugs Act (Rush) - prohibiting pay-for-delay agreements H.R. 1503, Orange Book Transparency Act (Kelly) - removal of invalidated patents from Orange Book H.R. 1506, FAIR Generics Act (Barragan) - changes to 180-day period of market exclusivity for first generic applicant H.R. 1520, Purple Book Continuity Act (Eshoo) - access to updated information on biologics and biosimilars H.R. 2038, State-Based, Market-Oriented Prescription Drug Negotiations Act (Meadows) - drug price negotiations H.R. 2064, Sunshine for Samples Act (Chu) - reporting requirements on drug samples H.R. 2069, SPIKE Act (Horsford) -justification for drug price increases H.R. 2087, Drug Price Transparency Act (Doggett) - reporting of drug pricing data under Medicare Part B H.R. 2113, Prescription Drug Sunshine, Transparency, Accountability and Reporting Act (Neal) - transparency in drug pricing H.R. 2115, Public Disclosure of Drug Discounts Act (Spanberger) - disclosure of negotiated Rx discounts H.R. 2279, Safe Step Act (Ruiz) - exceptions process for medication step therapy H.R. 2296, FAIR Drug Pricing Act (Schakowsky) - transparency requirements and justification for high list prices and drug price increases H.R. 2374, Stop Significant and Time-wasting Abuse Limiting Legitimate Innovation of New Generics Act (Jeffries) - citizen petition process H.R. 2375, Preserve Access to Affordable Generics and Biosimilars Act (Nadler) - prohibiting pay-for-delay agreements H.R. 2376, Prescription Pricing for the People Act (Collins) - FTC study on role of PBMs and competition and transparency in pharmaceutical supply chain H.R. 3379, Price Relief, Innovation, and Competition for Essential Drugs Act (Schakowsky) - exclusivity period for biological products H.R. 3805, Prescription Drug Rebate Reform Act of 2019 (Gallagher)- drug rebates H.R. 3927, PDMPs Help Patients Act of 2019 (McKinley)-integrating SUDs and behavioral health into PDMPs H.R. 3947, Competition Prescription Act of 2019 (Meadows)- drug pricing H.R. 4010, Emergency Access to Insulin Act of 2019 (Craig)- drug pricing H.R. 4106, Responsibility in Drug Advertising Act of 2019 (DeLauro)-transparency in drug pricing H.R. 4244, MAGIC Act (Kelly)-pathways for insulin approval H.R. 4398, Affordable Prescriptions for Patients Through Promoting Competition Act of 2019 (Cicilline)-drug pricing H.R. 4455, BIOSIM Act (Schrader)-access to biosimilars H.R. 4460, Turn the Tide Act (Kuster)-Opioids H.R. 4538, Closing Loopholes for Orphan Drugs Act (Welch)-Access to drugs H.R. 4640, Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2019 (DeFazio) - direct negotiation H.R. 4712, Fairness in Orphan Drug Exclusivity Act (Dean) - limitations on exclusive approval of orphan drugs H.R. 4810, Opioid Prescription Verification Act of 2019 (David) - dispensing of controlled substances H.R. 4906, Insulin Price Reduction Act (Diana DeGette) - insulin costs H.R. 5304, PBM Transparency in Prescription Drug Costs Act (Schrader) - PBMs H.R. 5364, End Price Gouging for Insulin Act (Beatty) - annual reference price for insulin products H.R. 5430, United States-Mexico-Canada Agreement Implementation Act (Hoyer) - drug pricing H.R. 5442, Lowest Price for Patients Act (Porter) - pharmacies to disclose any differential between the cost of a prescription drug H.R. 5444, Lower Insulin Costs Now Act (Underwood) - lowering insulin costs H.Con.Res. 55, Expressing the sense of Congress on the need to inform American consumers with more balanced purchasing information for prescription drugs through the disclosure of price information in direct-to-consumer (DTC) advertisements. (Burgess)-drug pricing Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to prescription drug rebates; issues relating to prescription drug price blueprint; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
S. 116, Modernizing Obstetric Medicine Standards Act of 2019 (MOMS Act) (Gillibrand)-maternal health S. 916, Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) (Durbin) -maternal health S. 1012, The Protecting Jessica Grubbs Legacy Act (Capito) - confidential sharing of substance use disorder information S. 1770, Resilience Investment, Support, and Expansion from Trauma Act (RISE from Trauma Act) (Durbin) - trauma care S. 1895, Lower Health Care Costs Act (Alexander-Murray) - surprise medical billing, prescription drug prices, transparency, public health initiatives, exchange of health information, mental health parity, pharmacy benefit manager (PBM) issues, provider directories, disclosure of proprietary information S. 2408, Telehealth Across State Lines Act of 2019 (Blackburn)- telehealth S. 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 (Schatz) - telehealth S. 2885, Stop Marketing and Revealing the Wearables and Trackers Consumer Health Data Act (Cassidy) - consumer health information S. 2897, Patient-Centered Outcomes Research Institute Reauthorization Act (Warner) - PCORI funding S. 2986, Social Determinants Accelerator Act of 2019 (Young) - Social Determinants of Health H.R. 506, Hospital Competition Act (Banks) - hospital consolidation H.R. 525, Strengthening the Health Care Fraud Prevention Task Force Act (Walden) - codification of Healthcare Fraud Prevention Partnership H.R. 861, End Surprise Billing Act (Doggett) - surprise medical bills H.R. 1395, Youth Mental Health Services Act (Roe) - mental health for students H.R. 1409, Transparency in All Health Care Pricing Act (Perlmutter) - transparency in health care pricing H.R. 1897, Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) (Kelly) -maternal health H.R. 2062, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information H.R. 2740, HHS Appropriations (DeLauro) - funding for HHS programs and agencies H.R. 3030, Patient-Centered Outcomes Research Extension Act (DeGette) - PCORI reauthorization H.R. 3180, Resilience Investment, Support, and Expansion from Trauma Act (RISE from Trauma Act) (Davis) -trauma care H.R. 3439, Protecting Access to Information for Effective & Necessary Treatment and Services Act (Beyer) - PCORI reauthorization H.R. 4004, Social Determinants Accelerator Act of 2019 (Bustos)- social determinants of health H.R. 4040, Protecting Access to Spinal Surgeries Act (Lewis)- site neutral IPPS payments H.R. 4215, Excellence in Maternal Health Act of 2019 (Bucshon)- maternal health H.R. 4336, Easy Enrollment Act of 2019 (Bera)- aligning enrollment for exchange plans with tax returns H.R. 4768, Home Visiting to Reduce Maternal Mortality and Morbidity Act (David) - maternal health H.R. 4900, Telehealth Across State Lines Act of 2019 (Roe) - telehealth H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019 (Thompson) - telehealth H.R. 4995, Maternal Health Quality Improvement Act of 2019 (Engel) - maternal health outcomes H.R. 5190, STAR Act (Harder) - telemedicine assistance for rural health clinics and health centers H.R. 5257, Telehealth Expansion Act of 2019 (Cox) - establish FCC telehealth program H.R. 5473, Enhance Access to Support Essential Behavioral Health Services Act (Bilirakis) - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; telemedicine; rural health; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.
S. 12, Health Savings Act (Rubio) - HSA improvements S. 80, Jobs and Premium Protection Act (Barrasso) - health insurance tax S. 172, Health Insurance Tax Relief Act (Gardner) - health insurance tax S. 684, Middle Class Health Benefits Tax Repeal Act (Heinrich) - Cadillac tax on employer-provided coverage S. 1089, Restoring Access to Medication Act (Roberts) - paying for OTC products with HSA funds S. 2366, Commonsense Reporting Act of 2019 (Warner)-Reporting system for employers and plans S. 2414, A bill to amend the Internal Revenue Code of 1986 to extend the Health Coverage Tax Credit (Portman)- using tax credits for health coverage S. 2440, Qualified Health Savings Account Distribution Act of 2019 (Sasse)- HSAs S. 2785, Fair Indexing for Health Care Affordability Act (Shaheen) - premium tax credit eligibility, MOOPs S. 2793, Primary Care Patient Protection Act of 2019 (King) - HDHPs deductible S. 3112, Personalized Care Act of 2019 (Cruz)- HSAs H.R. 603, Health Savings Account Expansion Act (Gallagher) - HSA improvements H.R. 748, Middle Class Health Benefits Tax Repeal Act (Courtney) - Cadillac tax on employer-provided coverage H.R. 1398, Health Insurance Tax Relief Act (Bera) - health insurance tax H.R. 1865, Further Consolidated Appropriations Act 2020 (Pascrell) - HIT repeal H.R. 2447, Jobs and Premium Protection Act (Brindisi) - health insurance tax H.R. 3709, Chronic Disease Management Act of 2019 (Blumenauer)- HSAs and HDHPs H.R. 4070, Commonsense Reporting Act of 2019 (Thompson)-Reporting system for employers and plans H.R. 4631, Excise Narcotics Distribution in the Epidemic Act of 2019 (Rose) - excise tax on opioid manufacturers H.R. 4651, American Future Healthcare Act of 2019 (King) - amends the Internal Revenue Code to expand health savings accounts H.R. 4652, Individual Health Insurance Marketplace Improvement Act (Langevin) - Individual Market Reinsurance fund H.R. 4716, Inhaler Coverage and Access Now Act (Cox) - provides a safe harbor for high deductible health plans without a deductible for certain inhalers Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims S. 1114, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap S. 2081, Stop Drug Companies from Overcharging Seniors in Medicare Part B Act of 2019 (Peters)- drugs in Part B S. 2252, Empowering States to Address Drug Costs Act (Van Hollen)- drug pricing S. 2446, Medicare Audiologist Access and Services Act of 2019 (Warren)-Medicare coverage of audiologist services S. 2650 - Medicare Prescription Drug Savings and Choice Act of 2019 (Durbin) - lowering prescription drug costs S. 2807, Hospice Care Improvement Act of 2019 (Portman) - Medicare hospice programs S. 2846, Protecting Patients Transportation to Care Act (Isakson) - Medicaid coverage of transportation S. 2911, Seniors Prescription Drug Relief Act of 2019 (Cassidy) - Part D smoothing S. 3000, Patient Shared Savings Act (Cassidy) - prescription drug plans S. 3001, Permanent Relief for Seniors and Medicare, Medicaid, Human Services Extension Act of 2019 (Toomey) - extensions S. 3029, Territories Medicare Prescription Drug Assistance Equity Act of 2019 (Menendez) - Territories, low-income Medicare part D beneficiaries S. 3078, Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2019 (Grassley) - Medicare appeals process S. 3129, Lower Costs, More Cures Act of 2019 (Crapo) - drug pricing H.R. 19, Lower Costs, More Cures Act of 2019 (Walden) - drug pricing H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program, health homes for children with medically complex conditions H.R. 2131, Medicare Advantage Quality Payment Relief Act (Kind-Kelly) - MA benchmark cap H.R. 2757, Creating Lower Cost Alternatives for Your Prescription Drugs Act (Cunningham) - eliminate copay for generic drugs in Medicare Part D H.R. 3107, Improving Seniors' Timely Access to Care Act (DelBene) - Medicare Advantage prior authorization H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act (Dingell) - MFP demonstration, spousal impoverishment protections, Medicaid drug rebate program H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act (Neal) - funding for quality measurement initiatives, Medicare coverage of mental health telehealth services, real-time benefit tools in Medicare Part D, Medicare eligibility and enrollment notices H.R. 3461, Community-Based Independence for Seniors Act (Sanchez-Kelly) - Community-Based Institutional Special Needs Plan H.R. 3613, State Accountability, Flexibility, and Equity for Hospitals Act of 2019 (Bilirakis) -Medicaid DSH payments H.R. 3631, Territories Health Care Improvement Act (Soto) -Medicaid funding H.R. 3644, Independence at Home Demonstration Act of 2019 (Burgess)-Medicare demonstration program H.R. 3925, Reducing Barriers to Substance Use Treatment Act (Tonko)- Opioids H.R. 3935, Protecting Patients Transportation to Care Act (Carter)-Medicaid coverage for transportation H.R. 4378, Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (Lowey)-Health extenders H.R. 4453, Protecting Seniors from Health Care Fraud Act of 2019 (Ruiz)-Distributing information to Medicare beneficiaries to prevent fraud H.R. 4527, Expanding Health Care Options for Early Retirees Act (Malinowski)-Option for first responders to buy-in to Medicare H.R. 4529, Promoting Access to Broadband Act of 2019 (Maloney)-Medicaid H.R. 4583, Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 (Schneider) - prescription drug affordability H.R. 4597, Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars Act of 2019 (Peters) - biosimilars, Part B H.R. 4618, Medicare Hearing Act of 2019 (McBath) - coverage for certain hearing items and services under part B H.R. 4619, Pharmaceutical Rebates for Excessive Pricing Above Inflation Act (Schakowsky) - drug rebates, Part D H.R. 4620, More Help for Seniors Act of 2019 (Rose) - expand eligibility for low-income subsidies under Part D of the Medicare program H.R. 4621, Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 (Blunt Rochester) - best practices re social determinants of health H.R. 4628, Better Tools to Lower Costs Act of 2019 (Scanlon) - resource requirements H.R. 4629, Star Rating for Biosimilars Act (Tonko) - biosimilars H.R. 4632, Better Transparency in Information for Medicare Beneficiaries Act of 2019 (Kind) - provides consumers information regarding premiums under LIS benchmark plans H.R. 4649, Capping Drug Costs for Seniors Act of 2019 (Horsford) - cap on beneficiary liability under part D of the Medicare program H.R. 4650, Medicare Dental Act of 2019 (Kelly) - Medicare dental coverage H.R. 4655, Enhancing Retirement Security for Medicare Beneficiaries Act of 2019 (Lee) - eligibility of individuals for premium and cost-sharing subsidies under part D H.R. 4661, Advancing Enrollment and Reducing Drug Costs Act of 2019 (Pappas) - Medicaid in territories H.R. 4663, Freedom from Price Gouging Act (Porter) - drug rebates, Part B H.R. 4665, Medicare Vision Act of 2019 (Schrier) - vision items and services under part B H.R. 4666, To amend title XVIII of the Social Security Act to provide certain low-income territorial residents with automatic eligibility for premium and cost-sharing subsidies under the Medicare program, and for other purposes (Shalala) - Medicare in territories H.R. 4669, Maximizing Drug Coverage for Low-Income Seniors Act of 2019 (Stevens) - auto enrollment and intelligent assignment H.R. 4671, Helping Seniors Afford Health Care Act (Kim) - Medicare affordability and low income beneficiaries H.R. 4676, Protecting Medicare Beneficiaries with Pre-Existing Conditions Act (Schneider) - Medigap H.R. 4699, To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals (Gonzales-Colon) - Part D, territories H.R. 4769, Medicare Prescription Drug Savings and Choice Act of 2019 (Schakowsky) - lowering prescription drug costs H.R. 4946, Ensuring Seniors Access to Local Pharmacies Act of 2019 (Welch) - equal access of Medicare beneficiaries to community pharmacies in underserved areas H.R. 4996, Helping Medicaid Offer Maternity Services Act of 2019 (Kelly) - State extension of Medicaid H.R. 5006, Expanding Access to Inpatient Mental Health Act (Emmer) - Medicaid coverage for SUD/mental health for institutionalized H.R. 5039, Life Sustaining Prescription Drug Price Relief Act of 2019 (Lipinski) - part D H.R. 5057, Pass- Through Technical Corrections Act (Tonko) - drug pass-through status under Medicare outpatient payment H.R. 5201, Telemental Health Expansion Act of 2019 (Matsui) - Medicare coverage of mental telehealth H.R. 5232, Road to Recovery Act (Fitzpatrick) - Medicaid and CHIP SUD treatment H.R. 5281, Drug Price Transparency in Medicaid Act of 2019 (Carter) - transparency and spread pricing affordability Discussion Draft, Medicare Part D Reform (Neal-Pallone-Brady-Walden) - maximum out-of-pocket limit, federal reinsurance payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2021 Rate Notice and Call Letter; issues related to MLTSS; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
S. 350, Competitive Health Insurance Reform Act (Daines) - McCarran-Ferguson Act S. 455, Marketing and Outreach Restoration to Empower Health Education Act (Shaheen) - funding for outreach and education on ACA Exchanges S. 466, Protecting Americans with Preexisting Conditions Act (Warner) - blocking updated Section 1332 guidance S. 560, Ensuring Lasting Smiles Act (Baldwin) - coverage mandate for treatment of congenital anomaly or birth defect S. 741, Cancer Drug Parity Act (Smith) -- cost sharing for oral anticancer drugs S. 913, Disclosure of Price Information to Enrollees (Braun) S. 961, Improving Health Insurance Affordability Act (Shaheen) - premium tax credits S. 964, Marketplace Certainty Act (Shaheen) - cost-sharing subsidies S. 967, Reducing Costs for Out-of-Network Services Act (Shaheen) - caps on out-of-network charges S. 981, Medicare-X Choice Act (Bennet) - public option S. 1033, CHOICE Act (Whitehouse) - public option S. 1125, Protect Act (Tillis) - pre-existing condition protections S. 1129, Medicare for All Act (Sanders) - government health insurance system S. 1170, Association Health Plans Act (Enzi) - codifying final rule for expanding AHPs S. 1266, Protecting Patients from Surprise Medical Bills Act (Scott) - surprise medical billing S. 1531, STOP Surprise Medical Bills Act (Cassidy-Bennet) - surprise medical billing S. 1576, Behavioral Health Coverage Transparency Act (Warren) - mental health parity S. 1577, Know the Price Act (Cassidy-Bennet) - restrictions on provider contracts S. 1737, Mental Health Parity Compliance Act (Murphy) - mental health parity S. 1948, Chronic Disease Management Act (Thune) - pre-deductible coverage of chronic disease prevention services S. 2546, Safe Step Act (Murkowski)-Step therapy exceptions H.R. 692, Pre-existing Conditions Protection Act (Walden) - pre-existing condition protections H.R. 986, Protecting Americans with Preexisting Conditions Act (Kuster) - blocking updated Section 1332 guidance H.R. 987, Marketing and Outreach Restoration to Empower Health Education Act (Blunt Rochester) - funding for outreach and education on ACA Exchanges, Navigator program, and establishment of state-based Health Insurance Exchanges; drug pricing proposals H.R. 1010, Short-Term Plans (Castor) - blocking final rule that expands short-term plans H.R. 1143, Educating Consumers on the Risks of Short-Term Plans Act (Eshoo) - standardized disclosures for short-term plans H.R. 1379, Ensuring Lasting Smiles Act (Peterson) - coverage mandate for treatment of congenital anomaly or birth defect H.R. 1384, Medicare for All Act (Jayapal) - government health insurance system H.R. 1385, State Allowance for a Variety of Exchanges Act (Kim) - funding for establishment of state-based Health Insurance Exchanges H.R. 1386, Expand Navigators Resources for Outreach, Learning, and Longevity Act (Castor) - funding for Navigator Program H.R. 1418, Competitive Health Insurance Reform Act (DeFazio) - McCarran-Ferguson Act H.R. 1425, State Health Care Premium Reduction Act (Craig) - funding for state reinsurance programs H.R. 1510, Premium Relief Act (Burgess) -- Patient and State Stability Fund H.R. 1730, Cancer Drug Parity Act (Higgins) -- cost sharing for oral anticancer drugs H.R. 1884, Protecting Pre-Existing Conditions and Making Health Care More Affordable Act (Pallone) - reinsurance funding, stabilization and affordability proposals H.R. 2000, Medicare-X Choice Act (Delgado) - public option H.R. 2061, Pathway to Universal Coverage Act (Bera) - auto-enrollment H.R. 2085, CHOICE Act (Schakowsky) - public option H.R. 2183, State Flexibility and Patient Choice Act (Marshall) - flexibility in state innovation waivers H.R. 2848, Parity Enforcement Act (Norcross) - mental health parity H.R. 2874, Behavioral Health Coverage Transparency Act (Kennedy) - mental health parity H.R. 3165, Mental Health Parity Compliance Act (Porter) - mental health parity H.R. 3502, Protecting People From Surprise Medical Bills Act (Ruiz) - surprise medical billing Discussion Draft, No Surprises Act (Pallone-Walden) - surprise medical billing H.R. 3630, No Surprises Act (Pallone)-surprise medical billing H.R. 3784, Air Ambulance Affordability Act of 2019 (Neguse)- air ambulances H.R. 4223, Protecting Patients from Surprise Medical Bills Act (Spano)-surprise medical billing H.R. 4379, Under Performing Directories that Affect Treating Emergencies Act (Axne)-provider directories H.R. 4457, Chronic Condition Copay Elimination Act (Underwood)- Eliminating copays for services/drugs for chronic conditions H.R. 4484, Flexibility Through Lower Expenses Health Care Act (Budd)-STLDI plans H.R. 4530, Native American Health Savings Improvement Act (Moolenaar)-HSAs H.R. 4575, Improving Provider Directories Act (Schrier)-provider directories H. Res. 271 (Allred) - resolution urging DOJ to reverse position in Texas v. United States litigation Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
S. 12, Health Savings Act (Rubio) - HSA improvements S. 80, Jobs and Premium Protection Act (Barrasso) - health insurance tax S. 172, Health Insurance Tax Relief Act (Gardner) - health insurance tax S. 684, Middle Class Health Benefits Tax Repeal Act (Heinrich) - Cadillac tax on employer-provided coverage S. 1089, Restoring Access to Medication Act (Roberts) - paying for OTC products with HSA funds S. 2366, Commonsense Reporting Act of 2019 (Warner)-Reporting system for employers and plans S. 2414, A bill to amend the Internal Revenue Code of 1986 to extend the Health Coverage Tax Credit. (Portman)- using tax credits for health coverage S. 2440, Qualified Health Savings Account Distribution Act of 2019 (Sasse)- HSAs H.R. 603, Health Savings Account Expansion Act (Gallagher) - HSA improvements H.R. 748, Middle Class Health Benefits Tax Repeal Act (Courtney) - Cadillac tax on employer-provided coverage H.R. 1398, Health Insurance Tax Relief Act (Bera) - health insurance tax H.R. 2447, Jobs and Premium Protection Act (Brindisi) - health insurance tax H.R. 3709, Chronic Disease Management Act of 2019 (Blumenauer)- HSAs and HDHPs H.R. 4070, Commonsense Reporting Act of 2019 (Thompson)-Reporting system for employers and plans Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims S. 1114, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap S. 2081, Stop Drug Companies from Overcharging Seniors in Medicare Part B Act of 2019 (Peters)- drugs in Part B S. 2252, Empowering States to Address Drug Costs Act (Van Hollen)- drug pricing S. 2446, Medicare Audiologist Access and Services Act of 2019 (Warren)-Medicare coverage of audiologist services H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program, health homes for children with medically complex conditions H.R. 2131, Medicare Advantage Quality Payment Relief Act (Kind-Kelly) - MA benchmark cap H.R. 2757, Creating Lower Cost Alternatives for Your Prescription Drugs Act (Cunningham) - eliminate copay for generic drugs in Medicare Part D H.R. 3107, Improving Seniors' Timely Access to Care Act (DelBene) - Medicare Advantage prior authorization H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act (Dingell) - MFP demonstration, spousal impoverishment protections, Medicaid drug rebate program H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act (Neal) - funding for quality measurement initiatives, Medicare coverage of mental health telehealth services, real-time benefit tools in Medicare Part D, Medicare eligibility and enrollment notices H.R. 3461, Community-Based Independence for Seniors Act (Sanchez-Kelly) - Community-Based Institutional Special Needs Plan Discussion Draft, Medicare Part D Reform (Neal-Pallone-Brady-Walden) - maximum out-of-pocket limit, federal reinsurance payments H.R. 3613, State Accountability, Flexibility, and Equity for Hospitals Act of 2019 (Bilirakis) -Medicaid DSH payments H.R. 3631, Territories Health Care Improvement Act (Soto) -Medicaid funding H.R. 3644, Independence at Home Demonstration Act of 2019 (Burgess)-Medicare demonstration program H.R. 3925, Reducing Barriers to Substance Use Treatment Act (Tonko)- Opioids H.R. 3935, Protecting Patients Transportation to Care Act (Carter)-Medicaid coverage for transportation H.R. 4378, Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (Lowey)-Health extenders H.R. 4453, Protecting Seniors from Health Care Fraud Act of 2019 (Ruiz)-Distributing information to Medicare beneficiaries to prevent fraud H.R. 4527, Expanding Health Care Options for Early Retirees Act (Malinowski)-Option for first responders to buy-in to Medicare H.R. 4529, Promoting Access to Broadband Act of 2019 (Maloney)-Medicaid Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2020 Rate Notice and Call Letter; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
S. 116, Modernizing Obstetric Medicine Standards Act of 2019 (MOMS Act) (Gillibrand)-maternal health S. 916, Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) (Durbin) -maternal health S. 1012, The Protecting Jessica Grubbs Legacy Act (Capito) - confidential sharing of substance use disorder information S. 1770, Resilience Investment, Support, and Expansion from Trauma Act (RISE from Trauma Act) (Durbin) - trauma care S. 1895, Lower Health Care Costs Act (Alexander-Murray) - surprise medical billing, prescription drug prices, transparency, public health initiatives, exchange of health information, mental health parity, pharmacy benefit manager (PBM) issues, provider directories, disclosure of proprietary information S. 2408, Telehealth Across State Lines Act of 2019 (Blackburn)- telehealth H.R. 506, Hospital Competition Act (Banks) - hospital consolidation H.R. 525, Strengthening the Health Care Fraud Prevention Task Force Act (Walden) - codification of Healthcare Fraud Prevention Partnership H.R. 861, End Surprise Billing Act (Doggett) - surprise medical bills H.R. 1395, Youth Mental Health Services Act (Roe) - mental health for students H.R. 1409, Transparency in All Health Care Pricing Act (Perlmutter) - transparency in health care pricing H.R. 1897, Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) (Kelly) -maternal health H.R. 2062, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information H.R. 2740, HHS Appropriations (DeLauro) - funding for HHS programs and agencies H.R. 3030, Patient-Centered Outcomes Research Extension Act (DeGette) - PCORI reauthorization H.R. 3180, Resilience Investment, Support, and Expansion from Trauma Act (RISE from Trauma Act) (Davis) -trauma care H.R. 3439, Protecting Access to Information for Effective & Necessary Treatment and Services Act (Beyer) - PCORI reauthorization H.R. 4004, Social Determinants Accelerator Act of 2019 (Bustos)- social determinants of health H.R. 4040, Protecting Access to Spinal Surgeries Act (Lewis)- site neutral IPPS payments H.R. 4215, Excellence in Maternal Health Act of 2019 (Bucshon)- maternal health H.R. 4336, Easy Enrollment Act of 2019 (Bera)- aligning enrollment for exchange plans with tax returns Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, White House Office
S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims S. 1114, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program, health homes for children with medically complex conditions H.R. 2131, Medicare Advantage Quality Payment Relief Act (Kind-Kelly) - MA benchmark cap H.R. 2757, Creating Lower Cost Alternatives for Your Prescription Drugs Act (Cunningham) - eliminate copay for generic drugs in Medicare Part D H.R. 3107, Improving Seniors' Timely Access to Care Act (DelBene) - Medicare Advantage prior authorization H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act (Dingell) - MFP demonstration, spousal impoverishment protections, Medicaid drug rebate program H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act (Neal) - funding for quality measurement initiatives, Medicare coverage of mental health telehealth services, real-time benefit tools in Medicare Part D, Medicare eligibility and enrollment notices H.R. 3461, Community-Based Independence for Seniors Act (Sanchez-Kelly) - Community-Based Institutional Special Needs Plan Discussion Draft, Medicare Part D Reform (Neal-Pallone-Brady-Walden) - maximum out-of-pocket limit, federal reinsurance payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2020 Rate Notice and Call Letter; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
S. 350, Competitive Health Insurance Reform Act (Daines) - McCarran-Ferguson Act S. 455, Marketing and Outreach Restoration to Empower Health Education Act (Shaheen) - funding for outreach and education on ACA Exchanges S. 466, Protecting Americans with Preexisting Conditions Act (Warner) - blocking updated Section 1332 guidance S. 560, Ensuring Lasting Smiles Act (Baldwin) - coverage mandate for treatment of congenital anomaly or birth defect S. 741, Cancer Drug Parity Act (Smith) -- cost sharing for oral anticancer drugs S. 913, Disclosure of Price Information to Enrollees (Braun) S. 961, Improving Health Insurance Affordability Act (Shaheen) - premium tax credits S. 964, Marketplace Certainty Act (Shaheen) - cost-sharing subsidies S. 967, Reducing Costs for Out-of-Network Services Act (Shaheen) - caps on out-of-network charges S. 981, Medicare-X Choice Act (Bennet) - public option S. 1033, CHOICE Act (Whitehouse) - public option S. 1125, Protect Act (Tillis) - pre-existing condition protections S. 1129, Medicare for All Act (Sanders) - government health insurance system S. 1170, Association Health Plans Act (Enzi) - codifying final rule for expanding AHPs S. 1266, Protecting Patients from Surprise Medical Bills Act (Scott) - surprise medical billing S. 1531, STOP Surprise Medical Bills Act (Cassidy-Bennet) - surprise medical billing S. 1576, Behavioral Health Coverage Transparency Act (Warren) - mental health parity S. 1577, Know the Price Act (Cassidy-Bennet) - restrictions on provider contracts S. 1737, Mental Health Parity Compliance Act (Murphy) - mental health parity S. 1948, Chronic Disease Management Act (Thune) - pre-deductible coverage of chronic disease prevention services H.R. 692, Pre-existing Conditions Protection Act (Walden) - pre-existing condition protections H.R. 986, Protecting Americans with Preexisting Conditions Act (Kuster) - blocking updated Section 1332 guidance H.R. 987, Marketing and Outreach Restoration to Empower Health Education Act (Blunt Rochester) - funding for outreach and education on ACA Exchanges, Navigator program, and establishment of state-based Health Insurance Exchanges; drug pricing proposals H.R. 1010, Short-Term Plans (Castor) - blocking final rule that expands short-term plans H.R. 1143, Educating Consumers on the Risks of Short-Term Plans Act (Eshoo) - standardized disclosures for short-term plans H.R. 1379, Ensuring Lasting Smiles Act (Peterson) - coverage mandate for treatment of congenital anomaly or birth defect H.R. 1384, Medicare for All Act (Jayapal) - government health insurance system H.R. 1385, State Allowance for a Variety of Exchanges Act (Kim) - funding for establishment of state-based Health Insurance Exchanges H.R. 1386, Expand Navigators Resources for Outreach, Learning, and Longevity Act (Castor) - funding for Navigator Program H.R. 1418, Competitive Health Insurance Reform Act (DeFazio) - McCarran-Ferguson Act H.R. 1425, State Health Care Premium Reduction Act (Craig) - funding for state reinsurance programs H.R. 1510, Premium Relief Act (Burgess) -- Patient and State Stability Fund H.R. 1730, Cancer Drug Parity Act (Higgins) -- cost sharing for oral anticancer drugs H.R. 1884, Protecting Pre-Existing Conditions and Making Health Care More Affordable Act (Pallone) - reinsurance funding, stabilization and affordability proposals H.R. 2000, Medicare-X Choice Act (Delgado) - public option H.R. 2061, Pathway to Universal Coverage Act (Bera) - auto-enrollment H.R. 2085, CHOICE Act (Schakowsky) - public option H.R. 2183, State Flexibility and Patient Choice Act (Marshall) - flexibility in state innovation waivers H.R. 2848, Parity Enforcement Act (Norcross) - mental health parity H.R. 2874, Behavioral Health Coverage Transparency Act (Kennedy) - mental health parity H.R. 3165, Mental Health Parity Compliance Act (Porter) - mental health parity H.R. 3502, Protecting People From Surprise Medical Bills Act (Ruiz) - surprise medical billing H. Res. 271 (Allred) - resolution urging DOJ to reverse position in Texas v. United States litigation Discussion Draft, No Surprises Act (Pallone-Walden) - surprise medical billing Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.
S. 12, Health Savings Act (Rubio) - HSA improvements S. 80, Jobs and Premium Protection Act - (Barrasso) - health insurance tax S. 172, Health Insurance Tax Relief Act (Gardner) - health insurance tax S. 684, Middle Class Health Benefits Tax Repeal Act (Heinrich) - Cadillac tax on employer-provided coverage S. 1089, Restoring Access to Medication Act (Roberts) - paying for OTC products with HSA funds H.R. 603, Health Savings Account Expansion Act (Gallagher) - HSA improvements H.R. 748, Middle Class Health Benefits Tax Repeal Act (Courtney) - Cadillac tax on employer-provided coverage H.R. 1398, Health Insurance Tax Relief Act (Bera) - health insurance tax H.R. 2447, Jobs and Premium Protection Act (Brindisi) - health insurance tax Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
S. 61, Safe and Affordable Drugs from Canada Act (Grassley) - drug importation S. 64, Preserve Access to Affordable Generics and Biosimilars Act (Grassley-Klobuchar) - prohibiting pay-for-delay settlements S. 73, End Taxpayer Subsidies for Drug Ads Act (Shaheen) - prohibiting tax deduction for DTC advertising expenses S. 102, Prescription Drug Price Relief Act (Sanders) - reforms linked to international pricing S. 340, CREATES Act (Leahy) - removing barriers to generic drugs S. 344, Hatch-Waxman Integrity Act (Tillis) - inter partes review process S. 366, FLAT Prices Act (Durbin) - reforms for drugs with sudden price spikes S. 378, Stop Price Gouging Act (Durbin) - excise tax for drugs that have price spikes S. 440, Preserving Access to Cost-Effective Drugs Act (Cotton) - sovereign immunity and Inter Partes Review process S. 474, SPIKE Act (Wyden) - justification for drug price increases S. 476, Creating Transparency to Have Drug Rebates Unlocked Act (Wyden) - drug price transparency S. 637, CURE High Drug Prices Act (Blumenthal) - remedies for price gouging S. 657, Point of Sale Rebates (Braun) S. 659, Biologic Patent Transparency Act (Collins) - patent disclosure requirements S. 660, Efficiency and Transparency in Petitions Act (Braun) - FDA citizen petition process S. 844, Short on Competition Act (Klobuchar) - remedies for marginally competitive drug markets S. 977, Transparency Drug Pricing Act (Scott) - transparency and drug pricing reforms S. 1209, Reforming Evergreening and Manipulation that Extends Drug Years Act (Cassidy) - preventing evergreening of patent protections S. 1224, Stop STALLING Act (Klobuchar) - citizen petition process S. 1227, Prescription Pricing for the People Act (Grassley) - FTC report on role of PBMs and allegations of anticompetitive conduct by manufacturers of sole-source drugs S. 1384, Prescription Drug Rebate Reform Act (Romney-Braun) - prescription drug cost sharing S. 1416, Affordable Prescriptions for Patients Act (Cornyn) - product hopping, patent thickets S. 1664, Prescription Drug Price Reporting Act (Scott) - prescription drug price reporting H.R. 465, Prescription Drug Price Relief Act (Khanna) - reforms linked to international pricing H.R. 478, Safe and Affordable Drugs from Canada Act (Pingree) - drug importation H.R. 938, BLOCKING Act (Schrader) - changes to 180-day period of market exclusivity for first generic applicant H.R. 965, CREATES Act (Cicilline) - removing barriers to generic drugs H.R. 985, FAST Generics Act (Welch) - removing barriers to generic drugs H.R. 990, Hatch-Waxman Integrity Act (Flores) - inter partes review process H.R. 1093, Stop Price Gouging Act (Pocan) - excise tax for drugs that have price spikes H.R. 1188, FLAT Prices Act (Golden) - reforms for drugs with sudden price spikes H.R. 1344, Competitive DRUGS Act (Doggett) - prohibiting pay-for-delay agreements H.R. 1419, Public Option Deficit Reduction Act (DeFazio) - public option H.R. 1499, Protecting Consumer Access to Generic Drugs Act (Rush) - prohibiting pay-for-delay agreements H.R. 1503, Orange Book Transparency Act (Kelly) - removal of invalidated patents from Orange Book H.R. 1506, FAIR Generics Act (Barragan) - changes to 180-day period of market exclusivity for first generic applicant H.R. 1520, Purple Book Continuity Act (Eshoo) - access to updated information on biologics and biosimilars H.R. 2038, State-Based, Market-Oriented Prescription Drug Negotiations Act (Meadows) - drug price negotiations H.R. 2064, Sunshine for Samples Act (Chu) - reporting requirements on drug samples H.R. 2069, SPIKE Act (Horsford) -justification for drug price increases H.R. 2087, Drug Price Transparency Act (Doggett) - reporting of drug pricing data under Medicare Part B H.R. 2113, Prescription Drug Sunshine, Transparency, Accountability and Reporting Act (Neal) - transparency in drug pricing H.R. 2115, Public Disclosure of Drug Discounts Act (Spanberger) - disclosure of negotiated Rx discounts H.R. 2279, Safe Step Act (Ruiz) - exceptions process for medication step therapy H.R. 2296, FAIR Drug Pricing Act (Schakowsky) - transparency requirements and justification for high list prices and drug price increases H.R. 2374, Stop Significant and Time-wasting Abuse Limiting Legitimate Innovation of New Generics Act (Jeffries) - citizen petition process H.R. 2375, Preserve Access to Affordable Generics and Biosimilars Act (Nadler) - prohibiting pay-for-delay agreements H.R. 2376, Prescription Pricing for the People Act (Collins) - FTC study on role of PBMs and competition and transparency in pharmaceutical supply chain H.R. 3379, Price Relief, Innovation, and Competition for Essential Drugs Act (Schakowsky) - exclusivity period for biological products Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to prescription drug rebates; issues relating to prescription drug price blueprint; direct-to-consumer advertising for prescription drugs; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
S. 350, Competitive Health Insurance Reform Act (Daines) - McCarran-Ferguson Act S. 455, Marketing and Outreach Restoration to Empower Health Education Act (Shaheen) - funding for outreach and education on ACA Exchanges S. 466, Protecting Americans with Preexisting Conditions Act (Warner) - blocking updated Section 1332 guidance S. 560, Ensuring Lasting Smiles Act (Baldwin) - coverage mandate for treatment of congenital anomaly or birth defect S. 741, Cancer Drug Parity Act (Smith) -- cost sharing for oral anticancer drugs S. 913, Disclosure of Price Information to Enrollees (Braun) S. 961, Improving Health Insurance Affordability Act (Shaheen) - premium tax credits S. 964, Marketplace Certainty Act (Shaheen) - cost-sharing subsidies S. 967, Reducing Costs for Out-of-Network Services Act (Shaheen) - caps on out-of-network charges S. 981, Medicare-X Choice Act (Bennet) - public option H.R. 692, Pre-existing Conditions Protection Act (Walden) - pre-existing condition protections H.R. 986, Protecting Americans with Preexisting Conditions Act (Kuster) - blocking updated Section 1332 guidance H.R. 987, Marketing and Outreach Restoration to Empower Health Education Act (Blunt Rochester) - funding for outreach and education on ACA Exchanges H.R. 1010, Short-Term Plans (Castor) - blocking final rule that expands short-term plans H.R. 1143, Educating Consumers on the Risks of Short-Term Plans Act (Eshoo) - standardized disclosures for short-term plans H.R. 1379, Ensuring Lasting Smiles Act (Peterson) - coverage mandate for treatment of congenital anomaly or birth defect H.R. 1385, State Allowance for a Variety of Exchanges Act (Kim) - funding for establishment of state-based Health Insurance Exchanges H.R. 1386, Expand Navigators Resources for Outreach, Learning, and Longevity Act (Castor) - funding for Navigator Program H.R. 1418, Competitive Health Insurance Reform Act (DeFazio) - McCarran-Ferguson Act H.R. 1425, State Health Care Premium Reduction Act (Craig) - funding for state reinsurance programs H.R. 1510, Premium Relief Act (Burgess) -- Patient and State Stability Fund H.R. 1730, Cancer Drug Parity Act (Higgins) -- cost sharing for oral anticancer drugs H.R. 1884, Protecting Pre-Existing Conditions and Making Health Care More Affordable Act (Pallone) - reinsurance funding, stabilization and affordability proposals H.R. 2000, Medicare-X Choice Act (Delgado) - public option H.R. 2061, Auto-Enrollment (Bera) Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues relating to the individual market; and other issues relating to health care reform implementation.
S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1384, Medicare for All Act (Jayapal) - Medicare for All health care system H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program Draft Medicare Advantage Quality Payment Relief Act (Kelly-Kind) - MA benchmark cap Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2019 Rate Notice and Call Letter; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
S. 12, Health Savings Act (Rubio) - HSA improvements S. 80, Jobs and Premium Protection Act - (Barrasso) - health insurance tax S. 172, Health Insurance Tax Relief Act (Gardner) - health insurance tax S. 684, Middle Class Health Benefits Tax Repeal Act (Heinrich) - Cadillac tax on employer-provided coverage H.R. 603, Health Savings Account Expansion Act (Gallagher) - HSA improvements H.R. 748, Middle Class Health Benefits Tax Repeal Act (Courtney) - Cadillac tax on employer-provided coverage H.R. 1398, Health Insurance Tax Relief Act (Bera) - health insurance tax Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 525, Strengthening the Health Care Fraud Prevention Task Force Act (Walden) - codification of Healthcare Fraud Prevention Partnership H.R. 506, Hospital Competition Act (Banks) - hospital consolidation H.R. 861, End Surprise Billing Act (Doggett) - surprise medical bills H.R. 1409. Transparency in All Health Care Pricing Act (Perlmutter) - transparency in health care pricing H.R. 2062, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information S. 1012, The Protecting Jessica Grubbs Legacy Act (Capito) - confidential sharing of substance use disorder information Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Council of Economic Advisers (CEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
S. 297, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug costs S. 974, CREATES Act (Leahy-Grassley) - access to generic drugs and biosimilars S. 1115, Making Pharmaceutical Markets More Competitive Act (Collins-McCaskill) - accelerated approval of generic therapies S. 1131, FAIR Drug Pricing Act (Baldwin-McCain) - transparency in prescription drug pricing S. 2553, Know the Lowest Price Act (Stabenow) - pharmacist-patient communications S. 2554, Patient Right to Know Drug Prices Act (Collins) - pharmacist-patient communications, reporting of biosimilar pay-for-delay settlements S. 3194, Capping Prescription Costs Act (Warren) - capping prescription copays S. 3738, Hatch-Waxman Integrity Act (Hatch) - inter partes review process S. 3792, Preserve Access to Affordable Generics and Biosimilars Act (Klobuchar-Grassley) - pay-for-delay settlements H.R. 749, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug costs H.R. 1703, Medical Product Communication Act (Griffith) - off-label exchange of information H.R. 2026, Pharmaceutical Information Exchange Act (Guthrie) - pre-approval health care economic information to payors H.R. 2051, Fair Access for Safe and Timely Generics Act (McKinley-Welch) - access to generic drugs H.R. 2212, CREATES Act (Marino-Cicilline) - access to generic drugs and biosimilars H.R. 2439, FAIR Drug Pricing Act (Schakowsky) - transparency in prescription drug pricing H.R. 2562, Making Pharmaceutical Markets More Competitive Act (Kelly) - accelerated approval of generic therapies H.R. 2999, Patients' Access to Treatments Act (McKinley) - limiting cost sharing in specialty drug tiers H.R. 5247, Right to Try Act (Fitzpatrick) - use of unapproved investigational drugs by patients with life-threatening conditions H.R. 6142, Reducing Drug Waste Act (Doggett) - packaging of medications H.R. 6157, Defense-Labor-HHS-Education Appropriations Act (Granger) -pharmaceutical price transparency in DTC advertising H.R. 6340, Capping Prescription Costs Act (Rosen) - capping prescription copays H.R. 6478, Biosimilars Competition Act (Sarbanes) - reporting of pay-for-delay settlements H.R. 6576, Drug-Price Transparency in Communications Act (Schakowsky) - disclosure of drug prices in DTC advertising H.R. 6733, Know the Cost Act (Carter) - pharmacist-patient communications H.R. 7251, Hatch-Waxman Integrity Act (Flores) - inter partes review process Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to prescription drug rebates; issues relating to prescription drug price blueprint; direct-to-consumer advertising for prescription drugs; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Bipartisan Health Care Stabilization Act (Alexander-Murray) - funding for cost sharing reduction benefits, stabilization of individual market Bipartisan Health Care Stabilization Act; updated version (Alexander-Walden-Collins-Costello) - funding for cost sharing reduction benefits and reinsurance, stabilization of individual market S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 581, Jessies Law (Manchin-Capito) - patient history of opioid use disorder S. 1201, Health Care Options for All Act (McCaskill) - coverage options in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction benefits S. 1516, Coverage Across State Lines (Heller) S. 1667, Protecting Consumers from Unreasonable Rates Act (Feinstein) - rate review S. 1835, Lower Premiums Through Reinsurance Act (Collins-Nelson) - invisible high risk pool and reinsurance programs S. 1976, Increasing Access to Care Act (Scott) - copper plan S. 1985, Protect Access to Birth Control Act (Murray) - coverage of contraceptive services S. 2052, Healthcare Market Certainty and Mandate Relief Act (Hatch) - funding for cost sharing reduction benefits, HSA improvements, ACA individual mandate S. 2241 (King) - fees on excepted benefits and standalone dental plans S. 2303, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - calculation of medical loss ratios S. 3388, Ensuring Coverage for Patients with Pre-Existing Conditions Act (Tillis) - protections for individuals with pre-existing conditions S. 3541, Reducing Costs for Out-of-Network Services Act (Shaheen) -cost-sharing for out-of-network services S. 3592, No More Surprise Medical Bills Act (Hassan) - surprise medical bills S. 3742, Cancer Drug Parity Act (Smith) - cost sharing for cancer drugs H.R. 2, Agriculture and Nutrition Act (Conaway) - agricultural association health plans H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 421, Allowing Greater Access to Safe and Effective Contraception Act (Love) - non-prescription contraceptives, HSA flexibility H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 1606, DOC Access Act (Carter) - reimbursement for dental and vision providers H.R. 3450, Protecting Consumers from Unreasonable Rates Act (Schakowsky) - rate review H.R. 3545, Overdose Prevention and Patient Safety Act (Murphy- Blumenauer) -- confidentiality of drug and alcohol treatment and prevention records H.R. 3976, Access to Marketplace Insurance Act (Cramer) - third party payments H.R. 4082, Protect Access to Birth Control Act (DeGette) - coverage of contraceptive services H.R. 4200, Healthcare Market Certainty and Mandate Relief Act (Brady) - funding for cost sharing reduction benefits, HSA improvements H.R. 4225 (Hudson) - fees on excepted benefits and standalone dental plans H.R. 4575, Access to Independent Health Insurance Advisors Act (Long-Schrader) - calculation of medical loss ratios H.R. 4666, Premium Relief Act (Costello) - Patient and State Stability Fund H.R. 4695, Bipartisan Market Stabilization and Innovation Act (Schrader) - stabilization of individual market H.R. 6311, Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act (Roskam) - access to catastrophic plans, definition of qualified health plans H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan H.R. 6496, Continuing Coverage for Preexisting Conditions Act (Joyce) - protections for individuals with pre-existing conditions H.R. 7003, Federal Invisible Risk Sharing Program (Schweikert) Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.
S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 1016, CONNECT For Health Act (Schatz) - telehealth S. 1169, Medicaid CARE Act (Durbin-Portman) - changes to Medicaid IMD exclusion S. 1688, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 1804, Medicare for All Act (Sanders) - single payer health system S. 1890, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Cardin) - Medigap coverage for beneficiaries with end-stage renal disease S. 1909, BENES Act (Casey) - notifications of Medicare eligibility S. 2027, Medicaid Third Party Liability Act (Portman) - Medicaid third party liability S. 2051, Medicare Care Coordination Improvement Act of 2017 (Portman) - barriers to payment reform models S. 2227, EMPOWER Care Act (Portman-Cantwell) - Medicaid Money Follows the Person Demonstration S. 2707, Informing Seniors About Opioids Act (Nelson) - opioid issues S. 2901, Expanding Telehealth Response to Ensure Addiction Treatment Act (Thune) - opioid issues S. 2904, Medicaid Substance Use Disorder Treatment Via Telehealth Act (Carper) - opioid issues S. 2908, Electronic Prior Authorization in Medicare Part D Act (Roberts) - opioid issues S. 3327, SENIOR Communities Protection Act (Cortez Masto) - preventing fraudulent opioid prescriptions S. 3496, Improving Seniors Access to Quality Benefits Act (Daines-King) - study on MA benchmark cap S. 3497, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap S. 3702, Right Rebate Act (Wyden-Grassley) - Medicaid drug rebate program Draft Bill: Medicare Long-Term Care Services and Supports Act (Pallone) - Long-Term Services and Supports Program H.R. 6, SUPPORT Patients and Families Act (Walden) - opioid initiatives, Medicare and Medicaid issues, budget offsets H.R. 695, Continuing Appropriations Act (Schiff) - Money Follows the Person demonstration, spousal impoverishment protections H.R. 849, Protecting Seniors Access to Medicare Act (Roe) - Independent Payment Advisory Board H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1148, FAST Act (Griffith) - access to telehealth-eligible stroke services under Medicare H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 2556, CONNECT For Health Act (Black) - telehealth H.R. 2575, BENES Act (Ruiz) - notifications of Medicare eligibility H.R. 2644, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Marino) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 2687, Medicaid CARE Act (Foster-Fitzpatrick) - changes to Medicaid IMD exclusion H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) H.R. 3263, Medicare Independence at Home Model of Care (Burgess) - demonstration program H.R. 3325, ACE Kids Act (Barton) - health homes for children with complex medical conditions H.R. 3360, Telehealth Enhancement Act (Harper) - telehealth in Medicare H.R. 3635, Local Coverage Determination Clarification Act (Jenkins) - procedures for Medicare administrative contractors H.R. 3727, Increasing Telehealth Access in Medicare Act (Black) - telehealth in MA plans H.R. 4143, Dialysis PATIENTS Demonstration Act (Smith) - alternative care delivery models and payment methodologies for patients with end-stage renal disease H.R. 4952, Improving Seniors Access to Quality Benefits Act (Kelly) - MA benchmark cap study H.R. 5306, EMPOWER Care Act (Guthrie) - extension of Money Follows the Person demonstration H.R. 5603, Access to Telehealth Services for Substance Use Disorders Act (Matsui) - opioid issues H.R. 5605, Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act (Ruiz) - opioid issues H.R. 5675, drug management programs for at-risk Medicare beneficiaries (Bilirakis) - opioid issues H.R. 5676, SENIOR Communities Protection Act (MacArthur) - preventing fraudulent opioid prescriptions H.R. 5684, Protecting Seniors from Opioid Abuse Act (Kelly) - opioid issues H.R. 5685, Medicare Opioid Safety Education Act (Faso) - opioid issues H.R. 5686, Medicare Clear Health Options in Care for Enrollees Act (Paulsen) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - communication between Medicare plan sponsors and CMS H.R. 5773, Preventing Addiction for Susceptible Seniors Act (Roskam) - opioid issues H.R. 5797, IMD CARE Act (Walters) - Medicaid IMD exclusion H.R. 5798, Opioid Screening and Chronic Pain Management Alternatives for Seniors Act (Bucshon) - opioid issues H.R. 5799, Medicaid Drug Review, Utilization, Good Governance Improvement Act (Blackburn) - opioid issues H.R. 5800, Medicaid IMD ADDITIONAL INFO Act (Upton) - opioid issues H.R. 5804, Post-Surgical Injections as an Opioid Alternative Act (Shimkus) - opioid issues H.R. 5808, Medicaid Pharmaceutical Home Act (Bilirakis) - opioid issues H.R. 5809, Postoperative Opioid Prevention Act (Peters) - opioid issues H.R. 5810, Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act (Lance) - opioid issues H.R. 5812, Improving Medicaid Data Timeliness Act (Griffith) - opioid issues H.R. 6431, Medigap Consumer Protection Act (Levin) - reforms to Medicare supplemental insurance H.R. 6561, Comprehensive Care for Seniors Act (Walorski) -- Program of All-Inclusive Care for the Elderly H.R. 6563, Lower Out-of-Pocket Costs for Seniors Act (Pallone-Neal) - Medicare Part D cliff H.R. 6662, Empowering Seniors Decision Enrollment Act (Paulsen) - special enrollment period for non-deemed Medicare Cost Plan enrollees H.R. 6690, Fighting Fraud to Protect Care for Seniors Act (Roskam) - Medicare pilot program for smart card technology H.R. 7122, Shared Accountability for Improved Patient Outcomes Act (Paulsen) - value-based payment and delivery arrangements H.R. 7217, IMPROVE Act (Barton) - Money Follows the Person demonstration, ACE Kids Act, Medicare drug rebate program, spousal impoverishment protections H.R. 7223, Right Rebate Act (Schrader-Welch) - Medicaid drug rebate program H.R. 7247, Incentivizing Shared Risk in Medicare Advantage Act (Brady) - MA prior authorization H.R. 7249, Better Prior Authorization Notification Act (Reed) - MA prior authorization H.R. 7250, Prior Authorization Improvement Act (Kelly) - MA prior authorization Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2019 Rate Notice and Call Letter; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax S. 2410, Chronic Disease Management Act (Thune) - flexibility for high-deductible health plans S. 3063, Health Insurance Tax Relief Act (Barrasso) - suspension of ACA health insurance tax H.R. 88, Retirement, Savings, and Other Tax Relief Act - relief from health insurance tax and Cadillac tax H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 3798, Save American Workers Act (Walorski) - delay in Cadillac tax H.R. 4616 (Nunes) - delay in ACA excise tax on employer-provided health coverage H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4620, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax H.R. 4894, Harmful Tax Prevention Act (Noem) - relief from ACA health insurance tax H.R. 4978, Chronic Disease Management Act (Black) - flexibility for high-deductible health plans H.R. 5138, Bipartisan HSA Improvement Act (Kelly) - HSA changes H.R. 5963, Health Insurance Premium Reduction Act (Noem) - suspension of ACA health insurance tax H.R. 6199, Restoring Access to Medication Act (Jenkins) - OTC medical products as qualified medical expense, HSA improvements H.R. 6301, Promoting High-Value Health Care Through Flexibility for High Deductible Health Plans Act (Roskam) - flexibility on first dollar coverage for HSA plans H.R. 6305, Bipartisan HSA Improvement Act (Kelly) - HSA flexibility; treatment of certain employment-related services; FSA and HRA conversions H.R. 6306, Health Care Security Act (Paulsen) - HSA contribution limits, spousal catch-up contributions, grace period for medical expenses H.R. 6309, Allowing Working Seniors to Keep Their Health Savings Accounts Act (Paulsen) - HSA contributions by Medicare-eligible individuals H.R. 6311, Increasing Access to Lower Premium Plans and Expanding HSAs Act (Roskam) - suspension of health insurance tax, HSA improvements H.R. 6312, Personal Health Investment Today Act (Smith) - medical care tax deduction for qualified sports and fitness expenses H.R. 6313, RAISE Health Benefits Act (Stivers) - Health FSA rollovers H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan H.R. 6317, Primary Care Enhancement Act (Paulsen) - participation by HSA-eligible individuals in direct primary care (DPC) arrangements Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
S. 297, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug costs S. 974, CREATES Act (Leahy-Grassley) - access to generic drugs and biosimilars S. 1115, Making Pharmaceutical Markets More Competitive Act (Collins-McCaskill) - accelerated approval of generic therapies S. 1131, FAIR Drug Pricing Act (Baldwin-McCain) - transparency in prescription drug pricing S. 2553, Know the Lowest Price Act (Stabenow) - pharmacist-patient communications S. 2554, Patient Right to Know Drug Prices Act (Collins) - pharmacist-patient communications, reporting of biosimilar pay-for-delay settlements S. 3194, Capping Prescription Costs Act (Warren) - capping prescription copays S. 3738, Hatch-Waxman Integrity Act (Hatch) - inter partes review process S. 3792, Preserve Access to Affordable Generics and Biosimilars Act (Klobuchar-Grassley) - pay-for-delay settlements H.R. 749, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug costs H.R. 1703, Medical Product Communication Act (Griffith) - off-label exchange of information H.R. 2026, Pharmaceutical Information Exchange Act (Guthrie) - pre-approval health care economic information to payors H.R. 2051, Fair Access for Safe and Timely Generics Act (McKinley-Welch) - access to generic drugs H.R. 2212, CREATES Act (Marino-Cicilline) - access to generic drugs and biosimilars H.R. 2439, FAIR Drug Pricing Act (Schakowsky) - transparency in prescription drug pricing H.R. 2562, Making Pharmaceutical Markets More Competitive Act (Kelly) - accelerated approval of generic therapies H.R. 2999, Patients' Access to Treatments Act (McKinley) - limiting cost sharing in specialty drug tiers H.R. 5247, Right to Try Act (Fitzpatrick) - use of unapproved investigational drugs by patients with life-threatening conditions H.R. 6142, Reducing Drug Waste Act (Doggett) - packaging of medications H.R. 6157, Defense-Labor-HHS-Education Appropriations Act (Granger) -pharmaceutical price transparency in DTC advertising H.R. 6340, Capping Prescription Costs Act (Rosen) - capping prescription copays H.R. 6478, Biosimilars Competition Act (Sarbanes) - reporting of pay-for-delay settlements H.R. 6576, Drug-Price Transparency in Communications Act (Schakowsky) - disclosure of drug prices in DTC advertising H.R. 6733, Know the Cost Act (Carter) - pharmacist-patient communications H.R. 7251, Hatch-Waxman Integrity Act (Flores) - inter partes review process Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to prescription drug rebates; issues relating to prescription drug price blueprint; direct-to-consumer advertising for prescription drugs; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
S. 1850, Legacy Act (Manchin-Capito) -- confidentiality of drug and alcohol treatment and prevention records S. 2460, Every Prescription Conveyed Securely Act (Bennet) - opioid issues S. 2680, Opioid Crisis Response Act (Alexander) - opioid initiatives, mental health parity S. 2789, Substance Abuse Prevention Act (Cornyn) - opioid initiatives, restrictions on step therapy S. 2812, Air Ambulance Consumer Protection Act (McCaskill) - air ambulance S. 2828, Sober Home Fraud Detection Act (Rubio) - best practices for identifying fraud in recovery housing S. 2891, Fighting the Opioid Epidemic with Sunshine Act (Grassley) - opioid issues S. 2892, Peer Support Enhancement and Evaluation Review Act (Cardin) - opioid issues S. 2898, Medication-Assisted Treatment Improvement Act (Casey) - opioid issues S. 2899, Caring Recovery for Infants and Babies Act (Brown) - opioid issues S. 2900, Comprehensive Screenings for Seniors Act (Brown) - opioid issues S. 2902, Better Data Sharing to Combat the Opioid Crisis Act (Cassidy) - opioid issues S. 2905, Strengthening Partnerships to Prevent Opioid Abuse Act (Toomey) - opioid issues S. 2910, Telehealth for Childrens Access to Services and Treatment Act (Roberts) - opioid issues S. 2911, Enhancing Patient Access to Non-Opioid Treatment Options (Heller) - opioid issues S. 2912, Opioid Addiction Treatment Programs Enhancement Act (Cassidy) - opioid issues S. 2920, Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act (McCaskill) - opioid issues S. 2922, Help for Moms and Babies Act (Stabenow) - opioid issues S. 2923, Building Capacity for Family-Focused Residential Treatment Act (Grassley) - opioid issues S. 2924, Supporting Family-Focused Residential Treatment Act (Scott) - opioid issues S. 3016, Action for Dental Health Act (Booker) - grants for oral health programs S. 3120, the HEAL Substance Use Disorders Act (Hatch) - opioid initiatives S. 3158, Labor-HHS-Education Appropriations Act (Blunt) - HHS funding S. 3254, Eliminating Kickbacks in Recovery Act (Rubio) - anti-kickback penalties for body brokers Draft Bill: Protecting Patients From Surprise Medical Bills Act (Cassidy) - surprise medical bills H.R. 6, SUPPORT Patients and Families Act (Walden) - opioid initiatives, Medicare and Medicaid issues, budget offsets H.R. 302, FAA Reauthorization Act - air ambulance issues H.R. 1215, Protecting Access to Care Act (King) - medical liability reform H.R. 1313, Preserving Employee Wellness Programs Act (Foxx) - employee wellness programs H.R. 2422, Action for Dental Health Act (Kelly) - oral health services and education for underserved populations H.R. 3331, adoption and use of EHR technology by behavioral health providers (Jenkins) - opioid issues H.R. 3528, Every Prescription Conveyed Securely Act (Clark) - opioid issues H.R. 4684, Ensuring Access to Quality Sober Living Act (Chu) - best practices for recovery housing H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act (Schweikert) - opioid issues H.R. 4998, Health Insurance for Former Foster Youth Act (Bass) - opioid issues H.R. 5100, Recovery Home Certification Act (Knight) -- anti-kickback penalties for body brokers H.R. 5477, Rural DOCS Act (O'Halleran) - opioid issues H.R. 5515, National Defense Authorization Act (Thornberry) H.R. 5562, Protecting NAS Babies Act (Jenkins) - opioid issues H.R. 5582, Abuse Deterrent Access Act (Carter) - opioid issues H.R. 5583, State reporting on certain adult health quality measures (Clarke) - opioid issues H.R. 5590, CMS Action Plan (Kinzinger) - opioid issues H.R. 5714, Education for Disposal of Unused Opioids Act (Black) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - opioid issues H.R. 5716, COMPASS Act (Roskam) - opioid issues H.R. 5723, Expanding Oversight of Opioid Prescribing and Payment Act (Tenney) - opioid issues H.R. 5725, BEST Act (Roskam) - opioid issues H.R. 5774, Combating Opioid Abuse for Care in Hospitals Act (Curbelo) - opioid issues H.R. 5775, Providing Reliable Options for Patients and Educational Resources Act (Paulsen) - opioid issues H.R. 5776, MOST Act (Neal) - opioid issues H.R. 5789, protections for pregnant and post-partum women (Foster) - opioid issues H.R. 5795, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information H.R. 5796, Responsible Education Achieves Care and Healthy Outcomes for Users' Treatment Act (Fitzpatrick) - opioid issues H.R. 5801, PARTNERSHIP Act (Griffith) - opioid issues H.R. 6082, Overdose Prevention and Patient Safety Act (Mullin) - confidential sharing of substance use disorder information H.R. 6147, Interior, Environment, Financial Services, Agriculture, FDA, Transportation, and Housing Appropriations Act (Calvert) - FDA funding H.R. 6157, Defense-Labor-HHS-Education Appropriations Act (Granger) - HHS funding H.R. 6753, Strengthening the Health Care Fraud Prevention Task Force Act (Walden) - codification of Healthcare Fraud Prevention Partnership H.R. 6878, Eliminating Kickbacks in Recovery Act (Deutch) - anti-kickback penalties for body brokers H.R. 6902, Eliminating Kickbacks in Recovery Act (Knight) - anti-kickback penalties for body brokers Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.
Bipartisan Health Care Stabilization Act (Alexander-Murray) - funding for cost sharing reduction benefits, stabilization of individual market Bipartisan Health Care Stabilization Act; updated version (Alexander-Walden-Collins-Costello) - funding for cost sharing reduction benefits and reinsurance, stabilization of individual market S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 581, Jessies Law (Manchin-Capito) - patient history of opioid use disorder S. 1201, Health Care Options for All Act (McCaskill) - coverage options in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction benefits S. 1516, Coverage Across State Lines (Heller) S. 1667, Protecting Consumers from Unreasonable Rates Act (Feinstein) - rate review S. 1835, Lower Premiums Through Reinsurance Act (Collins-Nelson) - invisible high risk pool and reinsurance programs S. 1976, Increasing Access to Care Act (Scott) - copper plan S. 1985, Protect Access to Birth Control Act (Murray) - coverage of contraceptive services S. 2052, Healthcare Market Certainty and Mandate Relief Act (Hatch) - funding for cost sharing reduction benefits, HSA improvements, ACA individual mandate S. 2241 (King) - fees on excepted benefits and standalone dental plans S. 2303, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - calculation of medical loss ratios S. 3388, Ensuring Coverage for Patients with Pre-Existing Conditions Act (Tillis) - protections for individuals with pre-existing conditions S. 3541, Reducing Costs for Out-of-Network Services Act (Shaheen) -cost-sharing for out-of-network services S. 3592, No More Surprise Medical Bills Act (Hassan) - surprise medical bills S. 3742, Cancer Drug Parity Act (Smith) - cost sharing for cancer drugs H.R. 2, Agriculture and Nutrition Act (Conaway) - agricultural association health plans H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 421, Allowing Greater Access to Safe and Effective Contraception Act (Love) - non-prescription contraceptives, HSA flexibility H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 1606, DOC Access Act (Carter) - reimbursement for dental and vision providers H.R. 3450, Protecting Consumers from Unreasonable Rates Act (Schakowsky) - rate review H.R. 3545, Overdose Prevention and Patient Safety Act (Murphy- Blumenauer) -- confidentiality of drug and alcohol treatment and prevention records H.R. 3976, Access to Marketplace Insurance Act (Cramer) - third party payments H.R. 4082, Protect Access to Birth Control Act (DeGette) - coverage of contraceptive services H.R. 4200, Healthcare Market Certainty and Mandate Relief Act (Brady) - funding for cost sharing reduction benefits, HSA improvements H.R. 4225 (Hudson) - fees on excepted benefits and standalone dental plans H.R. 4575, Access to Independent Health Insurance Advisors Act (Long-Schrader) - calculation of medical loss ratios H.R. 4666, Premium Relief Act (Costello) - Patient and State Stability Fund H.R. 4695, Bipartisan Market Stabilization and Innovation Act (Schrader) - stabilization of individual market H.R. 6311, Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act (Roskam) - access to catastrophic plans, definition of qualified health plans H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan H.R. 6496, Continuing Coverage for Preexisting Conditions Act (Joyce) - protections for individuals with pre-existing conditions H.R. 7003, Federal Invisible Risk Sharing Program (Schweikert) Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.
S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax S. 2410, Chronic Disease Management Act (Thune) - flexibility for high-deductible health plans S. 3063, Health Insurance Tax Relief Act (Barrasso) - suspension of ACA health insurance tax H.R. 88, Retirement, Savings, and Other Tax Relief Act - relief from health insurance tax and Cadillac tax H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 3798, Save American Workers Act (Walorski) - delay in Cadillac tax H.R. 4616 (Nunes) - delay in ACA excise tax on employer-provided health coverage H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4620, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax H.R. 4894, Harmful Tax Prevention Act (Noem) - relief from ACA health insurance tax H.R. 4978, Chronic Disease Management Act (Black) - flexibility for high-deductible health plans H.R. 5138, Bipartisan HSA Improvement Act (Kelly) - HSA changes H.R. 5963, Health Insurance Premium Reduction Act (Noem) - suspension of ACA health insurance tax H.R. 6199, Restoring Access to Medication Act (Jenkins) - OTC medical products as qualified medical expense, HSA improvements H.R. 6301, Promoting High-Value Health Care Through Flexibility for High Deductible Health Plans Act (Roskam) - flexibility on first dollar coverage for HSA plans H.R. 6305, Bipartisan HSA Improvement Act (Kelly) - HSA flexibility; treatment of certain employment-related services; FSA and HRA conversions H.R. 6306, Health Care Security Act (Paulsen) - HSA contribution limits, spousal catch-up contributions, grace period for medical expenses H.R. 6309, Allowing Working Seniors to Keep Their Health Savings Accounts Act (Paulsen) - HSA contributions by Medicare-eligible individuals H.R. 6311, Increasing Access to Lower Premium Plans and Expanding HSAs Act (Roskam) - suspension of health insurance tax, HSA improvements H.R. 6312, Personal Health Investment Today Act (Smith) - medical care tax deduction for qualified sports and fitness expenses H.R. 6313, RAISE Health Benefits Act (Stivers) - Health FSA rollovers H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan H.R. 6317, Primary Care Enhancement Act (Paulsen) - participation by HSA-eligible individuals in direct primary care (DPC) arrangements Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
S. 297, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug costs S. 974, CREATES Act (Leahy-Grassley) - access to generic drugs and biosimilars S. 1115, Making Pharmaceutical Markets More Competitive Act (Collins-McCaskill) - accelerated approval of generic therapies S. 1131, FAIR Drug Pricing Act (Baldwin-McCain) - transparency in prescription drug pricing S. 2553, Know the Lowest Price Act (Stabenow) - pharmacist-patient communications, S. 2554, Patient Right to Know Drug Prices Act (Collins) - pharmacist-patient communications, reporting of biosimilar pay-for-delay settlements S. 3194, Capping Prescription Costs Act (Warren) - capping prescription copays H.R. 749, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug costs H.R. 1703, Medical Product Communication Act (Griffith) - off-label exchange of information H.R. 2026, Pharmaceutical Information Exchange Act (Guthrie) - pre-approval health care economic information to payors H.R. 2051, Fair Access for Safe and Timely Generics Act (McKinley-Welch) - access to generic drugs H.R. 2212, CREATES Act (Marino-Cicilline) - access to generic drugs and biosimilars H.R. 2439, FAIR Drug Pricing Act (Schakowsky) - transparency in prescription drug pricing H.R. 2562, Making Pharmaceutical Markets More Competitive Act (Kelly) - accelerated approval of generic therapies H.R. 2999, Patients' Access to Treatments Act (McKinley) - limiting cost sharing in specialty drug tiers H.R. 5247, Right to Try Act (Fitzpatrick) - use of unapproved investigational drugs by patients with life-threatening conditions H.R. 6142, Reducing Drug Waste Act (Doggett) - packaging of medications H.R. 6157, Defense-Labor-HHS-Education Appropriations Act (Granger) -pharmaceutical price transparency in DTC advertising H.R. 6340, Capping Prescription Costs Act (Rosen) - capping prescription copays H.R. 6478, Biosimilars Competition Act (Sarbanes) - reporting of pay-for-delay settlements H.R. 6576, Drug-Price Transparency in Communications Act (Schakowsky) - disclosure of drug prices in DTC advertising H.R. 6733, Know the Cost Act (Carter) - pharmacist-patient communications Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues relating to opioids; issues relating to prescription drug price blueprint; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 1016, CONNECT For Health Act (Schatz) - telehealth S. 1169, Medicaid CARE Act (Durbin-Portman) - changes to Medicaid IMD exclusion S. 1688, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 1804, Medicare for All Act (Sanders) - single payer health system S. 1827, Keep Kids Insurance Dependable and Secure Act (Hatch-Wyden) - federal CHIP funding S. 1890, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Cardin) - Medigap coverage for beneficiaries with end-stage renal disease S. 2027, Medicaid Third Party Liability Act (Portman) - Medicaid third party liability S. 2227, EMPOWER Care Act (Portman-Cantwell) - Medicaid Money Follows the Person Demonstration S. 2707, Informing Seniors About Opioids Act (Nelson) - opioid issues S. 2901, Expanding Telehealth Response to Ensure Addiction Treatment Act (Thune) - opioid issues S. 2904, Medicaid Substance Use Disorder Treatment Via Telehealth Act (Carper) - opioid issues S. 2908, Electronic Prior Authorization in Medicare Part D Act (Roberts) - opioid issues S. 3327, SENIOR Communities Protection Act (Cortez Masto) - preventing fraudulent opioid prescriptions S. 3496, Improving Seniors Access to Quality Benefits Act (Daines-King) - study on MA benchmark cap S. 3497, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap Draft Bill: Medicare Long-Term Care Services and Supports Act (Pallone) - Long-Term Services and Supports Program Draft Bills: Prior Authorization in Medicare Advantage (House Ways and Means Committee) - prior authorization notifications, report to Congress S. 2051: Medicare Care Coordination Improvement Act of 2017 (Portman) - barriers to payment reform models H.R. 849, Protecting Seniors Access to Medicare Act (Roe) - Independent Payment Advisory Board H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1148, FAST Act (Griffith) - access to telehealth-eligible stroke services under Medicare H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 2556, CONNECT For Health Act (Black) - telehealth H.R. 2644, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Marino) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 2687, Medicaid CARE Act (Foster-Fitzpatrick) - changes to Medicaid IMD exclusion H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) H.R. 3168, Special Needs Plans (Tiberi-Levin) - SNP reauthorization H.R. 3263, Medicare Independence at Home Model of Care (Burgess) - demonstration program H.R. 3325, ACE Kids Act (Barton) - health homes for children with complex medical conditions H.R. 3360, Telehealth Enhancement Act (Harper) - telehealth in Medicare H.R. 3635, Local Coverage Determination Clarification Act (Jenkins) - procedures for Medicare administrative contractors H.R. 3727, Increasing Telehealth Access in Medicare Act (Black) - telehealth in MA plans H.R. 4143, Dialysis PATIENTS Demonstration Act of 2017 (Smith) - alternative care delivery models and payment methodologies for patients with end-stage renal disease H.R. 4952, Improving Seniors Access to Quality Benefits Act (Kelly) - MA benchmark cap study H.R. 5306, EMPOWER Care Act (Guthrie) - extension of Money Follows the Person Act H.R. 5603, Access to Telehealth Services for Substance Use Disorders Act (Matsui) - opioid issues H.R. 5605, Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act (Ruiz) - opioid issues H.R. 5675, drug management programs for at-risk Medicare beneficiaries (Bilirakis) - opioid issues H.R. 5676, SENIOR Communities Protection Act (MacArthur) - preventing fraudulent opioid prescriptions H.R. 5684, Protecting Seniors from Opioid Abuse Act (Kelly) - opioid issues H.R. 5685, Medicare Opioid Safety Education Act (Faso) - opioid issues H.R. 5686, Medicare Clear Health Options in Care for Enrollees Act (Paulsen) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - communication between Medicare plan sponsors and CMS H.R. 5773, Preventing Addiction for Susceptible Seniors Act (Roskam) - opioid issues H.R. 5797, IMD CARE Act (Walters) - Medicaid IMD exclusion H.R. 5798, Opioid Screening and Chronic Pain Management Alternatives for Seniors Act (Bucshon) - opioid issues H.R. 5799, Medicaid Drug Review, Utilization, Good Governance Improvement Act (Blackburn) - opioid issues H.R. 5800, Medicaid IMD ADDITIONAL INFO Act (Upton) - opioid issues H.R. 5804, Post-Surgical Injections as an Opioid Alternative Act (Shimkus) - opioid issues H.R. 5808, Medicaid Pharmaceutical Home Act (Bilirakis) - opioid issues H.R. 5809, Postoperative Opioid Prevention Act (Peters) - opioid issues H.R. 5810, Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act (Lance) - opioid issues H.R. 5812, Improving Medicaid Data Timeliness Act (Griffith) - opioid issues H.R. 6431, Medigap Consumer Protection Act (Levin) - reforms to Medicare supplemental insurance H.R. 6561, Comprehensive Care for Seniors Act (Walorski) -- Program of All-Inclusive Care for the Elderly H.R. 6563, Lower Out-of-Pocket Costs for Seniors Act (Pallone-Neal) - Medicare Part D cliff H.R. 6662, Empowering Seniors Decision Enrollment Act (Paulsen) - special enrollment period for non-deemed Medicare Cost Plan enrollees H.R. 6690, Fighting Fraud to Protect Care for Seniors Act (Roskam) - Medicare pilot program for smart card technology Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2019 policy and technical regulation for MA and Part D; issues relating to 2019 Rate Notice and Call Letter; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.
S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax S. 2410, Chronic Disease Management Act (Thune) - flexibility for high-deductible health plans S. 3063, Health Insurance Tax Relief Act (Barrasso) - suspension of ACA health insurance tax H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 3798, Save American Workers Act (Walorski) - delay in Cadillac tax H.R. 4616 (Nunes) - delay in ACA excise tax on employer-provided health coverage H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4620, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax H.R. 4894, Harmful Tax Prevention Act (Noem) - relief from ACA health insurance tax H.R. 4978, Chronic Disease Management Act (Black) - flexibility for high-deductible health plans H.R. 5138, Bipartisan HSA Improvement Act (Kelly) - HSA changes H.R. 5963, Health Insurance Premium Reduction Act (Noem) - suspension of ACA health insurance tax H.R. 6199, Restoring Access to Medication Act (Jenkins) - OTC medical products as qualified medical expense, HSA improvements H.R. 6301, Promoting High-Value Health Care Through Flexibility for High Deductible Health Plans Act (Roskam) - flexibility on first dollar coverage for HSA plans H.R. 6305, Bipartisan HSA Improvement Act (Kelly) - HSA flexibility; treatment of certain employment-related services; FSA and HRA conversions H.R. 6306, Health Care Security Act (Paulsen) - HSA contribution limits, spousal catch-up contributions, grace period for medical expenses H.R. 6309, Allowing Working Seniors to Keep Their Health Savings Accounts Act (Paulsen) - HSA contributions by Medicare-eligible individuals H.R. 6311, Increasing Access to Lower Premium Plans and Expanding HSAs Act (Roskam) - suspension of health insurance tax, HSA improvements H.R. 6312, Personal Health Investment Today Act (Smith) - medical care tax deduction for qualified sports and fitness expenses H.R. 6313, RAISE Health Benefits Act (Stivers) - Health FSA rollovers H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan H.R. 6317, Primary Care Enhancement Act (Paulsen) - participation by HSA-eligible individuals in direct primary care (DPC) arrangements Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
Bipartisan Health Care Stabilization Act (Alexander-Murray) - funding for cost sharing reduction benefits, stabilization of individual market Bipartisan Health Care Stabilization Act; updated version (Alexander-Walden-Collins-Costello) - funding for cost sharing reduction benefits and reinsurance, stabilization of individual market S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 581, Jessies Law (Manchin-Capito) - patient history of opioid use disorder S. 1201, Health Care Options for All Act (McCaskill) - coverage options in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction benefits S. 1516, Coverage Across State Lines (Heller) S. 1667, Protecting Consumers from Unreasonable Rates Act (Feinstein) - rate review S. 1835, Lower Premiums Through Reinsurance Act (Collins-Nelson) - invisible high risk pool and reinsurance programs S. 1850, Legacy Act (Manchin-Capito) -- confidentiality of drug and alcohol treatment and prevention records S. 1976, Increasing Access to Care Act (Scott) - copper plan S. 1985, Protect Access to Birth Control Act (Murray) - coverage of contraceptive services S. 2052, Healthcare Market Certainty and Mandate Relief Act (Hatch) - funding for cost sharing reduction benefits, HSA improvements, ACA individual mandate S. 2241 (King) - fees on excepted benefits and standalone dental plans S. 2303, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - calculation of medical loss ratios S. 3388, Ensuring Coverage for Patients with Pre-Existing Conditions Act (Tillis) - protections for individuals with pre-existing conditions H.R. 2, Agriculture and Nutrition Act (Conaway) - agricultural association health plans H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 421, Allowing Greater Access to Safe and Effective Contraception Act (Love) - non-prescription contraceptives, HSA flexibility H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 1606, DOC Access Act (Carter) - reimbursement for dental and vision providers H.R. 3450, Protecting Consumers from Unreasonable Rates Act (Schakowsky) - rate review H.R. 3545, Overdose Prevention and Patient Safety Act (Murphy- Blumenauer) -- confidentiality of drug and alcohol treatment and prevention records H.R. 3976, Access to Marketplace Insurance Act (Cramer) - third party payments H.R. 4082, Protect Access to Birth Control Act (DeGette) - coverage of contraceptive services H.R. 4200, Healthcare Market Certainty and Mandate Relief Act (Brady) - funding for cost sharing reduction benefits, HSA improvements H.R. 4225 (Hudson) - fees on excepted benefits and standalone dental plans H.R. 4575, Access to Independent Health Insurance Advisors Act (Long-Schrader) - calculation of medical loss ratios H.R. 4666, Premium Relief Act (Costello) - Patient and State Stability Fund H.R. 4695, Bipartisan Market Stabilization and Innovation Act (Schrader) - stabilization of individual market H.R. 6311, Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act (Roskam) - access to catastrophic plans, definition of qualified health plans H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan H.R. 6496, Continuing Coverage for Preexisting Conditions Act (Joyce) - protections for individuals with pre-existing conditions H.R. 7003, Federal Invisible Risk Sharing Program (Schweikert) Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of
S. 297, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug costs S. 974, CREATES Act (Leahy-Grassley) - access to generic drugs and biosimilars S. 1115, Making Pharmaceutical Markets More Competitive Act (Collins-McCaskill) - accelerated approval of generic therapies S. 1131, FAIR Drug Pricing Act (Baldwin-McCain) - transparency in prescription drug pricing S. 2553, Know the Lowest Price Act (Stabenow) - information on drug prices S. 2554, Patient Right to Know Drug Prices Act (Collins) - information on drug prices H.R. 749, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug costs H.R. 1703, Medical Product Communication Act (Griffith) - off-label exchange of information H.R. 2026, Pharmaceutical Information Exchange Act (Guthrie) - pre-approval health care economic information to payors H.R. 2051, Fair Access for Safe and Timely Generics Act (McKinley-Welch) - access to generic drugs H.R. 2212, CREATES Act (Marino-Cicilline) - access to generic drugs and biosimilars H.R. 2439, FAIR Drug Pricing Act (Schakowsky) - transparency in prescription drug pricing H.R. 2562, Making Pharmaceutical Markets More Competitive Act (Kelly) - accelerated approval of generic therapies H.R. 2999, Patients' Access to Treatments Act (McKinley) - limiting cost sharing in specialty drug tiers H.R. 5247, Right to Try Act (Fitzpatrick) - use of unapproved investigational drugs by patients with life-threatening conditions H.R. 6142, Reducing Drug Waste Act (Doggett) - packaging of medications Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues relating to opioids; issues relating to prescription drug price blueprint; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Bipartisan Health Care Stabilization Act (Alexander-Murray) - funding for cost sharing reduction benefits, stabilization of individual market Bipartisan Health Care Stabilization Act; updated version (Alexander-Walden-Collins-Costello) - funding for cost sharing reduction benefits and reinsurance, stabilization of individual market S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 581, Jessies Law (Manchin-Capito) - patient history of opioid use disorder S. 1201, Health Care Options for All Act (McCaskill) - coverage options in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1405, FAA Reauthorization Act (Thune) - air ambulance issues S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction benefits S. 1516, Coverage Across State Lines (Heller) S. 1667, Protecting Consumers from Unreasonable Rates Act (Feinstein) - rate review S. 1835, Lower Premiums Through Reinsurance Act (Collins-Nelson) - invisible high risk pool and reinsurance programs S. 1850, Legacy Act (Manchin-Capito) -- confidentiality of drug and alcohol treatment and prevention records S. 1976, Increasing Access to Care Act (Scott) - copper plan S. 1985, Protect Access to Birth Control Act (Murray) - coverage of contraceptive services S. 2052, Healthcare Market Certainty and Mandate Relief Act (Hatch) - funding for cost sharing reduction benefits, HSA improvements, ACA individual mandate S. 2241 (King) - fees on excepted benefits and standalone dental plans S. 2303, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - calculation of medical loss ratios H.R. 2, Agriculture and Nutrition Act (Conaway) - agricultural association health plans H.R. 4, FAA Reauthorization Act (Shuster) - air ambulance issues H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 421, Allowing Greater Access to Safe and Effective Contraception Act (Love) - non-prescription contraceptives, HSA flexibility H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 3450, Protecting Consumers from Unreasonable Rates Act (Schakowsky) - rate review H.R. 3545, Overdose Prevention and Patient Safety Act (Murphy- Blumenauer) -- confidentiality of drug and alcohol treatment and prevention records H.R. 3922, CHAMPION Act (Walden) - extension of federal CHIP funding, ACA grace periods, community health center funding H.R. 3976, Access to Marketplace Insurance Act (Cramer) - third party payments H.R. 4082, Protect Access to Birth Control Act (DeGette) - coverage of contraceptive services H.R. 4200, Healthcare Market Certainty and Mandate Relief Act (Brady) - funding for cost sharing reduction benefits, HSA improvements H.R. 4225 (Hudson) - fees on excepted benefits and standalone dental plans H.R. 4575, Access to Independent Health Insurance Advisors Act (Long-Schrader) - calculation of medical loss ratios H.R. 4666, Premium Relief Act (Costello) - Patient and State Stability Fund H.R. 4695, Bipartisan Market Stabilization and Innovation Act (Schrader) - stabilization of individual market H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.
S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) -PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 1016, CONNECT For Health Act (Schatz) - telehealth S. 1169, Medicaid CARE Act (Durbin-Portman) - changes to Medicaid IMD exclusion S. 1688, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 1804, Medicare for All Act (Sanders) - single payer health system S. 1827, Keep Kids Insurance Dependable and Secure Act (Hatch-Wyden) - federal CHIP funding S. 1890, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Cardin) - Medigap coverage for beneficiaries with end-stage renal disease S. 2027, Medicaid Third Party Liability Act (Portman) - Medicaid third party liability S. 2227, EMPOWER Care Act (Portman-Cantwell) - Medicaid Money Follows the Person Demonstration S. 2707, Informing Seniors About Opioids Act (Nelson) - opioid issues S. 2901, Expanding Telehealth Response to Ensure Addiction Treatment Act (Thune) - opioid issues S. 2904, Medicaid Substance Use Disorder Treatment Via Telehealth Act (Carper) - opioid issues S. 2908, Electronic Prior Authorization in Medicare Part D Act (Roberts) - opioid issues Draft Medicare Long-Term Care Services and Supports Act (Pallone) - Long-Term Services and Supports Program H.R. 195, Extension of Continuing Appropriations Act - CHIP funding extension for 2018-2023 and related provisions H.R. 849, Protecting Seniors Access to Medicare Act (Roe) - Independent Payment Advisory Board H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1148, FAST Act (Griffith) - access to telehealth-eligible stroke services under Medicare H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1892, Bipartisan Budget Act (Larson) - permanent authorization of Medicare Advantage Special Needs Plans; MA chronic care reforms: telehealth, supplemental benefits, value-based insurance design, star ratings; changes to Medicare Part D coverage gap and related discounts; CHIP funding extension for 2024-2027; funding for Puerto Ricos Medicaid program H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 2556, CONNECT For Health Act (Black) - telehealth H.R. 2644, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Marino) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 2687, Medicaid CARE Act (Foster-Fitzpatrick) - changes to Medicaid IMD exclusion H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) H.R. 3168, Special Needs Plans (Tiberi-Levin) - SNP reauthorization H.R. 3263, Medicare Independence at Home Model of Care (Burgess) - demonstration program H.R. 3325, ACE Kids Act (Barton) - coordinated care for children with complex medical conditions H.R. 3360, Telehealth Enhancement Act (Harper) - telehealth in Medicare H.R. 3727, Increasing Telehealth Access in Medicare Act (Black) - telehealth in MA plans H.R. 3921, HEALTHY KIDS Act (Burgess) - CHIP funding H.R. 4952, Improving Seniors Access to Quality Benefits Act (Kelly) - MA benchmark cap study H.R. 5603, Access to Telehealth Services for Substance Use Disorders Act (Matsui) - opioid issues H.R. 5605, Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act (Ruiz) - opioid issues H.R. 5675, drug management programs for at-risk Medicare beneficiaries (Bilirakis) - opioid issues H.R. 5676, SENIOR Communities Protection Act (MacArthur) - preventing fraudulent opioid prescriptions H.R. 5684, Protecting Seniors from Opioid Abuse Act (Kelly) - opioid issues H.R. 5685, Medicare Opioid Safety Education Act (Faso) - opioid issues H.R. 5686, Medicare Clear Health Options in Care for Enrollees Act (Paulsen) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - communication between Medicare plan sponsors and CMS H.R. 5773, Preventing Addiction for Susceptible Seniors Act (Roskam) - opioid issues H.R. 5797, IMD CARE Act (Walters) - Medicaid IMD exclusion H.R. 5798, Opioid Screening and Chronic Pain Management Alternatives for Seniors Act (Bucshon) - opioid issues H.R. 5799, Medicaid Drug Review, Utilization, Good Governance Improvement Act (Blackburn) - opioid issues H.R. 5800, Medicaid IMD ADDITIONAL INFO Act (Upton) - opioid issues H.R. 5804, Post-Surgical Injections as an Opioid Alternative Act (Shimkus) - opioid issues H.R. 5808, Medicaid Pharmaceutical Home Act (Bilirakis) - opioid issues H.R. 5809, Postoperative Opioid Prevention Act (Peters) - opioid issues H.R. 5810, Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act (Lance) - opioid issues H.R. 5812, Improving Medicaid Data Timeliness Act (Griffith) - opioid issues Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2019 policy and technical regulation for MA and Part D; issues relating to 2019 Rate Notice and Call Letter; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
S. 1625, FY 2018 Consolidated Appropriations Act (Royce) - funding for HHS programs and agencies, opioid initiatives, ACA risk corridors S. 2460, Every Prescription Conveyed Securely Act (Bennet) - opioid issues S. 2680, Opioid Crisis Response Act (Alexander) - opioid initiatives, mental health parity S. 2789, Substance Abuse Prevention Act (Cornyn) - opioid initiatives, restrictions on step therapy S. 2812, Air Ambulance Consumer Protection Act (McCaskill) - air ambulance S. 2891, Fighting the Opioid Epidemic with Sunshine Act (Grassley) - opioid issues S. 2892, Peer Support Enhancement and Evaluation Review Act (Cardin) - opioid issues S. 2898, Medication-Assisted Treatment Improvement Act (Casey) - opioid issues S. 2899, Caring Recovery for Infants and Babies Act (Brown) - opioid issues S. 2900, Comprehensive Screenings for Seniors Act (Brown) - opioid issues S. 2902, Better Data Sharing to Combat the Opioid Crisis Act (Cassidy) - opioid issues S. 2905, Strengthening Partnerships to Prevent Opioid Abuse Act (Toomey) - opioid issues S. 2910, Telehealth for Childrens Access to Services and Treatment Act (Roberts) - opioid issues S. 2911, Enhancing Patient Access to Non-Opioid Treatment Options (Heller) - opioid issues S. 2912, Opioid Addiction Treatment Programs Enhancement Act (Cassidy) - opioid issues S. 2920, Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act (McCaskill) - opioid issues S. 2922, Help for Moms and Babies Act (Stabenow) - opioid issues S. 2923, Building Capacity for Family-Focused Residential Treatment Act (Grassley) - opioid issues S. 2924, Supporting Family-Focused Residential Treatment Act (Scott) - opioid issues S. 2987, National Defense Authorization Act (Inhofe) S. 3120, the HEAL Substance Use Disorders Act (Hatch) - opioid initiatives S. 3158, FY 2019 Labor, HHS, Education Appropriations Act (Blunt) - HHS funding, ACA issues House version of FY 2019 Labor, HHS, Education Appropriations Act (Cole) - HHS funding, ACA issues H.R. 6, SUPPORT Patients and Families Act (Walden) - opioid initiatives, budget offsets H.R. 1215, Protecting Access to Care Act (King) - medical liability reform H.R. 1313, Preserving Employee Wellness Programs Act (Foxx) - employee wellness programs H.R. 2422, Action for Dental Health Act (Kelly) - oral health services and education for underserved populations H.R. 3331, adoption and use of EHR technology by behavioral health providers (Jenkins) - opioid issues H.R. 3528, Every Prescription Conveyed Securely Act (Clark) - opioid issues H.R. 3759, RAISE Family Caregivers Act (Harper-Castor) - support for family caregivers H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act (Schweikert) - opioid issues H.R. 4998, Health Insurance for Former Foster Youth Act (Bass) - opioid issues H.R. 5477, Rural DOCS Act (O'Halleran) - opioid issues H.R. 5562, Protecting NAS Babies Act (Jenkins) - opioid issues H.R. 5582, Abuse Deterrent Access Act (Carter) - opioid issues H.R. 5583, State reporting on certain adult health quality measures (Clarke) - opioid issues H.R. 5590, CMS Action Plan (Kinzinger) - opioid issues H.R. 5515, National Defense Authorization Act (Thornberry) H.R. 5714, Education for Disposal of Unused Opioids Act (Black) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - opioid issues H.R. 5716, COMPASS Act (Roskam) - opioid issues H.R. 5723, Expanding Oversight of Opioid Prescribing and Payment Act (Tenney) - opioid issues H.R. 5725, BEST Act (Roskam) - opioid issues H.R. 5774, Combating Opioid Abuse for Care in Hospitals Act (Curbelo) - opioid issues H.R. 5775, Providing Reliable Options for Patients and Educational Resources Act (Paulsen) - opioid issues H.R. 5776, MOST Act (Neal) - opioid issues H.R. 5789, protections for pregnant and post-partum women (Foster) - opioid issues H.R. 5795, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information H.R. 5796, Responsible Education Achieves Care and Healthy Outcomes for Users' Treatment Act (Fitzpatrick) - opioid issues H.R. 5801, PARTNERSHIP Act (Griffith) - opioid issues H.R. 6082, Overdose Prevention and Patient Safety Act (Mullin) - confidential sharing of substance use disorder information Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
S. 297, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug costs S. 974, CREATES Act (Leahy-Grassley) - access to generic drugs and biosimilars S. 1115, Making Pharmaceutical Markets More Competitive Act (Collins-McCaskill) - accelerated approval of generic therapies S. 1131, FAIR Drug Pricing Act (Baldwin-McCain) - transparency in prescription drug pricing S. 2553, Know the Lowest Price Act (Stabenow) - information on drug prices S. 2554, Patient Right to Know Drug Prices Act (Collins) - information on drug prices H.R. 749, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug costs H.R. 1703, Medical Product Communication Act (Griffith) - off-label exchange of information H.R. 2026, Pharmaceutical Information Exchange Act (Guthrie) - pre-approval health care economic information to payors H.R. 2051, Fair Access for Safe and Timely Generics Act (McKinley-Welch) - access to generic drugs H.R. 2212, CREATES Act (Marino-Cicilline) - access to generic drugs and biosimilars H.R. 2439, FAIR Drug Pricing Act (Schakowsky) - transparency in prescription drug pricing H.R. 2562, Making Pharmaceutical Markets More Competitive Act (Kelly) - accelerated approval of generic therapies H.R. 2999, Patients' Access to Treatments Act (McKinley) - limiting cost sharing in specialty drug tiers H.R. 5247, Right to Try Act (Fitzpatrick) - use of unapproved investigational drugs by patients with life-threatening conditions H.R. 6142, Reducing Drug Waste Act (Doggett) - packaging of medications Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues relating to opioids; issues relating to prescription drug price blueprint; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) -PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 1016, CONNECT For Health Act (Schatz) - telehealth S. 1169, Medicaid CARE Act (Durbin-Portman) - changes to Medicaid IMD exclusion S. 1688, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 1804, Medicare for All Act (Sanders) - single payer health system S. 1827, Keep Kids Insurance Dependable and Secure Act (Hatch-Wyden) - federal CHIP funding S. 1890, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Cardin) - Medigap coverage for beneficiaries with end-stage renal disease S. 2027, Medicaid Third Party Liability Act (Portman) - Medicaid third party liability S. 2227, EMPOWER Care Act (Portman-Cantwell) - Medicaid Money Follows the Person Demonstration S. 2707, Informing Seniors About Opioids Act (Nelson) - opioid issues S. 2901, Expanding Telehealth Response to Ensure Addiction Treatment Act (Thune) - opioid issues S. 2904, Medicaid Substance Use Disorder Treatment Via Telehealth Act (Carper) - opioid issues S. 2908, Electronic Prior Authorization in Medicare Part D Act (Roberts) - opioid issues Draft Medicare Long-Term Care Services and Supports Act (Pallone) - Long-Term Services and Supports Program H.R. 195, Extension of Continuing Appropriations Act - CHIP funding extension for 2018-2023 and related provisions H.R. 849, Protecting Seniors Access to Medicare Act (Roe) - Independent Payment Advisory Board H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1148, FAST Act (Griffith) - access to telehealth-eligible stroke services under Medicare H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1892, Bipartisan Budget Act (Larson) - permanent authorization of Medicare Advantage Special Needs Plans; MA chronic care reforms: telehealth, supplemental benefits, value-based insurance design, star ratings; changes to Medicare Part D coverage gap and related discounts; CHIP funding extension for 2024-2027; funding for Puerto Ricos Medicaid program H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 2556, CONNECT For Health Act (Black) - telehealth H.R. 2644, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Marino) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 2687, Medicaid CARE Act (Foster-Fitzpatrick) - changes to Medicaid IMD exclusion H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) H.R. 3168, Special Needs Plans (Tiberi-Levin) - SNP reauthorization H.R. 3263, Medicare Independence at Home Model of Care (Burgess) - demonstration program H.R. 3325, ACE Kids Act (Barton) - coordinated care for children with complex medical conditions H.R. 3360, Telehealth Enhancement Act (Harper) - telehealth in Medicare H.R. 3727, Increasing Telehealth Access in Medicare Act (Black) - telehealth in MA plans H.R. 3921, HEALTHY KIDS Act (Burgess) - CHIP funding H.R. 4952, Improving Seniors Access to Quality Benefits Act (Kelly) - MA benchmark cap study H.R. 5603, Access to Telehealth Services for Substance Use Disorders Act (Matsui) - opioid issues H.R. 5605, Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act (Ruiz) - opioid issues H.R. 5675, drug management programs for at-risk Medicare beneficiaries (Bilirakis) - opioid issues H.R. 5676, SENIOR Communities Protection Act (MacArthur) - preventing fraudulent opioid prescriptions H.R. 5684, Protecting Seniors from Opioid Abuse Act (Kelly) - opioid issues H.R. 5685, Medicare Opioid Safety Education Act (Faso) - opioid issues H.R. 5686, Medicare Clear Health Options in Care for Enrollees Act (Paulsen) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - communication between Medicare plan sponsors and CMS H.R. 5773, Preventing Addiction for Susceptible Seniors Act (Roskam) - opioid issues H.R. 5797, IMD CARE Act (Walters) - Medicaid IMD exclusion H.R. 5798, Opioid Screening and Chronic Pain Management Alternatives for Seniors Act (Bucshon) - opioid issues H.R. 5799, Medicaid Drug Review, Utilization, Good Governance Improvement Act (Blackburn) - opioid issues H.R. 5800, Medicaid IMD ADDITIONAL INFO Act (Upton) - opioid issues H.R. 5804, Post-Surgical Injections as an Opioid Alternative Act (Shimkus) - opioid issues H.R. 5808, Medicaid Pharmaceutical Home Act (Bilirakis) - opioid issues H.R. 5809, Postoperative Opioid Prevention Act (Peters) - opioid issues H.R. 5810, Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act (Lance) - opioid issues H.R. 5812, Improving Medicaid Data Timeliness Act (Griffith) - opioid issues Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2019 policy and technical regulation for MA and Part D; issues relating to 2019 Rate Notice and Call Letter; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax S. 2410, Chronic Disease Management Act (Thune) - flexibility for high-deductible health plans S. 3063, Health Insurance Tax Relief Act (Barrasso) - suspension of ACA health insurance tax H.R. 195, Extension of Continuing Appropriations Act - one-year suspension of ACA health insurance tax, two-year delay in ACA excise tax on employer-sponsored health plans H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 4616 (Nunes) - delay in ACA excise tax on employer-provided health coverage H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4620, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax H.R. 4894, Harmful Tax Prevention Act (Noem) - relief from ACA health insurance tax H.R. 4978, Chronic Disease Management Act (Black) - flexibility for high-deductible health plans H.R. 5138, Bipartisan HSA Improvement Act (Kelly) - HSA changes H.R. 5963, Health Insurance Premium Reduction Act (Noem) - suspension of ACA health insurance tax H.R. 6199, Restoring Access to Medication Act (Jenkins) -- OTC medical products as qualified medical expense H.R. 6301, Promoting High-Value Health Care Through Flexibility for High Deductible Health Plans Act (Roskam) - flexibility on first dollar coverage for HSA plans H.R. 6305, Bipartisan HSA Improvement Act (Kelly) - HSA flexibility H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
S. 1625, FY 2018 Consolidated Appropriations Act (Royce) - funding for HHS programs and agencies, opioid initiatives, ACA risk corridors S. 2460, Every Prescription Conveyed Securely Act (Bennet) - opioid issues S. 2680, Opioid Crisis Response Act (Alexander) - opioid initiatives, mental health parity S. 2789, Substance Abuse Prevention Act (Cornyn) - opioid initiatives, restrictions on step therapy S. 2812, Air Ambulance Consumer Protection Act (McCaskill) - air ambulance S. 2891, Fighting the Opioid Epidemic with Sunshine Act (Grassley) - opioid issues S. 2892, Peer Support Enhancement and Evaluation Review Act (Cardin) - opioid issues S. 2898, Medication-Assisted Treatment Improvement Act (Casey) - opioid issues S. 2899, Caring Recovery for Infants and Babies Act (Brown) - opioid issues S. 2900, Comprehensive Screenings for Seniors Act (Brown) - opioid issues S. 2902, Better Data Sharing to Combat the Opioid Crisis Act (Cassidy) - opioid issues S. 2905, Strengthening Partnerships to Prevent Opioid Abuse Act (Toomey) - opioid issues S. 2910, Telehealth for Childrens Access to Services and Treatment Act (Roberts) - opioid issues S. 2911, Enhancing Patient Access to Non-Opioid Treatment Options (Heller) - opioid issues S. 2912, Opioid Addiction Treatment Programs Enhancement Act (Cassidy) - opioid issues S. 2920, Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act (McCaskill) - opioid issues S. 2922, Help for Moms and Babies Act (Stabenow) - opioid issues S. 2923, Building Capacity for Family-Focused Residential Treatment Act (Grassley) - opioid issues S. 2924, Supporting Family-Focused Residential Treatment Act (Scott) - opioid issues S. 2987, National Defense Authorization Act (Inhofe) S. 3120, the HEAL Substance Use Disorders Act (Hatch) - opioid initiatives S. 3158, FY 2019 Labor, HHS, Education Appropriations Act (Blunt) - HHS funding, ACA issues House version of FY 2019 Labor, HHS, Education Appropriations Act (Cole) - HHS funding, ACA issues H.R. 6, SUPPORT Patients and Families Act (Walden) - opioid initiatives, budget offsets H.R. 1215, Protecting Access to Care Act (King) - medical liability reform H.R. 1313, Preserving Employee Wellness Programs Act (Foxx) - employee wellness programs H.R. 2422, Action for Dental Health Act (Kelly) - oral health services and education for underserved populations H.R. 3331, adoption and use of EHR technology by behavioral health providers (Jenkins) - opioid issues H.R. 3528, Every Prescription Conveyed Securely Act (Clark) - opioid issues H.R. 3759, RAISE Family Caregivers Act (Harper-Castor) - support for family caregivers H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act (Schweikert) - opioid issues H.R. 4998, Health Insurance for Former Foster Youth Act (Bass) - opioid issues H.R. 5477, Rural DOCS Act (O'Halleran) - opioid issues H.R. 5562, Protecting NAS Babies Act (Jenkins) - opioid issues H.R. 5582, Abuse Deterrent Access Act (Carter) - opioid issues H.R. 5583, State reporting on certain adult health quality measures (Clarke) - opioid issues H.R. 5590, CMS Action Plan (Kinzinger) - opioid issues H.R. 5515, National Defense Authorization Act (Thornberry) H.R. 5714, Education for Disposal of Unused Opioids Act (Black) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - opioid issues H.R. 5716, COMPASS Act (Roskam) - opioid issues H.R. 5723, Expanding Oversight of Opioid Prescribing and Payment Act (Tenney) - opioid issues H.R. 5725, BEST Act (Roskam) - opioid issues H.R. 5774, Combating Opioid Abuse for Care in Hospitals Act (Curbelo) - opioid issues H.R. 5775, Providing Reliable Options for Patients and Educational Resources Act (Paulsen) - opioid issues H.R. 5776, MOST Act (Neal) - opioid issues H.R. 5789, protections for pregnant and post-partum women (Foster) - opioid issues H.R. 5795, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information H.R. 5796, Responsible Education Achieves Care and Healthy Outcomes for Users' Treatment Act (Fitzpatrick) - opioid issues H.R. 5801, PARTNERSHIP Act (Griffith) - opioid issues H.R. 6082, Overdose Prevention and Patient Safety Act (Mullin) - confidential sharing of substance use disorder information Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
Bipartisan Health Care Stabilization Act (Alexander-Murray) - funding for cost sharing reduction benefits, stabilization of individual market Bipartisan Health Care Stabilization Act; updated version (Alexander-Walden-Collins-Costello) - funding for cost sharing reduction benefits and reinsurance, stabilization of individual market S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 581, Jessies Law (Manchin-Capito) - patient history of opioid use disorder S. 1201, Health Care Options for All Act (McCaskill) - coverage options in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction benefits S. 1516, Coverage Across State Lines (Heller) S. 1667, Protecting Consumers from Unreasonable Rates Act (Feinstein) - rate review S. 1771, FY 2018 Labor-HHS Appropriations Act (Blunt) - risk corridors and other ACA issues, funding for HHS programs and agencies S. 1835, Lower Premiums Through Reinsurance Act (Collins-Nelson) - invisible high risk pool and reinsurance programs S. 1850, Legacy Act (Manchin-Capito) -- confidentiality of drug and alcohol treatment and prevention records S. 1976, Increasing Access to Care Act (Scott) - copper plan S. 1985, Protect Access to Birth Control Act (Murray) - coverage of contraceptive services S. 2052, Healthcare Market Certainty and Mandate Relief Act (Hatch) - funding for cost sharing reduction benefits, HSA improvements, ACA individual mandate S. 2241 (King) - fees on excepted benefits and standalone dental plans S. 2303, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - calculation of medical loss ratios S. 2410, Chronic Disease Management Act (Thune) - flexibility for high-deductible health plans H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 421, Allowing Greater Access to Safe and Effective Contraception Act (Love) - non-prescription contraceptives, HSA flexibility H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 3354, FY 2018 Appropriations Act (Calvert) - risk corridors and other ACA issues, funding for HHS programs and agencies H.R. 3358, FY 2018 Labor-HHS Appropriations Act (Cole) - risk corridors and other ACA issues, funding for HHS programs and agencies H.R. 3450, Protecting Consumers from Unreasonable Rates Act (Schakowsky) - rate review H.R. 3545, Overdose Prevention and Patient Safety Act (Murphy- Blumenauer) -- confidentiality of drug and alcohol treatment and prevention records H.R. 3922, CHAMPION Act (Walden) - extension of federal CHIP funding, ACA grace periods, community health center funding H.R. 3976, Access to Marketplace Insurance Act (Cramer) - third party payments H.R. 4082, Protect Access to Birth Control Act (DeGette) - coverage of contraceptive services H.R. 4200, Healthcare Market Certainty and Mandate Relief Act (Brady) - funding for cost sharing reduction benefits, HSA improvements H.R. 4225 (Hudson) - fees on excepted benefits and standalone dental plans H.R. 4575, Access to Independent Health Insurance Advisors Act (Long-Schrader) - calculation of medical loss ratios H.R. 4666, Premium Relief Act (Costello) - Patient and State Stability Fund H.R. 4695, Bipartisan Market Stabilization and Innovation Act (Schrader) - stabilization of individual market H.R. 4978, Chronic Disease Management Act (Black) - flexibility for high-deductible health plans Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.
S. 297, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug costs S. 974, CREATES Act (Leahy-Grassley) - access to generic drugs and biosimilars S. 1115, Making Pharmaceutical Markets More Competitive Act (Collins-McCaskill) - accelerated approval of generic therapies S. 1131, FAIR Drug Pricing Act (Baldwin-McCain) - transparency in prescription drug pricing S. 2553, Know the Lowest Price Act (Stabenow) - information on drug prices S. 2554, Patient Right to Know Drug Prices Act (Collins) - information on drug prices H.R. 749, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug costs H.R. 1703, Medical Product Communication Act (Griffith) - off-label exchange of information H.R. 2026, Pharmaceutical Information Exchange Act (Guthrie) - pre-approval health care economic information to payors H.R. 2051, Fair Access for Safe and Timely Generics Act (McKinley-Welch) - access to generic drugs H.R. 2212, CREATES Act (Marino-Cicilline) - access to generic drugs and biosimilars H.R. 2439, FAIR Drug Pricing Act (Schakowsky) - transparency in prescription drug pricing H.R. 2562, Making Pharmaceutical Markets More Competitive Act (Kelly) - accelerated approval of generic therapies H.R. 2999, Patients' Access to Treatments Act (McKinley) - limiting cost sharing in specialty drug tiers H.R. 5247, Right to Try Act (Fitzpatrick) - use of unapproved investigational drugs by patients with life-threatening conditions Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues relating to opioids; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) -PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 1016, CONNECT For Health Act (Schatz) - telehealth S. 1169, Medicaid CARE Act (Durbin-Portman) - changes to Medicaid IMD exclusion S. 1688, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 1804, Medicare for All Act (Sanders) - single payer health system S. 1827, Keep Kids Insurance Dependable and Secure Act (Hatch-Wyden) - federal CHIP funding S. 1890, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Cardin) - Medigap coverage for beneficiaries with end-stage renal disease S. 2027, Medicaid Third Party Liability Act (Portman) - Medicaid third party liability S. 2227, EMPOWER Care Act (Portman-Cantwell) - Medicaid Money Follows the Person Demonstration Draft Medicare Extenders Bill (Senate Finance Committee) - continuation of expiring Medicare provisions H.R. 195, Extension of Continuing Appropriations Act - CHIP funding extension for 2018-2023 and related provisions H.R. 849, Protecting Seniors Access to Medicare Act (Roe) - Independent Payment Advisory Board H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1148, FAST Act (Griffith) - access to telehealth-eligible stroke services under Medicare H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1892, Bipartisan Budget Act (Larson) - permanent authorization of Medicare Advantage Special Needs Plans; MA chronic care reforms: telehealth, supplemental benefits, value-based insurance design, star ratings; changes to Medicare Part D coverage gap and related discounts; CHIP funding extension for 2024-2027; funding for Puerto Ricos Medicaid program H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 2556, CONNECT For Health Act (Black) - telehealth H.R. 2644, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Marino) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 2687, Medicaid CARE Act (Foster-Fitzpatrick) - changes to Medicaid IMD exclusion H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) H.R. 3168, Special Needs Plans (Tiberi-Levin) - SNP reauthorization H.R. 3263, Medicare Independence at Home Model of Care (Burgess) - demonstration program H.R. 3325, ACE Kids Act (Barton) - coordinated care for children with complex medical conditions H.R. 3360, Telehealth Enhancement Act (Harper) - telehealth in Medicare H.R. 3727, Increasing Telehealth Access in Medicare Act (Black) - telehealth in MA plans H.R. 3921, HEALTHY KIDS Act (Burgess) - CHIP funding Medicare Extenders Package (House Ways and Means Committee) - reauthorization of Special Needs Plans, telehealth, CMS authority to terminate MA contracts Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); proposed calendar year 2019 policy and technical regulation for MA and Part D; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
H.R. 1215, Protecting Access to Care Act (King) - medical liability reform H.R. 1313, Preserving Employee Wellness Programs Act (Foxx) - employee wellness programs S. 1625, FY 2018 Consolidated Appropriations Act (Royce) - funding for HHS programs and agencies, opioid initiatives, ACA risk corridors H.R. 2422, Action for Dental Health Act (Kelly) - oral health services and education for underserved populations H.R. 3759, RAISE Family Caregivers Act (Harper-Castor) - support for family caregivers Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
S. 114, VA Choice and Quality Employment Act (Heller) - VA Choice funding S. 1028, RAISE Family Caregivers Act (Collins-Baldwin) - support for family caregivers H.R. 1215, Protecting Access to Care Act (King) - medical liability reform H.R. 1313, Preserving Employee Wellness Programs Act (Foxx) - employee wellness programs H.R. 2422, Action for Dental Health Act (Kelly) - oral health services and education for underserved populations H.R. 3759, RAISE Family Caregivers Act (Harper-Castor) - support for family caregivers Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.
S. 297, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug costs S. 974, CREATES Act (Leahy-Grassley) - access to generic drugs and biosimilars S. 1115, Making Pharmaceutical Markets More Competitive Act (Collins-McCaskill) - accelerated approval of generic therapies S. 1131, FAIR Drug Pricing Act (Baldwin-McCain) - transparency in prescription drug pricing H.R. 749, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug costs H.R. 1703, Medical Product Communication Act (Griffith) - off-label exchange of information H.R. 2026, Pharmaceutical Information Exchange Act (Guthrie) -- pre-approval health care economic information to payors H.R. 2051, Fair Access for Safe and Timely Generics Act (McKinley-Welch) - access to generic drugs H.R. 2212, CREATES Act (Marino-Cicilline) - access to generic drugs and biosimilars H.R. 2439, FAIR Drug Pricing Act (Schakowsky) - transparency in prescription drug pricing H.R. 2562, Making Pharmaceutical Markets More Competitive Act (Kelly) - accelerated approval of generic therapies H.R. 2999, Patients' Access to Treatments Act (McKinley) - limiting cost sharing in specialty drug tiers Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues relating to opioids; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Bipartisan Health Care Stabilization Act (Alexander-Murray) - funding for cost sharing reduction benefits, stabilization of individual market Better Care Reconciliation Act (Enzi) - ACA repeal and replace issues; coverage provisions; market stabilization; McConnell Substitute Amendment; Cruz Consumer Freedom Option; Portman Medicaid Option for Cost Sharing; Paul Repeal Only Amendment; Graham-Cassidy-Heller-Johnson Block Grant Amendment S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 581, Jessies Law (Manchin-Capito) - patient history of opioid use disorder S. 1201, Health Care Options for All Act (McCaskill) - coverage options in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction benefits S. 1516, Coverage Across State Lines (Heller) S. 1667, Protecting Consumers from Unreasonable Rates Act (Feinstein) - rate review S. 1749, American Liberty Restoration Act (Hatch) - ACA individual coverage requirement S. 1771, FY 2018 Labor-HHS Appropriations Act (Blunt) - risk corridors and other ACA issues, funding for HHS programs and agencies S. 1835, Lower Premiums Through Reinsurance Act (Collins-Nelson) - invisible high risk pool and reinsurance programs S. 1850, Legacy Act (Manchin-Capito) -- confidentiality of drug and alcohol treatment and prevention records S. 1898 (Daines) - ACA individual coverage requirement S. 1976, Increasing Access to Care Act (Scott) - copper plan S. 1985, Protect Access to Birth Control Act (Murray) - coverage of contraceptive services S. 2052, Healthcare Market Certainty and Mandate Relief Act (Hatch) - funding for cost sharing reduction benefits, HSA improvements, ACA individual mandate S. 2241 (King) - fees on excepted benefits and standalone dental plans H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 421, Allowing Greater Access to Safe and Effective Contraception Act (Love) - non-prescription contraceptives, HSA flexibility H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; coverage provisions; market stabilization H.R. 2086, No Coverage, No Penalty Act (Blackburn) - waiving ACA individual mandate in areas with no QHPs H.R. 2516, Freedom from the ACA Tax Penalty Act (Young) - waiving ACA individual mandate in areas with no QHPs H.R. 3280, Financial Services and General Government Appropriations Act (Graves) - enforcement of ACA individual mandate H.R. 3354, FY 2018 Appropriations Act (Calvert) - risk corridors and other ACA issues, funding for HHS programs and agencies H.R. 3358, FY 2018 Labor-HHS Appropriations Act (Cole) - risk corridors and other ACA issues, funding for HHS programs and agencies H.R. 3450, Protecting Consumers from Unreasonable Rates Act (Schakowsky) - rate review H.R. 3545, Overdose Prevention and Patient Safety Act (Murphy- Blumenauer) -- confidentiality of drug and alcohol treatment and prevention records H.R. 3725, (Tiberi-Burgess) - ACA individual coverage requirement H.R. 3922, CHAMPION Act (Walden) - extension of federal CHIP funding, ACA grace periods, community health center funding H.R. 3976, Access to Marketplace Insurance Act (Cramer) - third party payments H.R. 4082, Protect Access to Birth Control Act (DeGette) - coverage of contraceptive services H.R. 4200, Healthcare Market Certainty and Mandate Relief Act (Brady) - funding for cost sharing reduction benefits, HSA improvements, ACA individual mandate H.R. 4225 (Hudson) - fees on excepted benefits and standalone dental plans H.R. 4575, Access to Independent Health Insurance Advisors Act (Long-Schrader) - calculation of medical loss ratios H.R. 4666, Premium Relief Act (Costello) - Patient and State Stability Fund H.R. 4695, Bipartisan Market Stabilization and Innovation Act (Schrader) - stabilization of individual market H.Con.Res. 71, Budget Resolution for FY 2018 (Black) - funding for federal health programs Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.
Better Care Reconciliation Act (Enzi) - ACA repeal and replace issues; Medicaid provisions S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) -PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 870, CHRONIC Care Act (Hatch-Wyden) - chronic care reforms, Medicare Advantage and Part D provisions S. 1016, CONNECT For Health Act (Schatz) - telehealth S. 1688, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 1804, Medicare for All Act (Sanders) - single payer health system S. 1827, Keep Kids Insurance Dependable and Secure Act (Hatch-Wyden) - federal CHIP funding S. 1890, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Cardin) - Medigap coverage for beneficiaries with end-stage renal disease S. 2027, Medicaid Third Party Liability Act (Portman) - Medicaid third party liability S. 2227, EMPOWER Care Act (Portman-Cantwell) - Medicaid Money Follows the Person Demonstration Draft Medicare Extenders Bill (Senate Finance Committee) - continuation of expiring Medicare provisions H.R. 352, State Health Flexibility Act (Rokita) - Medicaid block grants H.R. 849, Protecting Seniors Access to Medicare Act (Roe) - Independent Payment Advisory Board H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1148, FAST Act (Griffith) - access to telehealth-eligible stroke services under Medicare H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1370, Continuing Resolution (Frelinghuysen) - 6-month CHIP funding extension, community health center funding, paygo exemption to prevent sequestration cuts H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; Medicaid provisions H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 2556, CONNECT For Health Act (Black) - telehealth H.R. 2644, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Marino) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) H.R. 3168, Special Needs Plans (Tiberi-Levin) - SNP reauthorization H.R. 3263, Medicare Independence at Home Model of Care (Burgess) - demonstration program H.R. 3325, ACE Kids Act (Barton) - coordinated care for children with complex medical conditions H.R. 3360, Telehealth Enhancement Act (Harper) - telehealth in Medicare H.R. 3727, Increasing Telehealth Access in Medicare Act (Black) - telehealth in MA plans H.R. 3921, HEALTHY KIDS Act (Burgess) - CHIP funding H.J.Res. 123, Continuing Resolution (Frelinghuysen) - redistribution of unused CHIP allotments H.J.Res. 124, Continuing Resolution (Frelinghuysen) -extension of federal CHIP funding Medicare Extenders Package (House Ways and Means Committee) - reauthorization of Special Needs Plans, telehealth, CMS authority to terminate MA contracts Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); proposed calendar year 2019 policy and technical regulation for MA and Part D; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Council of Economic Advisers (CEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Economic Council (NEC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, Treasury, Dept of, White House Office
S. 297, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug costs S. 934, FDA Reauthorization Act (Alexander) - user fee programs, prescription drug and medical device amendments S. 974, CREATES Act (Leahy-Grassley) - access to generic drugs and biosimilars S. 1115, Making Pharmaceutical Markets More Competitive Act (Collins-McCaskill) - accelerated approval of generic therapies S. 1131, FAIR Drug Pricing Act (Baldwin-McCain) - transparency in prescription drug pricing H.R. 749, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug costs H.R. 1703, Medical Product Communication Act (Griffith) - off-label exchange of information H.R. 2026, Pharmaceutical Information Exchange Act (Guthrie) -- pre-approval health care economic information to payors H.R. 2051, Fair Access for Safe and Timely Generics Act (McKinley-Welch) - access to generic drugs H.R. 2212, CREATES Act (Marino-Cicilline) - access to generic drugs and biosimilars H.R. 2430, FDA Reauthorization Act (Walden) - user fee programs, prescription drug and medical device amendments H.R. 2439, FAIR Drug Pricing Act (Schakowsky) - transparency in prescription drug pricing H.R. 2562, Making Pharmaceutical Markets More Competitive Act (Kelly) - accelerated approval of generic therapies H.R. 2999, Patients' Access to Treatments Act (McKinley) - limiting cost sharing in specialty drug tiers Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues relating to opioids; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
S. 114, VA Choice and Quality Employment Act (Heller) - VA Choice funding S. 1028, RAISE Family Caregivers Act (Collins-Baldwin) - support for family caregivers H.R. 1215, Protecting Access to Care Act (King) - medical liability reform H.R. 1313, Preserving Employee Wellness Programs Act (Foxx) - employee wellness programs H.R. 2422, Action for Dental Health Act (Kelly) - oral health services and education for underserved populations H.R. 3759, RAISE Family Caregivers Act (Harper-Castor) - support for family caregivers Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; and other issues relating to health care reform implementation.
Better Care Reconciliation Act (Enzi) - ACA repeal and replace issues; Medicaid provisions S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) -PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 870, CHRONIC Care Act (Hatch-Wyden) - chronic care reforms, Medicare Advantage and Part D provisions S. 1016, CONNECT For Health Act (Schatz) - telehealth S. 1688, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 1804, Medicare for All Act (Sanders) - single payer health system S. 1827, Keep Kids Insurance Dependable and Secure Act (Hatch-Wyden) - federal CHIP funding S. 1890, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Cardin) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 352, State Health Flexibility Act (Rokita) - Medicaid block grants H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1148, FAST Act (Griffith) - access to telehealth-eligible stroke services under Medicare H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; Medicaid provisions H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 2556, CONNECT For Health Act (Black) - telehealth H.R. 2644, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Marino) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) H.R. 3168, Special Needs Plans (Tiberi-Levin) - SNP reauthorization H.R. 3263, Medicare Independence at Home Model of Care (Burgess) - demonstration program H.R. 3325, ACE Kids Act (Barton) - coordinated care for children with complex medical conditions H.R. 3360, Telehealth Enhancement Act (Harper) - telehealth in Medicare H.R. 3727, Increasing Telehealth Access in Medicare Act (Black) - telehealth in MA plans H.R. 3921, HEALTHY KIDS Act (Burgess) - CHIP funding Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Better Care Reconciliation Act (Enzi) - ACA repeal and replace issues; tax provisions; Heller amendment on Cadillac tax S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; tax provisions Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to the deductibility of employer-sponsored health coverage; issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
Discussion Draft Better Care Reconciliation Act (Enzi) - ACA repeal and replace issues; Medicaid provisions S.Con.Res. 3, Budget Resolution (Enzi) - ACA repeal and replace issues; Medicaid provisions S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) -PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 870, CHRONIC Care Act (Hatch-Wyden) - chronic care reforms, Medicare Advantage and Part D provisions S. 3168, Reauthorization of Medicare Advantage Special Needs Plans (Tiberi-Levin) H.R. 352, State Health Flexibility Act (Rokita) - Medicaid block grants H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; Medicaid provisions H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Discussion Draft Better Care Reconciliation Act (Enzi) - ACA repeal and replace issues; coverage provisions; market stabilization S.Con.Res. 3, Budget Resolution (Enzi) - ACA repeal and replace issues; coverage provisions; market stabilization S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 191, Patient Freedom Act (Cassidy-Collins) - replacement reforms; state options S. 1201, Health Care Options for All Act (McCaskill) - access to FEHBP in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction (CSR) payments S. 1516, Coverage Across State Lines (Heller) H.R. 277, American Health Care Reform Act (Roe) - replacement reforms H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; coverage provisions; market stabilization H.R. 2086, No Coverage, No Penalty Act (Blackburn) - waiving ACA individual mandate in areas with no QHPs H.R. 2516, Freedom from the ACA Tax Penalty Act (Young) - waiving ACA individual mandate in areas with no QHPs Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to all payor claims databases; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.
S. 297, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug costs S. 934, FDA Reauthorization Act (Alexander) - user fee programs, prescription drug and medical device amendments S. 974, CREATES Act (Leahy-Grassley) - access to generic drugs and biosimilars S. 1115, Making Pharmaceutical Markets More Competitive Act (Collins-McCaskill) - accelerated approval of generic therapies S. 1131, FAIR Drug Pricing Act (Baldwin-McCain) - transparency in prescription drug pricing H.R. 749, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug costs H.R. 1703, Medical Product Communication Act (Griffith) - off-label exchange of information H.R. 2026, Pharmaceutical Information Exchange Act (Guthrie) -- pre-approval health care economic information to payors H.R. 2051, Fair Access for Safe and Timely Generics Act (McKinley-Welch) - access to generic drugs H.R. 2212, CREATES Act (Marino-Cicilline) - access to generic drugs and biosimilars H.R. 2430, FDA Reauthorization Act (Walden) - user fee programs, prescription drug and medical device amendments H.R. 2439, FAIR Drug Pricing Act (Schakowsky) - transparency in prescription drug pricing H.R. 2562, Making Pharmaceutical Markets More Competitive Act (Kelly) - accelerated approval of generic therapies H.R. 2999, Patients' Access to Treatments Act (McKinley) - limiting cost sharing in specialty drug tiers Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Discussion Draft Better Care Reconciliation Act (Enzi) - ACA repeal and replace issues; tax provisions S.Con.Res. 3, Budget Resolution (Enzi) - ACA repeal and replace issues; tax provisions S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; tax provisions Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of
S.Con.Res. 3, Budget Resolution (Enzi) - ACA repeal and replace issues; coverage provisions; market stabilization S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 191, Patient Freedom Act (Cassidy-Collins) - replacement reforms; state options H.R. 277, American Health Care Reform Act (Roe) - replacement reforms H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; coverage provisions; market stabilization Draft: Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods Draft: State Age Rating Flexibility Act (Buchson) - age rating bands Draft: Health Coverage State Flexibility Act (Flores) - grace period for premium payments Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to all payor claims databases; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues relating to the individual market; and other issues relating to health care reform implementation.
H.R. 1215, Protecting Access to Care Act (King) - medical liability reform H.R. 1313, Preserving Employee Wellness Programs Act (Foxx) - employee wellness programs Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to small employer group size; issues related to Certificate of Public Advantage; and other issues relating to health care reform implementation.
S.Con.Res. 3, Budget Resolution (Enzi) - ACA repeal and replace issues; Medicaid provisions S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) -PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions H.R. 352, State Health Flexibility Act (Rokita) - Medicaid block grants H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; Medicaid provisions Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Treasury, Dept of
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 815, Access to Independent Health Insurance Advisors Act (Long-Schrader) - treatment of broker compensation in MLR calculation H.R. 954, CO-OP Consumer Protection Act (Smith) - exemption from individual mandate H.R. 1770, Data Security and Breach Notification Act (Blackburn-Welch) - data security H.R. 2205, Data Security Act (Neugebauer) - data security H.R. 2739, Cancer Drug Coverage Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 2868, Small Business Health Fairness Act (Johnson) - association health plans H.R. 3323, Dental and Optometric Care Access Act (Carter) - dental and vision benefits H.R. 3727, Health Insurance Rate Review Act (Schakowsky) - rate review H.R. 4299, Patient Opportunity Protection Act (Blum) - HIPAA excepted benefits H.R. 5410, Health Coverage State Flexibility Act (Flores) - grace period for recipients of advanced premium tax credits H.R. 5589, Plan Verification and Fairness Act (Blackburn) - pre-enrollment verification process H.R. 5921, State Age Rating Flexibility Act (Bucshon) - age rating flexibility H.R. 6019, Relief from Obamacare Mandate Act (Young) - exemption from individual mandate H.R. 6049, Protection from Insurance Exchange Monopolies Act (Heck) - exemption from individual mandate H.R. 5926, FY 2017 Labor-HHS-Education Appropriations Bill (Cole) - ACA risk corridors provision, HHS appropriations H. Res. 887, Public Option (DeFazio) S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 1099, Protecting Affordable Coverage for Employees Act (Scott-Shaheen) - ACA definition of small employer S. 1532, Affordability is Access Act (Murray) - coverage of OTC birth control S. 1566, Cancer Drug Coverage Parity Act (Kirk) - coverage of oral anti-cancer drugs S. 1661, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - treatment of broker compensation in MLR calculation S. 2172, Health Insurance Rate Review Act (Feinstein) - rate review S. 2803, Taxpayers Before Insurers Act (Sasse) - ACA reinsurance program S. 3296, Protection from ObamaCare Monopolies Act (McCain) - exemption from individual mandate S. 3297, Relief from Obamacare Mandate Act (Cotton) - exemption from individual mandate S. 3326, State Flexibility to Provide Affordable Health Options Act (Alexander) - ACA subsidies, exemption from individual mandate S. Res. 561, Public Option (Merkley) Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; and other issues relating to health care reform implementation.
H.R. 6, 21st Century Cures Act (Upton) - new cures and treatments H.R. 34, 21st Century Cures Act (Upton) - medical innovation, mental health, health information technology, telehealth, opioid funding, privacy H.R. 636, Federal Aviation Administration Reauthorization Act (Tiberi) - air ambulance amendments H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs H.R. 2300, Empowering Patients First Act (Price) - health reform issues H.R. 2646, Helping Families in Mental Health Crisis Act (Murphy) - compliance with parity requirements, mental health services H.R. 2712, Commonsense Reporting and Verification Act (Black) - employer reporting and eligibility verification for ACA subsidies H.R. 2745, Standard Merger and Acquisition Reviews Through Equal Rules Act (Farenthold) - FTC-DOJ rules for reviewing mergers H.R. 3099, RAISE Family Caregivers Act (Harper) - national strategy to support family caregivers H.R. 3463, Aligning Childrens Dental Coverage Act (Griffith-DeGette) - rules for stand-alone dental plans H.R. 4276, Behavioral Health Coverage Transparency Act (Kennedy) - disclosure requirements relating to mental health parity H.R. 4641, Best Practices for Pain Management (Brooks) - HHS Task Force to review, revise, and disseminate best practices for pain management H.R. 4771, HEALTH Act (Franks) - medical liability reforms H.R. 5284, World's Greatest Healthcare Plan Act (Sessions) - health reform issues Patient Choice, Affordability, Responsibility, and Empowerment Act (Burr-Hatch-Upton) - health reform issues S. 185, Promise for Antibiotics and Therapeutics for Health Act (Hatch) - FDA drug approval process S. 466, Quality Care for Moms and Babies Act (Stabenow) - pediatric quality measures S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs S. 961, Data Security Act (Carper) - data security S. 1077, Advancing Breakthrough Devices for Patients Act (Burr) - priority review of breakthrough medical devices S. 1427, Quality Measure Alignment Act (Stabenow) - facilitating coordination and alignment between public and private sectors on quality and efficiency measures S. 1719, RAISE Family Caregivers Act (Collins) - national strategy to support family caregivers S. 1996, Commonsense Reporting Act (Warner) - employer reporting and eligibility verification for ACA subsidies S. 2141, TRUST IT Act, (Cassidy) - health IT rating system S. 2646, Veterans Choice Improvement Act (Burr) - veterans health care S. 2680, Mental Health Reform Act (Alexander) - compliance with parity requirements, mental health services S. 2700, FDA and NIH Workforce Authorities Modernization Act (Alexander) - medical innovation amendments S. 2985, World's Greatest Healthcare Plan Act (Cassidy) - health reform issues S. 3244, Aligning Children's Dental Coverage Act (Roberts-Bennett) - rules for stand-alone dental plans Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to small employer group size; issues related to Certificate of Public Advantage; and other issues relating to health care reform implementation.
H.R. 9, Innovation Act (Goodlatte) - changes to inter partes review process H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers H.R. 4599, Reducing Unused Medications Act (Clark) - partial fillings of prescriptions H.R. 4784, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug issues H.R. 5122, Medicare Part B Prescription Drug Demonstration (Bucshon) H.R. 5951, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - Medicare Part D pharmacy payments H.R. 6043, Fair Accountability and Innovative Research Drug Pricing Act (Schakowsky) - reporting requirements for prescription drug price increases S. 1137, PATENT Act (Grassley) - changes to inter partes review process S. 2019, Preserve Access to Affordable Generics Act (Klobuchar-Grassley) - pay-for-delay settlements S. 2023, Prescription Drug Affordability Act (Sanders) - pharmaceutical issues S. 2578, Reducing Unused Medications Act (Warren) - partial fillings of prescriptions S. 2615, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug issues S. 2689, REGROW Act (Kirk) - stem cell /regenerative medicines S. 3056, CREATES Act (Leahy) - challenging anti-competitive practices of brand name drug manufacturers S. 3308, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - Medicare Part D pharmacy payments S. 3335, Fair Accountability and Innovative Research Drug Pricing Act (Baldwin) - reporting requirements for prescription drug price increases Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 34, 21st Century Cures Act (Upton) - qualified small employer health reimbursement arrangements H.R. 879, Ax the Tax on Middle Class Americans Health Plans Act (Guinta) - repeal of ACA excise tax on high cost employer-sponsored coverage H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication and Improving Health Savings Act (Jenkins) - HSA, FSA, and other tax-related issues H.R. 2050, Middle Class Health Benefits Tax Repeal Act (Courtney) - repeal of ACA excise tax on high-cost coverage H.R. 4469, Health Savings Act (Paulsen) - HSA and FSA issues H.R. 4723, Recovering Improper Subsidy Overpayments Act (Jenkins) - full recovery of overpayments of ACA premium tax credits H.R. 5324, Health Savings Account Expansion Act (Brat) - HSA issues H.R. 5445, Health Care Security Act (Paulsen) - HSA issues H.R. 5447, Small Business Health Care Relief Act (Boustany) -- excluding HRAs from definition of group health plan H.R. 5652, Access to Better Care Act (Black) - HSA/HDHP issue S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S. 2045, Middle Class Health Benefits Tax Repeal Act (Heller-Heinrich) - repeal of ACA excise tax on high-cost coverage S. 2075, American Worker Health Care Tax Relief Act (Brown) - repeal of ACA excise tax on high-cost coverage S. 2432, Obamacare Tax Transparency Act (Scott) - disclosure of premium attributable to health insurance tax S. 2499, Health Savings Act (Hatch) - HSA and FSA issues S. 2980, Health Savings Account Expansion Act (Flake) - HSA issues S. 3060, Small Business Health Care Relief Act (Grassley) -- excluding HRAs from definition of group health plan Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office
H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 5659, ESRD Choice Act (Smith) - option for ESRD patients to enroll in MA plans H.R. 5942, Dialysis PATIENTS Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 6265, Medigap Reforms (McDermott) S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
H.R. 9, Innovation Act (Goodlatte) - changes to inter partes review process H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers H.R. 4599, Reducing Unused Medications Act (Clark) - partial fillings of prescriptions H.R. 4784, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug issues H.R. 5122, Medicare Part B Prescription Drug Demonstration (Bucshon) H.R. 5951, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - Medicare Part D pharmacy payments H.R. 6043, Fair Accountability and Innovative Research Drug Pricing Act (Schakowsky) - reporting requirements for prescription drug price increases S. 1137, PATENT Act (Grassley) - changes to inter partes review process S. 2019, Preserve Access to Affordable Generics Act (Klobuchar-Grassley) - pay-for-delay settlements S. 2023, Prescription Drug Affordability Act (Sanders) - pharmaceutical issues S. 2578, Reducing Unused Medications Act (Warren) - partial fillings of prescriptions S. 2615, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug issues S. 2689, REGROW Act (Kirk) - stem cell /regenerative medicines S. 3056, CREATES Act (Leahy) - challenging anti-competitive practices of brand name drug manufacturers S. 3308, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - Medicare Part D pharmacy payments S. 3335, Fair Accountability and Innovative Research Drug Pricing Act (Baldwin) - reporting requirements for prescription drug price increases Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 879, Ax the Tax on Middle Class Americans Health Plans Act (Guinta) - repeal of ACA excise tax on high cost employer-sponsored coverage H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication and Improving Health Savings Act (Jenkins) - HSA, FSA, and other tax-related issues H.R. 2050, Middle Class Health Benefits Tax Repeal Act (Courtney) - repeal of ACA excise tax on high-cost coverage H.R. 4469, Health Savings Act (Paulsen) - HSA and FSA issues H.R. 4723, Recovering Improper Subsidy Overpayments Act (Jenkins) - full recovery of overpayments of ACA premium tax credits H.R. 5324, Health Savings Account Expansion Act (Brat) - HSA issues H.R. 5445, Health Care Security Act (Paulsen) - HSA issues H.R. 5447, Small Business Health Care Relief Act (Boustany) -- excluding HRAs from definition of group health plan H.R. 5652, Access to Better Care Act (Black) - HSA/HDHP issue S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S. 2045, Middle Class Health Benefits Tax Repeal Act (Heller-Heinrich) - repeal of ACA excise tax on high-cost coverage S. 2075, American Worker Health Care Tax Relief Act (Brown) - repeal of ACA excise tax on high-cost coverage S. 2432, Obamacare Tax Transparency Act (Scott) - disclosure of premium attributable to health insurance tax S. 2499, Health Savings Act (Hatch) - HSA and FSA issues S. 2980, Health Savings Account Expansion Act (Flake) - HSA issues S. 3060, Small Business Health Care Relief Act (Grassley) -- excluding HRAs from definition of group health plan Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 6, 21st Century Cures Act (Upton) - new cures and treatments H.R. 636, Federal Aviation Administration Reauthorization Act (Tiberi) - air ambulance amendments H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs H.R. 2646, Helping Families in Mental Health Crisis Act (Murphy) - compliance with parity requirements, mental health services H.R. 2712, Commonsense Reporting and Verification Act (Black) - employer reporting and eligibility verification for ACA subsidies H.R. 2745, Standard Merger and Acquisition Reviews Through Equal Rules Act (Farenthold) - FTC-DOJ rules for reviewing mergers H.R. 3099, RAISE Family Caregivers Act (Harper) - national strategy to support family caregivers H.R. 3463, Aligning Childrens Dental Coverage Act (Griffith-DeGette) - rules for stand-alone dental plans H.R. 4276, Behavioral Health Coverage Transparency Act (Kennedy) - disclosure requirements relating to mental health parity H.R. 4641, Best Practices for Pain Management (Brooks) - HHS Task Force to review, revise, and disseminate best practices for pain management H.R. 4771, HEALTH Act (Franks) - medical liability reforms H.R. 5054, Agriculture, Rural Development, Food and Drug Administration, and Related Agencies (Aderholt) - 21st Century Cures provisions S. 185, Promise for Antibiotics and Therapeutics for Health Act (Hatch) - FDA drug approval process S. 466, Quality Care for Moms and Babies Act (Stabenow) - pediatric quality measures S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - prescription opioid abuse S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs S. 961, Data Security Act (Carper) - data security S. 1077, Advancing Breakthrough Devices for Patients Act (Burr) - priority review of breakthrough medical devices S. 1427, Quality Measure Alignment Act (Stabenow) - facilitating coordination and alignment between public and private sectors on quality and efficiency measures S. 1719, RAISE Family Caregivers Act (Collins) - national strategy to support family caregivers S. 1996, Commonsense Reporting Act (Warner) - employer reporting and eligibility verification for ACA subsidies S. 2141, TRUST IT Act, (Cassidy) - health IT rating system S. 2646, Veterans Choice Improvement Act (Burr) - veterans health care S. 2680, Mental Health Reform Act (Alexander) - compliance with parity requirements, mental health services S. 2700, FDA and NIH Workforce Authorities Modernization Act (Alexander) - medical innovation amendments S. 3040, Labor, Health and Human Services, and Education Appropriations Act for fiscal year 2017 (Blunt) - funding for HHS programs and agencies, ACA risk corridors program S. 3244, Aligning Children's Dental Coverage Act (Roberts-Bennett) - rules for stand-alone dental plans Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to small employer group size; issues related to Certificate of Public Advantage; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
H.R. 879, Ax the Tax on Middle Class Americans Health Plans Act (Guinta) - repeal of ACA excise tax on high cost employer-sponsored coverage H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication and Improving Health Savings Act (Jenkins) - HSA, FSA, and other tax-related issues H.R. 2050, Middle Class Health Benefits Tax Repeal Act (Courtney) - repeal of ACA excise tax on high-cost coverage H.R. 4469, Health Savings Act (Paulsen) - HSA and FSA issues H.R. 4723, Recovering Improper Subsidy Overpayments Act (Jenkins) - full recovery of overpayments of ACA premium tax credits H.R. 5324, Health Savings Account Expansion Act (Brat) - HSA issues H.R. 5445, Health Care Security Act (Paulsen) - HSA issues H.R. 5447, Small Business Health Care Relief Act (Boustany) -- excluding HRAs from definition of group health plan S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S. 2045, Middle Class Health Benefits Tax Repeal Act (Heller-Heinrich) - repeal of ACA excise tax on high-cost coverage S. 2075, American Worker Health Care Tax Relief Act (Brown) - repeal of ACA excise tax on high-cost coverage S. 2432, Obamacare Tax Transparency Act (Scott) - disclosure of premium attributable to health insurance tax S. 2499, Health Savings Act (Hatch) - HSA and FSA issues S. 2980, Health Savings Account Expansion Act (Flake) - HSA issues S. 3060, Small Business Health Care Relief Act (Grassley) -- excluding HRAs from definition of group health plan Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 815, Access to Independent Health Insurance Advisors Act (Long-Schrader) - treatment of broker compensation in MLR calculation H.R. 1770, Data Security and Breach Notification Act (Blackburn-Welch) - data security H.R. 2205, Data Security Act (Neugebauer) - data security H.R. 2739, Cancer Drug Coverage Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 2868, Small Business Health Fairness Act (Johnson) - association health plans H.R. 3323, Dental and Optometric Care Access Act (Carter) - dental and vision benefits H.R. 3727, Health Insurance Rate Review Act (Schakowsky) - rate review H.R. 4299, Patient Opportunity Protection Act (Blum) - HIPAA excepted benefits H.R. 5410, Health Coverage State Flexibility Act (Flores) - grace period for recipients of advanced premium tax credits H.R. 5485, Financial Services and General Government Appropriations Act (Crenshaw) - risk corridors amendment H.R. 5589, Plan Verification and Fairness Act (Blackburn) - pre-enrollment verification process Draft Bill on Age Variation in Health Insurance Premium Rates (Brooks) S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 1099, Protecting Affordable Coverage for Employees Act (Scott-Shaheen) - ACA definition of small employer S. 1532, Affordability is Access Act (Murray) - coverage of OTC birth control S. 1566, Cancer Drug Coverage Parity Act (Kirk) - coverage of oral anti-cancer drugs S. 1661, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - treatment of broker compensation in MLR calculation S. 2172, Health Insurance Rate Review Act (Feinstein) - rate review S. 2803, Taxpayers Before Insurers Act (Sasse) - ACA reinsurance program Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues related to implementation of the Telephone Consumer Protection Act; and other issues relating to health care reform implementation.
H.R. 6, 21st Century Cures Act (Upton) - new cures and treatments H.R. 636, Federal Aviation Administration Reauthorization Act (Tiberi) - air ambulance amendments H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs H.R. 2646, Helping Families in Mental Health Crisis Act (Murphy) - compliance with parity requirements, mental health services H.R. 2712, Commonsense Reporting and Verification Act (Black) - employer reporting and eligibility verification for ACA subsidies H.R. 2745, Standard Merger and Acquisition Reviews Through Equal Rules Act (Farenthold) - FTC-DOJ rules for reviewing mergers H.R. 3099, RAISE Family Caregivers Act (Harper) - national strategy to support family caregivers H.R. 3463, Aligning Childrens Dental Coverage Act (Griffith-DeGette) - rules for stand-alone dental plans H.R. 4276, Behavioral Health Coverage Transparency Act (Kennedy) - disclosure requirements relating to mental health parity H.R. 4641, Best Practices for Pain Management (Brooks) - HHS Task Force to review, revise, and disseminate best practices for pain management H.R. 4771, HEALTH Act (Franks) - medical liability reforms H.R. 5054, Agriculture, Rural Development, Food and Drug Administration, and Related Agencies (Aderholt) - 21st Century Cures provisions H.J.Res. 88 (Roe) - disapproving DOL fiduciary regulation S. 185, Promise for Antibiotics and Therapeutics for Health Act (Hatch) - FDA drug approval process S. 466, Quality Care for Moms and Babies Act (Stabenow) - pediatric quality measures S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - prescription opioid abuse S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs S. 961, Data Security Act (Carper) - data security S. 1077, Advancing Breakthrough Devices for Patients Act (Burr) - priority review of breakthrough medical devices S. 1427, Quality Measure Alignment Act (Stabenow) - facilitating coordination and alignment between public and private sectors on quality and efficiency measures S. 1719, RAISE Family Caregivers Act (Collins) - national strategy to support family caregivers S. 1996, Commonsense Reporting Act (Warner) - employer reporting and eligibility verification for ACA subsidies S. 2141, TRUST IT Act, (Cassidy) - health IT rating system S. 2646, Veterans Choice Improvement Act (Burr) - veterans health care S. 2680, Mental Health Reform Act (Alexander) - compliance with parity requirements, mental health services S. 2700, FDA and NIH Workforce Authorities Modernization Act (Alexander) - medical innovation amendments S. 3040, Labor, Health and Human Services, and Education Appropriations Act for fiscal year 2017 (Blunt) - funding for HHS programs and agencies, ACA risk corridors program Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP;. implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to small employer group size; issues related to Certificate of Public Advantage; and other issues relating to health care reform implementation.
H.R. 9, Innovation Act (Goodlatte) - changes to inter partes review process H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers H.R. 4599, Reducing Unused Medications Act (Clark) - partial fillings of prescriptions H.R. 4784, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug issues S. 1137, PATENT Act (Grassley) - changes to inter partes review process S. 2019, Preserve Access to Affordable Generics Act (Klobuchar-Grassley) - pay-for-delay settlements S. 2023, Prescription Drug Affordability Act (Sanders) - pharmaceutical issues S. 2578, Reducing Unused Medications Act (Warren) - partial fillings of prescriptions S. 2615, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug issues S. 3056, CREATES Act (Leahy) - challenging anti-competitive practices of brand name drug manufacturers Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office
H.R. 879, Ax the Tax on Middle Class Americans Health Plans Act (Guinta) - repeal of ACA excise tax on high cost employer-sponsored coverage H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.R. 2050, Middle Class Health Benefits Tax Repeal Act (Courtney) - repeal of ACA excise tax on high-cost coverage H.R. 3762, Restoring Americans' Healthcare Freedom Reconciliation Act (Price) - ACA health insurance tax, excise tax on high-cost coverage, HSA and FSA provisions H.R. 4469, Health Savings Act (Paulsen) - HSA and FSA issues H.R. 4723, Recovering Improper Subsidy Overpayments Act (Jenkins) - full recovery of overpayments of ACA premium tax credits S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S. 2045, Middle Class Health Benefits Tax Repeal Act (Heller-Heinrich) - repeal of ACA excise tax on high-cost coverage S. 2075, American Worker Health Care Tax Relief Act (Brown) - repeal of ACA excise tax on high-cost coverage S. 2432, Obamacare Tax Transparency Act (Scott) - disclosure of premium attributable to health insurance tax S. 2499, Health Savings Act (Hatch) - HSA and FSA issues Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, , enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
H.R. 6, 21st Century Cures Act (Upton) - new cures and treatments H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs H.R. 2646, Helping Families in Mental Health Crisis Act (Murphy) - mental health reforms H.R. 2712, Commonsense Reporting and Verification Act (Black) - employer reporting and eligibility verification for ACA subsidies H.R. 2745, Standard Merger and Acquisition Reviews Through Equal Rules Act (Farenthold) - FTC-DOJ rules for reviewing mergers H.R. 3099, RAISE Family Caregivers Act (Harper) - national strategy to support family caregivers H.R. 3463, Aligning Childrens Dental Coverage Act (Griffith-DeGette) - rules for stand-alone dental plans H.R. 4771, HEALTH Act (Franks) - medical liability reforms S. 185, Promise for Antibiotics and Therapeutics for Health Act (Hatch) - FDA drug approval process S. 466, Quality Care for Moms and Babies Act (Stabenow) - pediatric quality measures S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - prescription opioid abuse S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs S. 961, Data Security Act (Carper) - data security S. 1077, Advancing Breakthrough Devices for Patients Act (Burr) - priority review of breakthrough medical devices S. 1427, Quality Measure Alignment Act (Stabenow) - facilitating coordination and alignment between public and private sectors on quality and efficiency measures S. 1719, RAISE Family Caregivers Act (Collins) - national strategy to support family caregivers S. 1996, Commonsense Reporting Act (Warner) - employer reporting and eligibility verification for ACA subsidies S. 2141, TRUST IT Act, (Cassidy) - health IT rating system S. 2646, Veterans Choice Improvement Act (Burr) - veterans health care S. 2680, Mental Health Reform Act (Alexander) - parity requirements, mental health services Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP;. implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to small employer group size; issues related to Certificate of Public Advantage; and other issues relating to health care reform implementation.
H.R. 9, Innovation Act (Goodlatte) - changes to inter partes review process H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers H.R. 4599, Reducing Unused Medications Act (Clark) - partial fillings of prescriptions H.R. 4784, Lower Drug Costs Through Competition Act (Schrader-Bilirakis) - prescription drug issues S. 1137, PATENT Act (Grassley) - changes to inter partes review process S. 2019, Preserve Access to Affordable Generics Act (Klobuchar-Grassley) - pay-for-delay settlements S. 2023, Prescription Drug Affordability Act (Sanders) - pharmaceutical issues S. 2578, Reducing Unused Medications Act (Warren) - partial fillings of prescriptions S. 2615, Increasing Competition in Pharmaceuticals Act (Collins-McCaskill) - prescription drug issues Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 879, Ax the Tax on Middle Class Americans Health Plans Act (Guinta) - repeal of ACA excise tax on high cost employer-sponsored coverage H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.R. 1295, Trade Preferences Extension Act (Holding) - TAA health coverage tax credits H.R. 2050, Middle Class Health Benefits Tax Repeal Act (Courtney) - repeal of ACA excise tax on high-cost coverage H.R. 3236, Surface Transportation and Veterans Health Care Choice Improvement Act (Shuster) - HSA provision for veterans S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S. 2045, Middle Class Health Benefits Tax Repeal Act (Heller-Heinrich) - repeal of ACA excise tax on high-cost coverage S. 2075, American Worker Health Care Tax Relief Act (Brown) - repeal of ACA excise tax on high-cost coverage Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 6, 21st Century Cures Act (Upton) - new cures and treatments H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs H.R. 2712, Commonsense Reporting and Verification Act (Black) - employer reporting and eligibility verification for ACA subsidies H.R. 3099, RAISE Family Caregivers Act (Harper) - national strategy to support family caregivers Reconciliation Bill approved by House Ways and Means Committee (Ryan) - ACA issues Reconciliation Bill approved by House Energy and Commerce Committee (Upton) - ACA issues Reconciliation Bill approved by House Education and Workforce Committee (Kline) - ACA issues S. 466, Quality Care for Moms and Babies Act (Stabenow) - pediatric quality measures S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs S. 961, Data Security Act (Carper) - data security S. 1077, Advancing Breakthrough Devices for Patients Act (Burr) - priority review of breakthrough medical devices S. 1427, Quality Measure Alignment Act (Stabenow) - facilitating coordination and alignment between public and private sectors on quality and efficiency measures S. 1719, RAISE Family Caregivers Act (Collins) - national strategy to support family caregivers S. 1996, Commonsense Reporting Act (Warner) - employer reporting and eligibility verification for ACA subsidies S. 2141, TRUST IT Act, (Cassidy) - health IT rating system Roadmap for ACA Replacement Legislation (Burr-Hatch-Upton) - health reforms H.R. 3463, Aligning Childrens Dental Coverage Act (Griffith-DeGette) - rules for stand-alone dental plans Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to nondiscrimination requirements; issues related to issues related to medical loss ratios; reference pricing; payment reform; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to small employer group size; issues related to Certificate of Public Advantage; and other issues relating to health care reform implementation.
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 815, Access to Independent Health Insurance Advisors Act (Long-Schrader) - treatment of broker compensation in MLR calculation H.R. 1560, Protecting Cyber Networks Act (Nunes) - cybersecurity H.R. 1624, Protecting Affordable Coverage for Employees Act (Guthrie-Cardenas) - ACA definition of small employer H.R. 1731, National Cybersecurity Protection Advancement Act (McCaul) - cybersecurity H.R. 1770, Data Security and Breach Notification Act (Blackburn-Welch) - data security H.R. 2739, Cancer Drug Coverage Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 2868, Small Business Health Fairness Act (Johnson) - association health plans H.R. 3020, Labor-HHS-Education Appropriations Bill (Cole) - ACA risk corridors provision, HHS appropriations S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 754, Cybersecurity Information Sharing Act (Burr) - cybersecurity S. 1099, Protecting Affordable Coverage for Employees Act (Scott-Shaheen) - ACA definition of small employer S. 1532, Affordability is Access Act (Murray) - coverage of OTC birth control S. 1566, Cancer Drug Coverage Parity Act (Kirk) - coverage of oral anti-cancer drugs S. 1661, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - treatment of broker compensation in MLR calculation S. 1695, Labor-HHS-Education Appropriations Bill (Blunt) - ACA risk corridors provision, HHS appropriations S. 2132, Labor-HHS-Education Appropriations Bill (Cochran) - ACA risk corridors provision, HHS appropriations Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues related to implementation of the Telephone Consumer Protection Act; and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Patent & Trademark Office (PTO), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) - antitrust policy H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 1560, Protecting Cyber Networks Act (Nunes) - cybersecurity H.R. 1624, Protecting Affordable Coverage for Employees Act (Guthrie) - ACA definition of small employer S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 531, Removing Limitations on Insurance Effectiveness and Flexibility Act (Flake) - catastrophic plans S. 647, Health Care Choice Act (Cruz) - national marketplace for individual health insurance S. 754, Cybersecurity Information Sharing Act (Burr) - cybersecurity Discussion Draft for Data Security and Breach Notification Act (Blackburn-Welch) - data security Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.Con.Res. 27, Budget Resolution (Price) - ACA health insurance tax S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S.Con.Res. 11, Budget Resolution (Enzi) - ACA health insurance tax Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, health insurer and employer reporting of health coverage, and other issues relating to health care reform implementation.
H.R. 2, Medicare Access and CHIP Reauthorization Act - Medicare physician payment reform, CHIP funding, Medigap, Medicare Advantage Special Needs Plans, Medicare Cost Plans, fraud provisions, QI and TMA programs H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 919, CHIP Extension and Improvement Act (Green) - federal CHIP funding H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1470, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - Medicare physician payment reforms H.Con.Res. 27, Budget Resolution (Price) - Medicare, Medicaid, CHIP issues S. 522, Protecting And Retaining Our CHIP Act (Brown) - federal CHIP funding S. 810, SGR Repeal and Medicare Provider Payment Modernization Act (Hatch) - Medicare physician payment reforms S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S.Con.Res. 11, Budget Resolution (Enzi) - Medicare, Medicaid, CHIP issues Discussion Draft for CHIP Legislation (Hatch-Upton-Pitts) - federal CHIP funding Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease such as Ebola; and other issues relating to health care reform implementation. *Add MACPAC to Agency List
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 879, Ax the Tax on Middle Class Americans Health Plans Act (Guinta) - repeal of ACA excise tax on high cost employer-sponsored coverage H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.R. 2029, Consolidated Appropriations Act - health insurance tax, excise tax on high-cost coverage H.R. 2050, Middle Class Health Benefits Tax Repeal Act (Courtney) - repeal of ACA excise tax on high-cost coverage H.R. 3762, Restoring Americans' Healthcare Freedom Reconciliation Act (Price) - ACA health insurance tax, excise tax on high-cost coverage, HSA and FSA provisions S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S. 2045, Middle Class Health Benefits Tax Repeal Act (Heller-Heinrich) - repeal of ACA excise tax on high-cost coverage S. 2075, American Worker Health Care Tax Relief Act (Brown) - repeal of ACA excise tax on high-cost coverage S. 2432, Obamacare Tax Transparency Act (Scott) - disclosure of premium attributable to health insurance tax Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 6, 21st Century Cures Act (Upton) - new cures and treatments H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs H.R. 2029, Consolidated Appropriations Act - HHS appropriations H.R. 2646, Helping Families in Mental Health Crisis Act (Murphy) - mental health reforms H.R. 2712, Commonsense Reporting and Verification Act (Black) - employer reporting and eligibility verification for ACA subsidies H.R. 3099, RAISE Family Caregivers Act (Harper) - national strategy to support family caregivers H.R. 3463, Aligning Childrens Dental Coverage Act (Griffith-DeGette) - rules for stand-alone dental plans S. 466, Quality Care for Moms and Babies Act (Stabenow) - pediatric quality measures S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs S. 961, Data Security Act (Carper) - data security S. 1077, Advancing Breakthrough Devices for Patients Act (Burr) - priority review of breakthrough medical devices S. 1427, Quality Measure Alignment Act (Stabenow) - facilitating coordination and alignment between public and private sectors on quality and efficiency measures S. 1719, RAISE Family Caregivers Act (Collins) - national strategy to support family caregivers S. 1996, Commonsense Reporting Act (Warner) - employer reporting and eligibility verification for ACA subsidies S. 2141, TRUST IT Act, (Cassidy) - health IT rating system Roadmap for ACA Replacement Legislation (Burr-Hatch-Upton) - health reforms H.R. 3323, Dental and Optometric Care Access Act (Carter) Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP;. implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to small employer group size; issues related to Certificate of Public Advantage; and other issues relating to health care reform implementation.
H.R. 9, Innovation Act (Goodlatte) - changes to inter partes review process H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers S. 1137, PATENT Act (Grassley) - changes to inter partes review process S. 2019, Preserve Access to Affordable Generics Act (Klobuchar-Grassley) - pay-for-delay settlements S. 2023, Prescription Drug Affordability Act (Sanders) - pharmaceutical issues Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 815, Access to Independent Health Insurance Advisors Act (Long-Schrader) - treatment of broker compensation in MLR calculation H.R. 1314, Bipartisan Budget Act - SSDI and disability issues, auto-enrollment requirement for large employers H.R. 1560, Protecting Cyber Networks Act (Nunes) - cybersecurity H.R. 1624, Protecting Affordable Coverage for Employees Act (Guthrie-Cardenas) - ACA definition of small employer H.R. 1731, National Cybersecurity Protection Advancement Act (McCaul) - cybersecurity H.R. 1770, Data Security and Breach Notification Act (Blackburn-Welch) - data security H.R. 2029, Consolidated Appropriations Act - ACA risk corridors program, cybersecurity H.R. 2205, Data Security Act (Neugebauer) - data security H.R. 2739, Cancer Drug Coverage Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 2868, Small Business Health Fairness Act (Johnson) - association health plans H.R. 3020, Labor-HHS-Education Appropriations Bill (Cole) - ACA risk corridors provision, HHS appropriations H.R. 3727, Health Insurance Rate Review Act (Schakowsky) - rate review H.R. 3762, Restoring Americans' Healthcare Freedom Reconciliation Act (Price) - ACA premium stabilization programs, individual mandate H.R. 4299, Patient Opportunity Protection Act (Blum) - HIPAA excepted benefits S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 754, Cybersecurity Information Sharing Act (Burr) - cybersecurity S. 1099, Protecting Affordable Coverage for Employees Act (Scott-Shaheen) - ACA definition of small employer S. 1532, Affordability is Access Act (Murray) - coverage of OTC birth control S. 1566, Cancer Drug Coverage Parity Act (Kirk) - coverage of oral anti-cancer drugs S. 1661, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - treatment of broker compensation in MLR calculation S. 1695, Labor-HHS-Education Appropriations Bill (Blunt) - ACA risk corridors provision, HHS appropriations S. 2132, Labor-HHS-Education Appropriations Bill (Cochran) - ACA risk corridors provision, HHS appropriations S. 2172, Health Insurance Rate Review Act (Feinstein) - rate review Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues related to implementation of the Telephone Consumer Protection Act; and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - rulemaking schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List
H.R. 879, Ax the Tax on Middle Class Americans Health Plans Act (Guinta) - repeal of ACA excise tax on high cost employer-sponsored coverage H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.R. 1295, Trade Preferences Extension Act (Holding) - TAA health coverage tax credits H.R. 2050, Middle Class Health Benefits Tax Repeal Act (Courtney) - repeal of ACA excise tax on high-cost coverage H.R. 3236, Surface Transportation and Veterans Health Care Choice Improvement Act (Shuster) - HSA provision for veterans S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S. 2045, Middle Class Health Benefits Tax Repeal Act (Heller-Heinrich) - repeal of ACA excise tax on high-cost coverage S. 2075, American Worker Health Care Tax Relief Act (Brown) - repeal of ACA excise tax on high-cost coverage Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 815, Access to Independent Health Insurance Advisors Act (Long-Schrader) - treatment of broker compensation in MLR calculation H.R. 1560, Protecting Cyber Networks Act (Nunes) - cybersecurity H.R. 1624, Protecting Affordable Coverage for Employees Act (Guthrie-Cardenas) - ACA definition of small employer H.R. 1731, National Cybersecurity Protection Advancement Act (McCaul) - cybersecurity H.R. 1770, Data Security and Breach Notification Act (Blackburn-Welch) - data security H.R. 2739, Cancer Drug Coverage Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 2868, Small Business Health Fairness Act (Johnson) - association health plans H.R. 3020, Labor-HHS-Education Appropriations Bill (Cole) - ACA risk corridors provision, HHS appropriations S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 754, Cybersecurity Information Sharing Act (Burr) - cybersecurity S. 1099, Protecting Affordable Coverage for Employees Act (Scott-Shaheen) - ACA definition of small employer S. 1532, Affordability is Access Act (Murray) - coverage of OTC birth control S. 1566, Cancer Drug Coverage Parity Act (Kirk) - coverage of oral anti-cancer drugs S. 1661, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - treatment of broker compensation in MLR calculation S. 1695, Labor-HHS-Education Appropriations Bill (Blunt) - ACA risk corridors provision, HHS appropriations S. 2132, Labor-HHS-Education Appropriations Bill (Cochran) - ACA risk corridors provision, HHS appropriations Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues related to implementation of the Telephone Consumer Protection Act; and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Patent & Trademark Office (PTO), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 928 (Boustany-Sinema) - full repeal of ACA health insurance tax H.R. 1270, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.Con.Res. 27, Budget Resolution (Price) - ACA health insurance tax S. 183, Jobs and Premium Protection Act (Barrasso) - full repeal of ACA health insurance tax S. 254, Small Business Health Relief Act (Portman) - full repeal of ACA health insurance tax, HSA and FSA issues S. 709, Restoring Access to Medication Act (Roberts) - HSA and FSA issues S. 879, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S.Con.Res. 11, Budget Resolution (Enzi) - ACA health insurance tax Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, health insurer and employer reporting of health coverage, and other issues relating to health care reform implementation.
H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) - antitrust policy H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 1560, Protecting Cyber Networks Act (Nunes) - cybersecurity H.R. 1624, Protecting Affordable Coverage for Employees Act (Guthrie) - ACA definition of small employer S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 531, Removing Limitations on Insurance Effectiveness and Flexibility Act (Flake) - catastrophic plans S. 647, Health Care Choice Act (Cruz) - national marketplace for individual health insurance S. 754, Cybersecurity Information Sharing Act (Burr) - cybersecurity Discussion Draft for Data Security and Breach Notification Act (Blackburn-Welch) - data security Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 2, Medicare Access and CHIP Reauthorization Act - Medicare physician payment reform, CHIP funding, Medigap, Medicare Advantage Special Needs Plans, Medicare Cost Plans, fraud provisions, QI and TMA programs H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 919, CHIP Extension and Improvement Act (Green) - federal CHIP funding H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1470, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - Medicare physician payment reforms H.Con.Res. 27, Budget Resolution (Price) - Medicare, Medicaid, CHIP issues S. 522, Protecting And Retaining Our CHIP Act (Brown) - federal CHIP funding S. 810, SGR Repeal and Medicare Provider Payment Modernization Act (Hatch) - Medicare physician payment reforms S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S.Con.Res. 11, Budget Resolution (Enzi) - Medicare, Medicaid, CHIP issues Discussion Draft for CHIP Legislation (Hatch-Upton-Pitts) - federal CHIP funding Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease such as Ebola; and other issues relating to health care reform implementation. *Add MACPAC to Agency List
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 2, Medicare Access and CHIP Reauthorization Act - Medicare physician payment reform, CHIP funding, Medigap, Medicare Advantage Special Needs Plans, Medicare Cost Plans, fraud provisions, QI and TMA programs H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1892, Trade Adjustment Assistance Reauthorization Act (Reichert) - Medicare sequestration cuts H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - rulemaking schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.Con.Res. 27, Budget Resolution (Price) - Medicare, Medicaid, health policy issues S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1268, Trade Adjustment Assistance Reauthorization Act (Hatch) - Medicare sequestration cuts S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S.Con.Res. 11, Budget Resolution (Enzi) - Medicare, Medicaid, health policy issues Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, Recovery Audit Contractor (RAC) audits, Part D prescriber enrollment requirement, and provider directories and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); ICD-10; Value-Based Insurance Design; Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease; and other issues relating to health care reform implementation. *Add MACPAC to Agency List
H.R. 6, 21st Century Cures Act (Upton) - new cures and treatments H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs S. 466, Quality Care for Moms and Babies Act (Stabenow) - pediatric quality measures S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs S. 961, Data Security Act (Carper) - data security S. 1077, Advancing Breakthrough Devices for Patients Act (Burr) - priority review of breakthrough medical devices S. 1427, Quality Measure Alignment Act (Stabenow) - facilitating coordination and alignment between public and private sectors on quality and efficiency measures Roadmap for ACA Replacement Legislation (Burr-Hatch-Upton) - health reforms Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP;. implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); financing for infectious disease; and other issues relating to health care reform implementation.
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) - antitrust policy H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 815, Access to Independent Health Insurance Advisors Act (Long-Schrader) - treatment of broker compensation in MLR calculation H.R. 1560, Protecting Cyber Networks Act (Nunes) - cybersecurity H.R. 1624, Protecting Affordable Coverage for Employees Act (Guthrie-Cardenas) - ACA definition of small employer H.R. 1731, National Cybersecurity Protection Advancement Act (McCaul) - cybersecurity H.R. 1770, Data Security and Breach Notification Act (Blackburn-Welch) - data security H.R. 2462, Health Insurance Industry Fair Competition Act (DeFazio) - antitrust policy H.R. 2739, Cancer Drug Coverage Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 2868, Small Business Health Fairness Act (Johnson) - association health plans H.R. 3020, Labor-HHS-Education Appropriations Bill (Cole) - ACA risk corridors provision, HHS appropriations S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 531, Removing Limitations on Insurance Effectiveness and Flexibility Act (Flake) - catastrophic plans S. 647, Health Care Choice Act (Cruz) - national marketplace for individual health insurance S. 754, Cybersecurity Information Sharing Act (Burr) - cybersecurity S. 1099, Protecting Affordable Coverage for Employees Act (Scott-Shaheen) - ACA definition of small employer S. 1532, Affordability is Access Act (Murray) - coverage of OTC birth control S. 1566, Cancer Drug Coverage Parity Act (Kirk) - coverage of oral anti-cancer drugs S. 1661, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - treatment of broker compensation in MLR calculation S. 1695, Labor-HHS-Education Appropriations Bill (Blunt) - ACA risk corridors provision, HHS appropriations Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; application of fiduciary standards to group health plans, issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 9, Innovation Act (Goodlatte) - changes to inter partes review process H.R. 1600, Patients' Access to Treatments Act (McKinley-Capps) - specialty drug tiers S. 1137, PATENT Act (Grassley) - changes to inter partes review process Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 30, Save American Workers Act (Young) - definition of full-time employee H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) - antitrust policy H.R. 117, Reclaiming Individual Liberty Act (Garrett) - ACA individual mandate H.R. 221, ACA Taxpayer Bailout Prevention Act (Harris) - risk corridors program H.R. 371, Care for All Act (Fortenberry) - catastrophic plans H.R. 494, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 543, Health Care Choice Act (Blackburn) - national marketplace for individual health insurance H.R. 724, Taxpayer Bailout Protection Act (Lance) - risk corridors program H.R. 1560, Protecting Cyber Networks Act (Nunes) - cybersecurity H.R. 1624, Protecting Affordable Coverage for Employees Act (Guthrie) - ACA definition of small employer S. 30, Forty Hours Is Full Time Act (Collins) - definition of full-time employee S. 123, ACA Taxpayer Bailout Prevention Act (Rubio) - risk corridors program S. 158, Employee Health Care Protection Act (Cassidy) - grandfathering of health coverage S. 359, Taxpayer Bailout Protection Act (Cassidy) - risk corridors program S. 531, Removing Limitations on Insurance Effectiveness and Flexibility Act (Flake) - catastrophic plans S. 647, Health Care Choice Act (Cruz) - national marketplace for individual health insurance S. 754, Cybersecurity Information Sharing Act (Burr) - cybersecurity Discussion Draft for Data Security and Breach Notification Act (Blackburn-Welch) - data security Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 691, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 1189, Preserving Employee Wellness Programs Act (Kline) - employee wellness programs S. 620, Preserving Employee Wellness Programs Act (Alexander) - employee wellness programs Discussion Document for 21st Century Cures (Upton) - new cures and treatments Roadmap for ACA Replacement Legislation (Burr-Hatch-Upton) - health reforms HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP;. implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); financing for infectious disease such as Ebola; and other issues relating to health care reform implementation.
H.R. 2, Medicare Access and CHIP Reauthorization Act - Medicare physician payment reform, CHIP funding, Medigap, Medicare Advantage Special Needs Plans, Medicare Cost Plans, fraud provisions, QI and TMA programs H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 919, CHIP Extension and Improvement Act (Green) - federal CHIP funding H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1470, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - Medicare physician payment reforms H.Con.Res. 27, Budget Resolution (Price) - Medicare, Medicaid, CHIP issues S. 522, Protecting And Retaining Our CHIP Act (Brown) - federal CHIP funding S. 810, SGR Repeal and Medicare Provider Payment Modernization Act (Hatch) - Medicare physician payment reforms S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S.Con.Res. 11, Budget Resolution (Enzi) - Medicare, Medicaid, CHIP issues Discussion Draft for CHIP Legislation (Hatch-Upton-Pitts) - federal CHIP funding Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease such as Ebola; and other issues relating to health care reform implementation. *Add MACPAC to Agency List
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) - MA special needs plans H.R. 4998, MA Participant Bill of Rights Act (DeLauro) - MA plan provider networks H.R. 5113, Protecting Seniors' Medicare Choices from Obamacare Act (Coffman) - MA stabilization program H.R. 5183, Value Based Insurance Design for Better Care Act (Black) - MA demonstration to test VBID methodologies H.R. 5364, CHIP Extension and Improvement Act (Pallone) - federal CHIP funding Draft Bill, Protecting the Integrity of Medicare Act (Brady) - preventing fraud in Medicare and Medicaid S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues S. 25 (Hatch) - extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal S. 2361, Stop SCAMS Act (Nelson-Collins) - reducing Medicare fraud S. 2461, CHIP Extension Act (Rockefeller) --- federal CHIP funding S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) - MA plan provider networks S. 2783, Value Based Insurance Design for Better Care Act (Thune) - MA demonstration to test VBID methodologies Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.
H.R. 763, Jobs and Premium Protection Act (Boustany-Matheson) -repeal of ACA health insurance tax H.R. 1248, Family Health Care Flexibility Act (Paulsen) - HSA and FSA issues H.R. 1342, Helping Save Americans Health Care Choices Act (Fleming) - HSA and FSA issues H.R. 2194, Family and Retirement Health Investment Act (Paulsen) - HSA and FSA issues H.R. 2835, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.R. 3367, HIT Delay Bill (Boustany-Bera) - delay of ACA health insurance tax H.R. 4600, Tax Free Health Insurance Act (King) - tax treatment of health insurance premiums H.R. 4777, Health Savings Act (Burgess) - HSA issues S. 24, Small Business Health Relief Act (Portman) - HIT repeal, HSA and FSA changes S. 603, Jobs and Premium Protection Act (Barrasso-Hatch) - repeal of ACA health insurance tax S. 610, Family Health Care Flexibility Act (Johanns) - HSA and FSA issues S. 1031, Family and Retirement Health Investment Act (Hatch) - HSA and FSA issues S. 1485, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S. 2260, EXPIRE Act (Wyden) - tax provisions Barrasso Amendment to S. 2569, Bring Jobs Home Act - repeal of ACA health insurance tax Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, health insurer and employer reporting of health coverage, and other issues relating to health care reform implementation.
H.R. 1326, Health Care Price Transparency Promotion Act (Burgess) - price transparency H.R. 1701, Cutting Costly Codes Act (Poe) - ICD-10 implementation H.R. 2853, Hospital Price Transparency and Disclosure Act (Lipinski) - transparency of hospital prices H.R. 3077, TELE-MED Act (Nunes-Pallone) - telemedicine H.R. 3750, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 4302, Protecting Access to Medicare Act (Pitts) - ICD-10 Implementation S. 44, Medical Care Access Protection Act (Portman) - medical liability reform S. 972, Cutting Costly Codes Act (Coburn) - ICD-10 implementation S. 1897, Personal Data Privacy and Security Act (Leahy) - privacy, data security issues Labor, HHS, and Education Appropriations Bill (Harkin) - funding for HHS programs, ACA amendments HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; OPM data warehouse for FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges) and other issues relating to health care reform implementation.
H.R. 460, Patients' Access to Treatments Act (McKinley) - cost sharing in a specialty drug tier H.R. 1367, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) - FEHBP prescription drugs S. 214, Preserve Access to Affordable Generics Act (Klobuchar) - access to generic drugs Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office
H.R. 83, Consolidated and Further Continuing Appropriations Act - ACA risk corridor program, expatriate plans, HHS appropriations H.R. 1326, Health Care Price Transparency Promotion Act (Burgess) - price transparency H.R. 1701, Cutting Costly Codes Act (Poe) - ICD-10 implementation H.R. 2853, Hospital Price Transparency and Disclosure Act (Lipinski) - transparency of hospital prices H.R. 3077, TELE-MED Act (Nunes-Pallone) - telemedicine H.R. 3750, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 4302, Protecting Access to Medicare Act (Pitts) - ICD-10 Implementation S. 44, Medical Care Access Protection Act (Portman) - medical liability reform S. 972, Cutting Costly Codes Act (Coburn) - ICD-10 implementation S. 1897, Personal Data Privacy and Security Act (Leahy) - privacy, data security issues HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP;; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); financing for infectious disease such as Ebola; and other issues relating to health care reform implementation.
H.R. 460, Patients' Access to Treatments Act (McKinley) - cost sharing in a specialty drug tier H.R. 1367, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) - FEHBP prescription drugs H.R. 3116, MODDERN Cures Act (Lance) - innovations in diagnostics, drug exclusivity H.R. 3742, Antibiotic Development to Advance Patient Treatment Act (Gingrey) - treatments for serious or life-threatening diseases S. 214, Preserve Access to Affordable Generics Act (Klobuchar) - access to generic drugs Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 4, Jobs for America Act (Camp) - ACA provisions H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) - antitrust policy H.R. 544, LIBERTY Act (Gingrey-Matheson) - age rating rules H.R. 743, Health Insurance Industry Fair Competition Act (DeFazio) - antitrust policy H.R. 762, Health Care Choice Act (Blackburn) - national marketplace for individual coverage H.R. 911, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 1019, Health Insurance Rate Review Act (Schakowsky) - rate review H.R. 1188, Preserving Our Hometown Independent Pharmacies Act (Marino) - antitrust policy H.R. 1205, Patients Right to Know Act (Walden) - disclosures on SBC documents H.R. 1558, Small Business Health Relief Act (Collins) - HIT repeal, other ACA changes H.R. 2328, Access to Professional Health Insurance Advisors Act (Rogers-Barrow) - MLR impact on agents and brokers H.R. 2668, Fairness for American Families Act (Young) - delay of ACA individual mandate H.R. 2698, Federal Employee Short-Term Disability Insurance Act (Norton) - short-term disability program for federal employees H.R. 3121, American Health Care Reform Act (Roe) - replacement health reforms H.R. 3350, Keep Your Health Plan Act (Upton) - continuation of existing plans H.R. 3425, Health Care Access Fairness and Penalty Delay Act (Lipinski-Sinema) - delay of open enrollment and individual mandate penalties H.R. 3489, (Tiberi) - repeal of ACA transitional reinsurance fee H.R. 3504, Consumer Protection and Rate Review Act (Schakowsky) - rate review H.R. 3517, Federal and State Insurance Exchange Access Fairness and Penalty Delay Act (Schrader) - individual mandate delay H.R. 3522, Employee Health Care Protection Act (Cassidy) - continuation of current group coverage H.R. 3541, Obamacare Taxpayer Bailout Prevention Act (Griffin) - repeal of ACA risk corridor program H.R. 3598, Catastrophic Plan Bill (Fortenberry) - expanded access to catastrophic plans H.R. 3745, Coverage Protection Act (Kirkpatrick) - continuation of coverage for consumers unable to enroll in QHPs H.R. 3812, No Bailouts for Insurance Industry Act (Coffman) - ACA reinsurance and risk corridor programs H.R. 3851, No Bailouts for Insurance Industry Act (Lance) - ACA reinsurance and risk corridor programs H.R. 3985, Stop ACA's Risky Provisions Act (Westmoreland) - ACAs reinsurance, risk corridor, and risk adjustment programs H.R. 4118, SIMPLE Fairness Act (Jenkins) - delay in ACA individual mandate penalties H.R. 4302, Protecting Access to Medicare Act (Pitts) - ACA Limits on Deductibles for Plans in Small Group Market H.R. 4354, ACA Taxpayer Bailout Protection Act (Griffin) - ACA risk corridor program H.R. 4406, Taxpayer Bailout Protection Act (Lance) - ACA risk corridor program H.R. 4414, Expatriate Health Coverage Clarification Act (Carney) - relief from ACA for expatriate health plans H.R. 4735, Health Care Fairness and Stability Act (Nolan-McKinley) - ACA transitional reinsurance program H.R. 5175, Protecting Americans from Illegal Bailouts Act (Lance) - ACA risk corridor program S. 24, Small Business Health Relief Act (Portman) - HIT repeal, other ACA changes S. 482, Health Insurance Rate Review Act (Feinstein) - rate review S. 650, Access to Independent Health Insurance Advisors Act (Landrieu) - MLR impact on agents and brokers S. 764, Patients Right to Know Act (Cornyn) - disclosures on SBC documents S. 1473, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) - model disclosure forms S. 1481, Long Term Care Insurance Integrity Act (Klobuchar) - third party review of disputed claims S. 1642, Keeping the ACA Promise Act (Landrieu-Manchin) - continuation of existing plans, notification requirements S. 1671, (Manchin-Kirk) - individual mandate delay S. 1693, ACA Enrollment Extension Act (Shaheen) - extending open enrollment, delaying individual mandate penalties S. 1699, Continuous Coverage Act (Mark Udall) - continuation of existing plans S. 1726, Obamacare Taxpayer Bailout Prevention Act (Rubio) - repeal of ACA risk corridor program S. 1729, Expanded Consumer Choice Act (Begich) - adding copper level of coverage to ACA Exchanges S. 1866, Coverage Protection Act (Merkley) - continuation of coverage, retroactive coverage S. 2166, Treating Families Fairly Act (Manchin) - ACA determinations of full-time equivalent employees S. 2168, Small Business Stability Act (Heitkamp) - ACA definition of a large employer S. 2173, Consumers Having Options in Choosing Enrollment Act (Landrieu) - ACA direct enrollment S. 2174, Commonsense Competition and Access to Health Insurance Act (Warner) - offering health insurance coverage across state lines S. 2175, Enhancing Access for Agents and Brokers Act (Landrieu) - access for independent agents and brokers to information about Exchange enrollment S. 2176, Commonsense Reporting Act (Warner) - ACA reporting requirements S. 2214, ACA Taxpayer Bailout Protection Act (Rubio) - ACA risk corridor program S. 2253, Health Care Fairness and Stability Act (Franken-Kirk) - ACA transitional reinsurance program S. 2578, Protect Women's Health From Corporate Interference Act (Murray) - contraceptive coverage S. 2733, Obamacare Opt-Out Act (McCain-Barrasso) - certification process for opting out of ACA individual mandate S. 2801, Health Care Consumer Choices Preservation Act (Enzi) - conditions on automatic renewals H.R. 5860, Small Business Healthcare Relief Act of 2014 (Boustany) -addresses use of Health Reimbursement Accounts and other employer funding of premiums Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 647 / H.R. 5771, ABLE Act - ABLE accounts for individuals with severe disabilities H.R. 763, Jobs and Premium Protection Act (Boustany-Matheson) -repeal of ACA health insurance tax H.R. 1248, Family Health Care Flexibility Act (Paulsen) - HSA and FSA issues H.R. 1342, Helping Save Americans Health Care Choices Act (Fleming) - HSA and FSA issues H.R. 2194, Family and Retirement Health Investment Act (Paulsen) - HSA and FSA issues H.R. 2835, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.R. 3367, HIT Delay Bill (Boustany-Bera) - delay of ACA health insurance tax H.R. 4600, Tax Free Health Insurance Act (King) - tax treatment of health insurance premiums H.R. 4777, Health Savings Act (Burgess) - HSA issues S. 24, Small Business Health Relief Act (Portman) - HIT repeal, HSA and FSA changes S. 603, Jobs and Premium Protection Act (Barrasso-Hatch) - repeal of ACA health insurance tax S. 610, Family Health Care Flexibility Act (Johanns) - HSA and FSA issues S. 1031, Family and Retirement Health Investment Act (Hatch) - HSA and FSA issues S. 1485, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, health insurer and employer reporting of health coverage, and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 763, Jobs and Premium Protection Act (Boustany-Matheson) -repeal of ACA health insurance tax H.R. 1248, Family Health Care Flexibility Act (Paulsen) - HSA and FSA issues H.R. 1342, Helping Save Americans Health Care Choices Act (Fleming) - HSA and FSA issues H.R. 2194, Family and Retirement Health Investment Act (Paulsen) - HSA and FSA issues H.R. 2835, Restoring Access to Medication Act (Jenkins) - HSA and FSA issues H.R. 3367, HIT Delay Bill (Boustany-Bera) - delay of ACA health insurance tax H.R. 4600, Tax Free Health Insurance Act (King) - tax treatment of health insurance premiums H.R. 4777, Health Savings Act (Burgess) - HSA issues S. 24, Small Business Health Relief Act (Portman) - HIT repeal, HSA and FSA changes S. 603, Jobs and Premium Protection Act (Barrasso-Hatch) - repeal of ACA health insurance tax S. 610, Family Health Care Flexibility Act (Johanns) - HSA and FSA issues S. 1031, Family and Retirement Health Investment Act (Hatch) - HSA and FSA issues S. 1485, Americans Giving Care to Elders Act (Klobuchar) - tax credits for family caregivers S. 2260, EXPIRE Act (Wyden) - tax provisions Barrasso Amendment to S. 2569, Bring Jobs Home Act - repeal of ACA health insurance tax Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, health insurer and employer reporting of health coverage, and other issues relating to health care reform implementation.
H.R. 4, Jobs for America Act (Camp) - ACA provisions H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) - antitrust policy H.R. 544, LIBERTY Act (Gingrey-Matheson) - age rating rules H.R. 743, Health Insurance Industry Fair Competition Act (DeFazio) - antitrust policy H.R. 762, Health Care Choice Act (Blackburn) - national marketplace for individual coverage H.R. 911, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R. 1019, Health Insurance Rate Review Act (Schakowsky) - rate review H.R. 1188, Preserving Our Hometown Independent Pharmacies Act (Marino) - antitrust policy H.R. 1205, Patients Right to Know Act (Walden) - disclosures on SBC documents H.R. 1558, Small Business Health Relief Act (Collins) - HIT repeal, other ACA changes H.R. 2328, Access to Professional Health Insurance Advisors Act (Rogers-Barrow) - MLR impact on agents and brokers H.R. 2668, Fairness for American Families Act (Young) - delay of ACA individual mandate H.R. 2698, Federal Employee Short-Term Disability Insurance Act (Norton) - short-term disability program for federal employees H.R. 3121, American Health Care Reform Act (Roe) - replacement health reforms H.R. 3350, Keep Your Health Plan Act (Upton) - continuation of existing plans H.R. 3425, Health Care Access Fairness and Penalty Delay Act (Lipinski-Sinema) - delay of open enrollment and individual mandate penalties H.R. 3489, (Tiberi) - repeal of ACA transitional reinsurance fee H.R. 3504, Consumer Protection and Rate Review Act (Schakowsky) - rate review H.R. 3517, Federal and State Insurance Exchange Access Fairness and Penalty Delay Act (Schrader) - individual mandate delay H.R. 3522, Employee Health Care Protection Act (Cassidy) - continuation of current group coverage H.R. 3541, Obamacare Taxpayer Bailout Prevention Act (Griffin) - repeal of ACA risk corridor program H.R. 3598, Catastrophic Plan Bill (Fortenberry) - expanded access to catastrophic plans H.R. 3745, Coverage Protection Act (Kirkpatrick) - continuation of coverage for consumers unable to enroll in QHPs H.R. 3812, No Bailouts for Insurance Industry Act (Coffman) - ACA reinsurance and risk corridor programs H.R. 3851, No Bailouts for Insurance Industry Act (Lance) - ACA reinsurance and risk corridor programs H.R. 3985, Stop ACA's Risky Provisions Act (Westmoreland) - ACAs reinsurance, risk corridor, and risk adjustment programs H.R. 4118, SIMPLE Fairness Act (Jenkins) - delay in ACA individual mandate penalties H.R. 4302, Protecting Access to Medicare Act (Pitts) - ACA Limits on Deductibles for Plans in Small Group Market H.R. 4354, ACA Taxpayer Bailout Protection Act (Griffin) - ACA risk corridor program H.R. 4406, Taxpayer Bailout Protection Act (Lance) - ACA risk corridor program H.R. 4414, Expatriate Health Coverage Clarification Act (Carney) - relief from ACA for expatriate health plans H.R. 4735, Health Care Fairness and Stability Act (Nolan-McKinley) - ACA transitional reinsurance program H.R. 5175, Protecting Americans from Illegal Bailouts Act (Lance) - ACA risk corridor program S. 24, Small Business Health Relief Act (Portman) - HIT repeal, other ACA changes S. 482, Health Insurance Rate Review Act (Feinstein) - rate review S. 650, Access to Independent Health Insurance Advisors Act (Landrieu) - MLR impact on agents and brokers S. 764, Patients Right to Know Act (Cornyn) - disclosures on SBC documents S. 1473, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) - model disclosure forms S. 1481, Long Term Care Insurance Integrity Act (Klobuchar) - third party review of disputed claims S. 1642, Keeping the ACA Promise Act (Landrieu-Manchin) - continuation of existing plans, notification requirements S. 1671, (Manchin-Kirk) - individual mandate delay S. 1693, ACA Enrollment Extension Act (Shaheen) - extending open enrollment, delaying individual mandate penalties S. 1699, Continuous Coverage Act (Mark Udall) - continuation of existing plans S. 1726, Obamacare Taxpayer Bailout Prevention Act (Rubio) - repeal of ACA risk corridor program S. 1729, Expanded Consumer Choice Act (Begich) - adding copper level of coverage to ACA Exchanges S. 1866, Coverage Protection Act (Merkley) - continuation of coverage, retroactive coverage S. 2166, Treating Families Fairly Act (Manchin) - ACA determinations of full-time equivalent employees S. 2168, Small Business Stability Act (Heitkamp) - ACA definition of a large employer S. 2173, Consumers Having Options in Choosing Enrollment Act (Landrieu) - ACA direct enrollment S. 2174, Commonsense Competition and Access to Health Insurance Act (Warner) - offering health insurance coverage across state lines S. 2175, Enhancing Access for Agents and Brokers Act (Landrieu) - access for independent agents and brokers to information about Exchange enrollment S. 2176, Commonsense Reporting Act (Warner) - ACA reporting requirements S. 2214, ACA Taxpayer Bailout Protection Act (Rubio) - ACA risk corridor program S. 2253, Health Care Fairness and Stability Act (Franken-Kirk) - ACA transitional reinsurance program S. 2578, Protect Women's Health From Corporate Interference Act (Murray) - contraceptive coverage S. 2733, Obamacare Opt-Out Act (McCain-Barrasso) - certification process for opting out of ACA individual mandate S. 2801, Health Care Consumer Choices Preservation Act (Enzi) - conditions on automatic renewals Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 1326, Health Care Price Transparency Promotion Act (Burgess) - price transparency H.R. 1701, Cutting Costly Codes Act (Poe) - ICD-10 implementation H.R. 2853, Hospital Price Transparency and Disclosure Act (Lipinski) - transparency of hospital prices H.R. 3077, TELE-MED Act (Nunes-Pallone) - telemedicine H.R. 3750, Telehealth Modernization Act (Matsui-Johnson) - telemedicine H.R. 4302, Protecting Access to Medicare Act (Pitts) - ICD-10 Implementation S. 44, Medical Care Access Protection Act (Portman) - medical liability reform S. 972, Cutting Costly Codes Act (Coburn) - ICD-10 implementation S. 1897, Personal Data Privacy and Security Act (Leahy) - privacy, data security issues Labor, HHS, and Education Appropriations Bill (Harkin) - funding for HHS programs, ACA amendments HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; OPM data warehouse for FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges) and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office
H.R. 460, Patients' Access to Treatments Act (McKinley) cost sharing in a specialty drug tier16. Specific Lobbying Issues (continued): H.R. 1367, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) FEHBP prescription drugs H.R. 3204, Drug Quality and Security Act (Upton) drug safety issues S. 214, Preserve Access to Affordable Generics Act (Klobuchar) access to generic drugs Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) antitrust policy16. Specific Lobbying Issues (continued): H.R. 544, LIBERTY Act (Gingrey-Matheson) age rating rules H.R. 743, Health Insurance Industry Fair Competition Act (DeFazio) antitrust policy H.R. 762, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 911, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R. 1019, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1188, Preserving Our Hometown Independent Pharmacies Act (Marino) antitrust policy H.R. 1205, Patients Right to Know Act (Walden) disclosures on SBC documents H.R. 1558, Small Business Health Relief Act (Collins) HIT repeal, other ACA changes H.R. 2328, Access to Professional Health Insurance Advisors Act (Rogers-Barrow) MLR impact on agents and brokers H.R. 2668, Fairness for American Families Act (Young) delay of ACA individual mandate H.R. 2698, Federal Employee Short-Term Disability Insurance Act (Norton) short-term disability program for federal employees H.R. 3121, American Health Care Reform Act (Roe) replacement health reforms H.R. 3350, Keep Your Health Plan Act (Upton) continuation of existing plans H.R. 3425, Health Care Access Fairness and Penalty Delay Act (Lipinski-Sinema) delay of open enrollment and individual mandate penalties H.R. 3489, (Tiberi) repeal of ACA transitional reinsurance fee H.R. 3504, Consumer Protection and Rate Review Act (Schakowsky) rate review H.R. 3517, Federal and State Insurance Exchange Access Fairness and Penalty Delay Act (Schrader) individual mandate delay H.R. 3522, Employee Health Care Protection Act (Cassidy) continuation of current group coverage H.R. 3541, Obamacare Taxpayer Bailout Prevention Act (Griffin) repeal of ACA risk corridor program H.R. 3598, Catastrophic Plan Bill (Fortenberry) expanded access to catastrophic plans H.R. 3745, Coverage Protection Act (Kirkpatrick) continuation of coverage for consumers unable to enroll in QHPs H.R. 3812, No Bailouts for Insurance Industry Act (Coffman) ACA reinsurance and risk corridor programs H.R. 3851, No Bailouts for Insurance Industry Act (Lance) ACA reinsurance and risk corridor programs H.R. 3985, Stop ACA's Risky Provisions Act (Westmoreland) ACAs reinsurance, risk corridor, and risk adjustment programs H.R. 4118, SIMPLE Fairness Act (Jenkins) delay in ACA individual mandate penalties H.R. 4302, Protecting Access to Medicare Act (Pitts) ACA Limits on Deductibles for Plans in Small Group Market H.R. 4354, ACA Taxpayer Bailout Protection Act (Griffin) ACA risk corridor program H.R. 4406, Taxpayer Bailout Protection Act (Lance) ACA risk corridor program H.R. 4414, Expatriate Health Coverage Clarification Act (Carney) relief from ACA for expatriate health plans H.R. 4735, Health Care Fairness and Stability Act (Nolan-McKinley) ACA transitional reinsurance program S. 24, Small Business Health Relief Act (Portman) HIT repeal, other ACA changes S. 482, Health Insurance Rate Review Act (Feinstein) rate review S. 650, Access to Independent Health Insurance Advisors Act (Landrieu) MLR impact on agents and brokers S. 764, Patients Right to Know Act (Cornyn) disclosures on SBC documents S. 1473, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms S. 1481, Long Term Care Insurance Integrity Act (Klobuchar) third party review of disputed claims S. 1642, Keeping the ACA Promise Act (Landrieu-Manchin) continuation of existing plans, notification requirements S. 1671, (Manchin-Kirk) individual mandate delay S. 1693, ACA Enrollment Extension Act (Shaheen) extending open enrollment, delaying individual mandate penalties S. 1699, Continuous Coverage Act (Mark Udall) continuation of existing plans S. 1726, Obamacare Taxpayer Bailout Prevention Act (Rubio) repeal of ACA risk corridor program S. 1729, Expanded Consumer Choice Act (Begich) adding copper level of coverage to ACA Exchanges S. 1866, Coverage Protection Act (Merkley) continuation of coverage, retroactive coverage S. 2166, Treating Families Fairly Act (Manchin) ACA determinations of full-time equivalent employees S. 2168, Small Business Stability Act (Heitkamp) ACA definition of a large employer S. 2173, Consumers Having Options in Choosing Enrollment Act (Landrieu) ACA direct enrollment16. Specific Lobbying Issues (continued): S. 2174, Commonsense Competition and Access to Health Insurance Act (Warner) offering health insurance coverage across state lines S. 2175, Enhancing Access for Agents and Brokers Act (Landrieu) access for independent agents and brokers to information about Exchange enrollments. S. 2176, Commonsense Reporting Act (Warner) ACA reporting requirements S. 2214, ACA Taxpayer Bailout Protection Act (Rubio) ACA risk corridor program S. 2253, Health Care Fairness and Stability Act (Franken-Kirk) ACA transitional reinsurance program Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 1326, Health Care Price Transparency Promotion Act (Burgess) price transparency16. Specific Lobbying Issues (continued): H.R. 1701, Cutting Costly Codes Act (Poe) ICD-10 implementation H.R. 2853, Hospital Price Transparency and Disclosure Act (Lipinski) transparency of hospital prices H.R. 3077, TELE-MED Act (Nunes-Pallone) telemedicine H.R. 4302, Protecting Access to Medicare Act (Pitts) ICD-10 Implementation S. 44, Medical Care Access Protection Act (Portman) medical liability reform S. 972, Cutting Costly Codes Act (Coburn) ICD-10 implementation S. 1897, Personal Data Privacy and Security Act (Leahy) privacy, data security issues Labor, HHS, and Education Appropriations Bill (Harkin) funding for HHS programs, ACA amendments Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; OPM data warehouse for FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment (commonly referred to as the 3 Rs); dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges) and other issues relating to health care reform implementation.
H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits16. Specific Lobbying Issues (continued): H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) MA payment and enrollment issues, wellness incentives H.R. 2810, Medicare Patient Access and Quality Improvement Act (Burgess/Camp) SGR repeal, quality- and value-based payment reforms H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) MA special needs plans H.R. 4998, MA Participant Bill of Rights Act (DeLauro) MA plan provider networks H.Con.Res. 96, Budget Resolution (Ryan) Medicare, Medigap, Medicaid, ACA issues S. 11, Fiscal Sustainability Act (Corker) Medicare, Medigap, Medicaid issues S. 25 (Hatch) extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal S. 2361, Stop SCAMS Act (Nelson-Collins) reducing Medicare fraud S. 2461, CHIP Extension Act (Rockefeller) --- CHIP reauthorization S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) MA plan provider networks16. Specific Lobbying Issues (continued): Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation. 17. Houses of Congress and Federal Agencies (continued): Medicaid and CHIP Payment and Access Commission (MACPAC)
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office
H.R. 1326, Health Care Price Transparency Promotion Act (Burgess) price transparency16. Specific Lobbying Issues (continued): H.R. 1701, Cutting Costly Codes Act (Poe) ICD-10 implementation H.R. 2775, Continuing Appropriations Act (Black) ACA issues H.R. 2853, Hospital Price Transparency and Disclosure Act (Lipinski) transparency of hospital prices H.R. 3547, the Consolidated Appropriations Act (Smith) ACA issues, FY 2014 appropriations H.R. 4302, Protecting Access to Medicare Act (Pitts) ICD-10 Implementation S. 44, Medical Care Access Protection Act (Portman) medical liability reform S. 972, Cutting Costly Codes Act (Coburn) ICD-10 implementation S. 1897, Personal Data Privacy and Security Act (Leahy) privacy, data security issues U.S. Senate Special Committee on Aging Draft of Stop SCAMS Act (not yet introduced) - anti-fraud activities, including coding, Healthcare Fraud Prevention Partnership, and MEDPAC report Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; OPM data warehouse for FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges) and other issues relating to health care reform implementation. 18. Name of Lobbyists (continued): C. Lawrence: Assistant, Legislative Director for Rep. Bill Cassidy (LA-6); May 2008-July 200: Staff Assistant, Legislative Correspondent for Rep. Tom Price (GA-6)
H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) antitrust policy16. Specific Lobbying Issues (continued): H.R. 544, LIBERTY Act (Gingrey-Matheson) age rating rules H.R. 743, Health Insurance Industry Fair Competition Act (DeFazio) antitrust policy H.R. 762, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 911, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R. 1019, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1188, Preserving Our Hometown Independent Pharmacies Act (Marino) antitrust policy H.R. 1205, Patients Right to Know Act (Walden) disclosures on SBC documents H.R. 1558, Small Business Health Relief Act (Collins) HIT repeal, other ACA changes H.R. 2328, Access to Professional Health Insurance Advisors Act (Rogers-Barrow) MLR impact on agents and brokers H.R. 2668, Fairness for American Families Act (Young) delay of ACA individual mandate H.R. 2698, Federal Employee Short-Term Disability Insurance Act (Norton) short-term disability program for federal employees H.R. 3121, American Health Care Reform Act (Roe) replacement health reforms H.R. 3350, Keep Your Health Plan Act (Upton) continuation of existing plans H.R. 3425, Health Care Access Fairness and Penalty Delay Act (Lipinski-Sinema) delay of open enrollment and individual mandate penalties H.R. 3489, (Tiberi) repeal of ACA transitional reinsurance fee H.R. 3504, Consumer Protection and Rate Review Act (Schakowsky) rate review H.R. 3517, Federal and State Insurance Exchange Access Fairness and Penalty Delay Act (Schrader) individual mandate delay H.R. 3522, Employee Health Care Protection Act (Cassidy) continuation of current group coverage H.R. 3541, Obamacare Taxpayer Bailout Prevention Act (Griffin) repeal of ACA risk corridor program H.R. 3745, Coverage Protection Act (Kirkpatrick) continuation of coverage for consumers unable to enroll in QHPs H.R. 3812, No Bailouts for Insurance Industry Act (Coffman) ACA reinsurance and risk corridor programs H.R. 3851, No Bailouts for Insurance Industry Act (Lance) ACA reinsurance and risk corridor programs H.R. 3985, Stop ACA's Risky Provisions Act (Westmoreland) ACAs reinsurance, risk corridor, and risk adjustment programs H.R. 4118, SIMPLE Fairness Act (Jenkins) delay in ACA individual mandate penalties H.R. 4302, Protecting Access to Medicare Act (Pitts) ACA Limits on Deductibles for Plans in Small Group Market S. 24, Small Business Health Relief Act (Portman) HIT repeal, other ACA changes S. 482, Health Insurance Rate Review Act (Feinstein) rate review S. 650, Access to Independent Health Insurance Advisors Act (Landrieu) MLR impact on agents and brokers S. 764, Patients Right to Know Act (Cornyn) disclosures on SBC documents S. 1473, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms S. 1481, Long Term Care Insurance Integrity Act (Klobuchar) third party review of disputed claims S. 1642, Keeping the ACA Promise Act (Landrieu-Manchin) continuation of existing plans, notification requirements S. 1671, (Manchin-Kirk) individual mandate delay S. 1693, ACA Enrollment Extension Act (Shaheen) extending open enrollment, delaying individual mandate penalties S. 1699, Continuous Coverage Act (Mark Udall) continuation of existing plans S. 1726, Obamacare Taxpayer Bailout Prevention Act (Rubio) repeal of ACA risk corridor program S. 1729, Expanded Consumer Choice Act (Begich) adding copper level of coverage to ACA Exchanges S. 1866, Coverage Protection Act (Merkley) continuation of coverage, retroactive coverage S. 2166, Treating Families Fairly Act (Manchin) ACA determinations of full-time equivalent employees S. 2168, Small Business Stability Act (Heitkamp) ACA definition of a large employer S. 2173, Consumers Having Options in Choosing Enrollment Act (Landrieu) ACA direct enrollment S. 2174, Commonsense Competition and Access to Health Insurance Act (Warner) offering health insurance coverage across state lines S. 2175, Enhancing Access for Agents and Brokers Act (Landrieu) access for independent agents and brokers to information about Exchange enrollment S. 2176, Commonsense Reporting Act (Warner) ACA reporting requirements16. Specific Lobbying Issues (continued): Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation. 18. Name of Lobbyists (continued): C. Lawrence: Assistant, Legislative Director for Rep. Bill Cassidy (LA-6); May 2008-July 200: Staff Assistant, Legislative Correspondent for Rep. Tom Price (GA-6)
H.R. 763, Jobs and Premium Protection Act (Boustany-Matheson) repeal of ACA health insurance tax16. Specific Lobbying Issues (continued): H.R. 1248, Family Health Care Flexibility Act (Paulsen) HSA and FSA issues H.R. 1342, Helping Save Americans Health Care Choices Act (Fleming) HSA and FSA issues H.R. 2194, Family and Retirement Health Investment Act (Paulsen) HSA and FSA issues H.R. 2835, Restoring Access to Medication Act (Jenkins) HSA and FSA issues H.R. 3367, HIT Delay Bill (Boustany-Bera) delay of ACA health insurance tax S. 24, Small Business Health Relief Act (Portman) HIT repeal, HSA and FSA changes S. 603, Jobs and Premium Protection Act (Barrasso-Hatch) repeal of ACA health insurance tax S. 610, Family Health Care Flexibility Act (Johanns) HSA and FSA issues S. 1031, Family and Retirement Health Investment Act (Hatch) HSA and FSA issues S. 1485, Americans Giving Care to Elders Act (Klobuchar) tax credits for family caregivers Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, health insurer and employer reporting of health coverage, and other issues relating to health care reform implementation. 18. Name of Lobbyists (continued): C. Lawrence: Assistant, Legislative Director for Rep. Bill Cassidy (LA-6); May 2008-July 200: Staff Assistant, Legislative Correspondent for Rep. Tom Price (GA-6)
H.R. 1367, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) FEHBP prescription drugs16. Specific Lobbying Issues (continued): H.R. 3204, Drug Quality and Security Act (Upton) drug safety issues S. 214, Preserve Access to Affordable Generics Act (Klobuchar) access to generic drugs Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation. 18. Name of Lobbyists (continued): C. Lawrence: Assistant, Legislative Director for Rep. Bill Cassidy (LA-6); May 2008-July 200: Staff Assistant, Legislative Correspondent for Rep. Tom Price (GA-6)
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 1367, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) FEHBP prescription drugs16. Specific Lobbying Issues (continued): H.R. 3204, Drug Quality and Security Act (Upton) drug safety issues S. 214, Preserve Access to Affordable Generics Act (Klobuchar) access to generic drugs Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) antitrust policy16. Specific Lobbying Issues (continued): H.R. 544, LIBERTY Act (Gingrey-Matheson) age rating rules H.R. 743, Health Insurance Industry Fair Competition Act (DeFazio) antitrust policy H.R. 762, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 911, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R. 1019, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1188, Preserving Our Hometown Independent Pharmacies Act (Marino) antitrust policy H.R. 1205, Patients Right to Know Act (Walden) disclosures on SBC documents H.R. 1558, Small Business Health Relief Act (Collins) HIT repeal, other ACA changes H.R. 2328, Access to Professional Health Insurance Advisors Act (Rogers-Barrow) MLR impact on agents and brokers H.R. 2668, Fairness for American Families Act (Young) delay of ACA individual mandate H.R. 2698, Federal Employee Short-Term Disability Insurance Act (Norton) short-term disability program for federal employees H.R. 3121, American Health Care Reform Act (Roe) replacement health reforms H.R. 3350, Keep Your Health Plan Act (Upton) continuation of existing plans H.R. 3425, Health Care Access Fairness and Penalty Delay Act (Lipinski-Sinema) delay of open enrollment and individual mandate penalties H.R. 3489, (Tiberi) repeal of ACA transitional reinsurance fee H.R. 3504, Consumer Protection and Rate Review Act (Schakowsky) rate review H.R. 3517, Federal and State Insurance Exchange Access Fairness and Penalty Delay Act (Schrader) individual mandate delay H.R. 3522, Employee Health Care Protection Act (Cassidy) continuation of current group coverage H.R. 3541, Obamacare Taxpayer Bailout Prevention Act (Griffin) repeal of ACA risk corridor program H.R. 3745, Coverage Protection Act (Kirkpatrick) continuation of coverage for consumers unable to enroll in QHPs S. 24, Small Business Health Relief Act (Portman) HIT repeal, other ACA changes S. 482, Health Insurance Rate Review Act (Feinstein) rate review S. 650, Access to Independent Health Insurance Advisors Act (Landrieu) MLR impact on agents and brokers S. 764, Patients Right to Know Act (Cornyn) disclosures on SBC documents S. 1473, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms S. 1481, Long Term Care Insurance Integrity Act (Klobuchar) third party review of disputed claims S. 1642, Keeping the ACA Promise Act (Landrieu-Manchin) continuation of existing plans, notification requirements S. 1671, (Manchin-Kirk) individual mandate delay S. 1693, ACA Enrollment Extension Act (Shaheen) extending open enrollment, delaying individual mandate penalties S. 1699, Continuous Coverage Act (Mark Udall) continuation of existing plans S. 1726, Obamacare Taxpayer Bailout Prevention Act (Rubio) repeal of ACA risk corridor program S. 1729, Expanded Consumer Choice Act (Begich) adding copper level of coverage to ACA Exchanges S. 1866, Coverage Protection Act (Merkley) continuation of coverage, retroactive coverage Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 1326, Health Care Price Transparency Promotion Act (Burgess) price transparency16. Specific Lobbying Issues (continued): H.R. 1701, Cutting Costly Codes Act (Poe) ICD-10 implementation H.R. 2775, Continuing Appropriations Act (Black) ACA issues H.R. 2853, Hospital Price Transparency and Disclosure Act (Lipinski) transparency of hospital prices S. 44, Medical Care Access Protection Act (Portman) medical liability reform S. 972, Cutting Costly Codes Act (Coburn) ICD-10 implementation S. 1284, Labor, HHS, and Education Appropriations Bill (Harkin) funding for HHS programs and agencies; amendment to block implementation of ACA individual mandate Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets, identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; OPM data warehouse for FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges) and other issues relating to health care reform implementation.
H.R. 763, Jobs and Premium Protection Act (Boustany-Matheson) repeal of ACA health insurance tax16. Specific Lobbying Issues (continued): H.R. 1248, Family Health Care Flexibility Act (Paulsen) HSA and FSA issues H.R. 1342, Helping Save Americans Health Care Choices Act (Fleming) HSA and FSA issues H.R. 2194, Family and Retirement Health Investment Act (Paulsen) HSA and FSA issues H.R. 2835, Restoring Access to Medication Act (Jenkins) HSA and FSA issues H.R. 3367, HIT Delay Bill (Boustany-Bera) delay of ACA health insurance tax S. 24, Small Business Health Relief Act (Portman) HIT repeal, HSA and FSA changes S. 603, Jobs and Premium Protection Act (Barrasso-Hatch) repeal of ACA health insurance tax S. 610, Family Health Care Flexibility Act (Johanns) HSA and FSA issues S. 1031, Family and Retirement Health Investment Act (Hatch) HSA and FSA issues S. 1485, Americans Giving Care to Elders Act (Klobuchar) tax credits for family caregivers Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 1367, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) FEHBP prescription drugs16. Specific Lobbying Issues (continued): S. 214, Preserve Access to Affordable Generics Act (Klobuchar) access to generic drugs H.R. 3204, Drug Quality and Security Act (Upton) - safety of drug compounding and the security of the pharmaceutical supply chain Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) antitrust policy16. Specific Lobbying Issues (continued): H.R. 544, LIBERTY Act (Gingrey-Matheson) age rating rules H.R. 743, Health Insurance Industry Fair Competition Act (DeFazio) antitrust policy H.R. 762, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 911, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R. 1019, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1188, Preserving Our Hometown Independent Pharmacies Act (Marino) antitrust policy H.R. 1205, Patients Right to Know Act (Walden) disclosures on SBC documents H.R. 1558, Small Business Health Relief Act (Collins) HIT repeal, other ACA changes H.R. 2328, Access to Professional Health Insurance Advisors Act (Rogers-Barrow) MLR impact on agents and brokers H.R. 2668, Fairness for American Families Act (Young) delay of ACA individual mandate H.R. 2698, Federal Employee Short-Term Disability Insurance Act (Norton) short-term disability program for federal employees H.R. 3121, American Health Care Reform Act (Roe) replacement health reforms H.J.Res. 59, Continuing Resolution (Rogers) ACA individual mandate S. 24, Small Business Health Relief Act (Portman) HIT repeal, other ACA changes S. 482, Health Insurance Rate Review Act (Feinstein) rate review S. 650, Access to Independent Health Insurance Advisors Act (Landrieu) MLR impact on agents and brokers S. 764, Patients Right to Know Act (Cornyn) disclosures on SBC documents S. 1473, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms S. 1481, Long Term Care Insurance Integrity Act (Klobuchar) third party review of disputed claims Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits16. Specific Lobbying Issues (continued): H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) MA payment and enrollment issues, wellness incentives H.R. 2810, Medicare Patient Access and Quality Improvement Act (Burgess) SGR repeal, quality- and value-based payment reforms House Ways and Means Committee Discussion Draft of Medicare Physician Payment Reform (not yet introduced) SGR repeal, quality- and value-based payment reforms House Ways and Means Committee Draft Medicare Reforms S. 11, Fiscal Sustainability Act (Corker) Medicare, Medigap, Medicaid issues S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) wellness incentives Senate Finance Committee Discussion Draft of Medicare Physician Payment Reform (not yet introduced) SGR repeal, quality- and value-based payment reforms H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) Part D drug utilization review Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); SNP reauthorization; quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program;16. Regulatory Issues (con't): Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation. 17. Selected Agencies (con't): Medicaid and CHIP Payment and Access Commission (MACPAC)
H.R. 763, Jobs and Premium Protection Act (Boustany-Matheson) HIT repeal16. Specific Lobbying Issues (continued): H.R. 1248, Family Health Care Flexibility Act (Paulsen) HSA and FSA issues H.R. 1342, Helping Save Americans Health Care Choices Act (Fleming) HSA and FSA issues H.R. 2194, Family and Retirement Health Investment Act (Paulsen) HSA and FSA issues H.R. 2835, Restoring Access to Medication Act (Jenkins) HSA and FSA issues S. 24, Small Business Health Relief Act (Portman) HIT repeal, HSA and FSA changes S. 603, Jobs and Premium Protection Act (Barrasso-Hatch) HIT repeal S. 610, Family Health Care Flexibility Act (Johanns) HSA and FSA issues S. 1031, Family and Retirement Health Investment Act (Hatch) HSA and FSA issues S. 1485, Americans Giving Care to Elders Act (Klobuchar) tax credits for family caregivers Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) antitrust policy16. Specific Lobbying Issues (continued): H.R. 544, LIBERTY Act (Gingrey-Matheson) age rating rules H.R. 743, Health Insurance Industry Fair Competition Act (DeFazio) antitrust policy H.R. 762, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 911, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R. 1019, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1188, Preserving Our Hometown Independent Pharmacies Act (Marino) antitrust policy H.R. 1205, Patients Right to Know Act (Walden) disclosures on SBC documents H.R. 1558, Small Business Health Relief Act (Collins) HIT repeal, other ACA changes H.R. 2328, Access to Professional Health Insurance Advisors Act (Rogers-Barrow) MLR impact on agents and brokers S. 24, Small Business Health Relief Act (Portman) HIT repeal, other ACA changes S. 482, Health Insurance Rate Review Act (Feinstein) rate review S. 650, Access to Independent Health Insurance Advisors Act (Landrieu) MLR impact on agents and brokers S. 764, Patients Right to Know Act (Cornyn) disclosures on SBC documents Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 763, Jobs and Premium Protection Act (Boustany-Matheson) HIT repeal16. Specific Lobbying Issues (continued): H.R. 1248, Family Health Care Flexibility Act (Paulsen) HSA and FSA issues H.R. 1342, Helping Save Americans Health Care Choices Act (Fleming) HSA and FSA issues H.R. 2194, Family and Retirement Health Investment Act (Paulsen) HSA and FSA issues S. 24, Small Business Health Relief Act (Portman) HIT repeal, HSA and FSA changes S. 603, Jobs and Premium Protection Act (Barrasso-Hatch) HIT repeal S. 610, Family Health Care Flexibility Act (Johanns) HSA and FSA issues S. 1031, Family and Retirement Health Investment Act (Hatch) HSA and FSA issues Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate, W-2 reporting requirements, health reimbursement accounts, deductibility limits for insurer compensation, and other issues relating to health care reform implementation.
H.R. 1367, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) FEHBP prescription drugs16. Specific Lobbying Issues (continued): S. 214, Preserve Access to Affordable Generics Act (Klobuchar) access to generic drugs Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 1326, Health Care Price Transparency Promotion Act (Burgess) price transparency16. Specific Lobbying Issues (continued): H.R. 1701, Cutting Costly Codes Act (Poe) ICD-10 implementation S. 44, Medical Care Access Protection Act (Portman) medical liability reform S. 972, Cutting Costly Codes Act (Coburn) ICD-10 implementation Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets, identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; OPM data warehouse for FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges) and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.Con.Res. 25, House Budget Resolution (Ryan) public program issues, deficit reduction proposals16. Specific Lobbying Issues (continued): S.Con.Res. 8, Senate Budget Resolution (Murray) public program issues, deficit reduction proposals H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) wellness incentives S. 11, Fiscal Sustainability Act (Corker) Medicare, Medigap, Medicaid issues S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) wellness incentives Discussion Drafts of Medicare Physician Payment Reform Bills (not yet introduced) SGR repeal, quality- and value-based payment reforms Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs;Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.
H.R. 99, Health Insurance Industry Antitrust Enforcement Act (Conyers) antitrust policy16. Specific Lobbying Issues (continued): H.R. 544, LIBERTY Act (Gingrey-Matheson) age rating rules H.R. 743, Health Insurance Industry Fair Competition Act (DeFazio) antitrust policy H.R. 762, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 911, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R. 1019, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1188, Preserving Our Hometown Independent Pharmacies Act (Marino) antitrust policy H.R. 1205, Patients Right to Know Act (Walden) disclosures on SBC documents H.R. 1558, Small Business Health Relief Act (Collins) HIT repeal, other ACA changes H.R. 2328, Access to Professional Health Insurance Advisors Act (Rogers-Barrow) MLR impact on agents and brokers S. 24, Small Business Health Relief Act (Portman) HIT repeal, other ACA changes S. 482, Health Insurance Rate Review Act (Feinstein) rate review S. 650, Access to Independent Health Insurance Advisors Act (Landrieu) MLR impact on agents and brokers S. 764, Patients Right to Know Act (Cornyn) disclosures on SBC documents Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues related to the continuation of reporting requirements for state LTCI partnership programs; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; and issues related to supplemental products, and other issues relating to health care reform implementation.
H.R. 1326, Health Care Price Transparency Promotion Act (Burgess) price transparency16. Specific Lobbying Issues (continued): H.R. 1701, Cutting Costly Codes Act (Poe) ICD-10 implementation S. 44, Medical Care Access Protection Act (Portman) medical liability reform S. 972, Cutting Costly Codes Act (Coburn) ICD-10 implementation Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets, identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; OPM data warehouse for FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; accountable care organizations; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to the federally-facilitated marketplaces (i.e., Exchanges) and other issues relating to health care reform implementation.
H.R. 1367, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) FEHBP prescription drugs16. Specific Lobbying Issues (continued): S. 214, Preserve Access to Affordable Generics Act (Klobuchar) access to generic drugs Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 933, Consolidated and Further Continuing Appropriations Act (Rogers) FY 201316. Specific Lobbying Issues (continued): appropriations for HHS programs and agencies H.R. 1326, Health Care Price Transparency Promotion Act (Burgess) price transparency S. 44, Medical Care Access Protection Act (Portman) medical liability reform Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets, identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; OPM data warehouse for FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; health insurance exchanges; preexisting condition insurance plans; accountable care organizations; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters for 2014; essential health benefits, actuarial value, and accreditation; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products; issues related to HIPAA excepted benefits; and other issues relating to health care reform implementation.
H.R. 1367, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act16. Specific Lobbying Issues (continued): (Lynch) FEHBP prescription drugs S. 214, Preserve Access to Affordable Generics Act (Klobuchar) access to generic drugs Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 763, Jobs and Premium Protection Act (Boustany-Matheson) HIT repeal16. Specific Lobbying Issues (continued): H.R. 1248, Family Health Care Flexibility Act (Paulsen) HSA and FSA issues H.R. 1342, Helping Save Americans Health Care Choices Act (Fleming) HSA and FSA issues S. 24, Small Business Health Relief Act (Portman) HIT repeal, HSA and FSA changes S. 603, Jobs and Premium Protection Act (Barrasso-Hatch) HIT repeal S. 610, Family Health Care Flexibility Act (Johanns) HSA and FSA issues Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate, W-2 reporting requirements, health insurer fee, and other issues relating to health care reform implementation.
H.R. 99, Health Insurance Industry Antitrust Enforcement Act16. Specific Lobbying Issues (continued): (Conyers) antitrust policy H.R. 544, LIBERTY Act (Gingrey-Matheson) age rating rules H.R. 743, Health Insurance Industry Fair Competition Act (DeFazio) antitrust policy H.R. 762, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 911, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R. 1019, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1188, Preserving Our Hometown Independent Pharmacies Act (Marino) antitrust policy H.R. 1205, Patients Right to Know Act (Walden) disclosures on SBC documents S. 24, Small Business Health Relief Act (Portman) ACA changes S. 482, Health Insurance Rate Review Act (Feinstein) rate review S. 650, Access to Independent Health Insurance Advisors Act (Landrieu) MLR impact on agents and brokers Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, and issues related to supplemental products, and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 8, American Taxpayer Relief Act Medicare issues, budget offsets 16. Specific Lobbying Issues (continued): H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger) H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) Medicare secondary payer rules H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods H.R. 2190, Medicare Drug Savings Act (Waxman) rebates for dual eligibles H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) extension of Medicare cost plans H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney) H.R. 3519 (Towns) exempting Medicare from sequestration H.R. 3691, Senior Medicare Fairness Act (Paulsen) frailty adjuster for certain MA SNPs H.R. 4254, Medicare Advantage Program Integrity Act (Stark) MA payment changes H.R. 5872, Sequestration Transparency Act (Hensarling) H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs H.R. 6232, Medicare Better Health Rewards Program Act (Paulsen) incentives for wellness and prevention H.R. 6300, Medicaid Long-Term Care Reform Act (Boustany) LTC and Medicaid issues S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) incentives for wellness and prevention S. 3673, Dollar for Dollar Act (Corker) Medicare, Medigap, Medicaid reforms Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues raised by initial implementation in 2014; implications of sequestration in 2013 for Medicare Advantage and Part D plans; implications of the new health insurance plan tax (aka insurer fee) for MA plans starting in 2014; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Regulatory Issues (con't): Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the new health insurance plan tax (aka insurer fee) on Medicaid health plans starting in 2014; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.
H.R. 979, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) FEHBP prescription drugs 16. Specific Lobbying Issues (continued): H.R.1946, Preserving Hometown Independent Pharmacies Act (Marino) antitrust exemption for independent pharmacies H.R. 3995, Protecting Consumer Access to Generic Drugs Act (Rush) pay-for-delay settlements S. 27, Preserve Access to Affordable Generics Act (Kohl) pay-for-delay settlements S. 2002, Online Pharmacy Safety Act (Feinstein) establishes standards for on-line pharmacies S. 2193, Ensuring Safe Medical Devices for Patients (Merkley) FDA oversight of medical devices S. 3187, the FDA Safety and Innovation Act (Harkin) pharmaceutical, medical device issues Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R.369, Health Savings and Affordability Act (Austria) HSA improvements 16. Specific Lobbying Issues (continued): H.R. 436, Health Care Cost Reduction Act (Paulsen) HSA, HRA, FSA provisions, ACA provisions H.R. 450, Restoring Assistance for Families' and Seniors' Health Expenses Act (Reichert) repeal of HSA and FSA restrictions H.R. 524, Restoring Consumer-driven Health Care Act (Quayle) repeal of HSA restrictions H.R. 605, Patients' Freedom to Choose Act (Paulsen) repeal of HSA and FSA restrictions H.R. 1004, Health Flexible Spending Arrangements Improvements Act (Boustany) -- distribution of unused amounts from a Health FSA H.R. 1370, Repeal of ACA Premium Tax (Boustany) H.R. 2010, Family and Retirement Health Investment Act (Paulsen) HSA and FSA improvements H.R. 2529, Restoring Access to Medication Act (Jenkins) use of HSA funds and FSA funds to purchase OTC medications H.R. 5842, Restoring Access to Medication Act (Jenkins) use of HSA, HRA, and FSA funds for over-the-counter medications H.R. 5858, Health Savings Accounts Improvements Act (Herger) HSA provisions H.R. 6005, Long-Term Care and Retirement Security Act (Courtney) tax incentives for purchase of LTC insurance, consumer protections H.R. 6088, Repeal of the Unfair Taxes on Health Care Act (Schweikert) repeal of ACA premium tax and restrictions on HSAs / FSAs H.R. 6137, Helping Save Americans' Health Care Choices Act (Fleming) HSA and FSA provisions H.R. 6162, Ensuring Women's Access to Free-Market Healthcare Act (Cassidy) pregnancy-related coverage by HSA plans S. 312, Patients' Freedom to Choose Act (Hutchison) repeal of HSA and FSA restrictions S. 1098, Family and Retirement Health Investment Act (Hatch) HSA and FSA improvements S. 1368, Restoring Access to Medication Act (Roberts) use of HSA funds and FSA funds to purchase OTC medications S. 1880, Jobs and Premium Protection Act (Barrasso) repeal of health insurance premium tax S. 2237, Small Business Jobs and Tax Relief Act (Reid) amendment to repeal ACA premium tax S. 2516, the FDA Safety and Innovation Act (Harkin) pharmaceutical, medical device issues S. 3187, the FDA Safety and Innovation Act (Harkin) pharmaceutical, medical device issues Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate, W-2 reporting requirements, health insurer fee, and other issues relating to health care reform implementation.
H.R. 63, Long-Term Care Insurance Reform Act (Doggett) LTC insurance reforms 16. Specific Lobbying Issues (continued): H.R. 111, Breast Cancer Patient Protection Act (DeLauro) minimum hospital stays for mastectomy patients H.R. 346, Health Care Choice Act (Pearce ) national marketplace for individual coverage H.R.371, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 416, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1050, Small Business Health Fairness Act (Johnson) association health plans H.R. 1150, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R.1206, Access to Professional Health Insurance Advisors Act (Rogers) agent commissions, medical loss ratios H.R. 1943, Health Insurance Industry Fair Competition Act (DeFazio) changes to McCarran-Ferguson Act H.R. 2077, MLR Repeal Act (Price) medical loss ratios H.R. 2645, Medigap Medical Loss Ratio Improvement Act (Stark) MLRs for Medigap policies H.R. 2958, Federal Employee Short-Term Disability Insurance Act (Holmes Norton) disability program for federal employees H.R. 5838, Health Insurance Industry Antitrust Enforcement Act (Conyers) changes to McCarran-Ferguson Act H.R.6283, Guaranteed Access to Health Insurance Act (Burgess) reinsurance, high risk pools S. 137, Health Insurance Rate Review Act (Feinstein) rate review S. 159, Confidence in Long-Term Care Insurance Act (Kohl) LTC insurance reforms S. 1416, Medigap Medical Loss Ratio Improvement Act (Kerry) MLRs for Medigap policies S. 1500, Ensure Children Have Health Care Act (Murkowski/Enzi) enrollment period for child-only policies S. 2068, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 2288, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 3229, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) -- model disclosure form for marketing long-term care insurance policies S. 3230, Long-Term Care Integrity Act (Klobuchar) -- claims dispute resolution procedures S. 3271, Equal Access to Medicare Options Act (Kerry) Medigap provisions, MA enrollment provisions Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger) 16. Specific Lobbying Issues (continued): H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) Medicare secondary payer rules H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods H.R. 2190, Medicare Drug Savings Act (Waxman) rebates for dual eligibles H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) extension of Medicare cost plans H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney) H.R. 3519 (Towns) exempting Medicare from sequestration H.R. 3691, Senior Medicare Fairness Act (Paulsen) frailty adjuster for certain MA SNPs H.R. 4254, Medicare Advantage Program Integrity Act (Stark) MA payment changes H.R. 5872, Sequestration Transparency Act (Hensarling) H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs H.R. 6232, Medicare Better Health Rewards Program Act (Paulsen) incentives for wellness and prevention H.R. 6300, Medicaid Long-Term Care Reform Act (Boustany) LTC and Medicaid issues S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) incentives for wellness and prevention Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues raised by initial implementation in 2014; implications of sequestration in 2013 for Medicare Advantage and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital Regulatory Issues (continued): days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.
H.R. 979, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) FEHBP prescription drugs 16. Specific Lobbying Issues (continued): H.R.1946, Preserving Hometown Independent Pharmacies Act (Marino) antitrust exemption for independent pharmacies H.R. 3995, Protecting Consumer Access to Generic Drugs Act (Rush) pay-for-delay settlements S. 27, Preserve Access to Affordable Generics Act (Kohl) pay-for-delay settlements S. 2002, Online Pharmacy Safety Act (Feinstein) establishes standards for on-line pharmacies S. 2193, Ensuring Safe Medical Devices for Patients (Merkley) FDA oversight of medical devices S. 3187, the FDA Safety and Innovation Act (Harkin) pharmaceutical, medical device issues Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
H.R. 63, Long-Term Care Insurance Reform Act (Doggett) LTC insurance reforms 16. Specific Lobbying Issues (continued): H.R. 111, Breast Cancer Patient Protection Act (DeLauro) minimum hospital stays for mastectomy patients H.R. 346, Health Care Choice Act (Pearce ) national marketplace for individual coverage H.R.371, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 416, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1050, Small Business Health Fairness Act (Johnson) association health plans H.R. 1150, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R.1206, Access to Professional Health Insurance Advisors Act (Rogers) agent commissions, medical loss ratios H.R. 1943, Health Insurance Industry Fair Competition Act (DeFazio) changes to McCarran-Ferguson Act H.R. 2077, MLR Repeal Act (Price) medical loss ratios H.R. 2645, Medigap Medical Loss Ratio Improvement Act (Stark) MLRs for Medigap policies H.R. 2958, Federal Employee Short-Term Disability Insurance Act (Holmes Norton) disability program for federal employees H.R. 5838, Health Insurance Industry Antitrust Enforcement Act (Conyers) changes to McCarran-Ferguson Act H.R.6283, Guaranteed Access to Health Insurance Act (Burgess) reinsurance, high risk pools S. 137, Health Insurance Rate Review Act (Feinstein) rate review S. 159, Confidence in Long-Term Care Insurance Act (Kohl) LTC insurance reforms S. 1416, Medigap Medical Loss Ratio Improvement Act (Kerry) MLRs for Medigap policies S. 1500, Ensure Children Have Health Care Act (Murkowski/Enzi) enrollment period for child-only policies S. 2068, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 2288, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 3229, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) -- model disclosure form for marketing long-term care insurance policies S. 3230, Long-Term Care Integrity Act (Klobuchar) -- claims dispute resolution procedures S. 3271, Equal Access to Medicare Options Act (Kerry) Medigap provisions, MA enrollment provisions Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; and other issues relating to health care reform implementation.
H.R.369, Health Savings and Affordability Act (Austria) HSA improvements 16. Specific Lobbying Issues (continued): H.R. 436, Health Care Cost Reduction Act (Paulsen) HSA, HRA, FSA provisions, ACA provisions H.R. 450, Restoring Assistance for Families' and Seniors' Health Expenses Act (Reichert) repeal of HSA and FSA restrictions H.R. 524, Restoring Consumer-driven Health Care Act (Quayle) repeal of HSA restrictions H.R. 605, Patients' Freedom to Choose Act (Paulsen) repeal of HSA and FSA restrictions H.R. 1004, Health Flexible Spending Arrangements Improvements Act (Boustany) -- distribution of unused amounts from a Health FSA H.R. 1370, Repeal of ACA Premium Tax (Boustany) H.R. 2010, Family and Retirement Health Investment Act (Paulsen) HSA and FSA improvements H.R. 2529, Restoring Access to Medication Act (Jenkins) use of HSA funds and FSA funds to purchase OTC medications H.R. 5842, Restoring Access to Medication Act (Jenkins) use of HSA, HRA, and FSA funds for over-the-counter medications H.R. 5858, Health Savings Accounts Improvements Act (Herger) HSA provisions H.R. 6005, Long-Term Care and Retirement Security Act (Courtney) tax incentives for purchase of LTC insurance, consumer protections H.R. 6088, Repeal of the Unfair Taxes on Health Care Act (Schweikert) repeal of ACA premium tax and restrictions on HSAs / FSAs H.R. 6137, Helping Save Americans' Health Care Choices Act (Fleming) HSA and FSA provisions H.R. 6162, Ensuring Women's Access to Free-Market Healthcare Act (Cassidy) pregnancy-related coverage by HSA plans S. 312, Patients' Freedom to Choose Act (Hutchison) repeal of HSA and FSA restrictions S. 1098, Family and Retirement Health Investment Act (Hatch) HSA and FSA improvements S. 1368, Restoring Access to Medication Act (Roberts) use of HSA funds and FSA funds to purchase OTC medications S. 1880, Jobs and Premium Protection Act (Barrasso) repeal of health insurance premium tax S. 2237, Small Business Jobs and Tax Relief Act (Reid) amendment to repeal ACA premium tax S. 2516, the FDA Safety and Innovation Act (Harkin) pharmaceutical, medical device issues S. 3187, the FDA Safety and Innovation Act (Harkin) pharmaceutical, medical device issues Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate, W-2 reporting requirements, and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 5, HEALTH Act (Gingrey) IPAB repeal, medical liability reform, McCarran-Ferguson 16. Specific Lobbying Issues (continued): H.R. 452, Medicare Decisions Accountability Act (Roe) IPAB repeal, medical liability reform, McCarran-Ferguson H.R.611, BEST PRACTICES Act (Rush) data security H.R. 1173, Fiscal Responsibility and Retirement Security Act (Boustany) National Clearinghouse for LTC Information H.R. 1409, Quality Health Care Coalition Act (Conyers) antitrust exemption for physicians H.R. 1707, Data Accountability and Trust Act (Rush) data security H.R. 1841, Data Accountability and Trust Act (Stearns) data security H.R. 2576, (Black) eligibility for health care assistance H.R. 2577, Secure and Fortify Electronic Data Act (Bono Mack) data security H.R. 2676, Small Business Health Relief Act (Schweikert) repeal of premium tax and other ACA provisions H.R. 5652, Sequester Replacement Reconciliation Act (Ryan) ACA provisions, deficit reduction proposals H.R. 5800, Health Care Price Transparency Promotion Act (Burgess) price transparency H.R. 5909, Comprehensive Dental Reform Act (Cummings) expanded access to dental services S. 1049, Small Business Health Relief Act (Kyl) repeal of premium tax and other ACA provisions S. 1099, HEALTH Act (Blunt) medical liability reform S. 1151, Personal Data Privacy and Security Act (Leahy) privacy, data security S. 1207, Data Security and Breach Notification Act (Pryor) data security S. 1408, Data Breach Notification Act (Feinstein) data security S. 1535, Personal Data Protection and Breach Accountability Act (Blumenthal) data security S. 1789, 21st Century Postal Service Act (Lieberman) -- health benefits for postal employees S. 2111, Cyber Crime Protection Security Act (Leahy) privacy S. 3272, Comprehensive Dental Reform Act (Sanders) expanded access to dental services S. 3295, Labor, HHS, Education Appropriations Act (Harkin) funding for HHS programs and agencies, ACA related amendments S. 3333, Data Security and Breach Notification Act (Toomey) data security S. 3351, Protect Our Health Privacy Act (Franken) privacy Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets, identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; transition from the similarly sized subscriber group (SSSG) requirement to an MLR; OPM data warehouse; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues related to genetics and genetic nondiscrimination; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; health insurance exchanges; preexisting condition insurance plans; accountable care organizations; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to privacy, security, and other regulation of the Internet and electronic commerce; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; dependent coverage; summary of benefits and coverage disclosures; and other issues relating to health care reform implementation.
H.R. 63, Long-Term Care Insurance Reform Act (Doggett) LTC insurance reforms H.R. 111, Breast Cancer Patient Protection Act (DeLauro) minimum hospital stays for mastectomy patients H.R. 346, Health Care Choice Act (Pearce ) national marketplace for individual coverage 16. Specific Lobbying Issues (continued): H.R.371, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 416, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1050, Small Business Health Fairness Act (Johnson) association health plans H.R. 1150, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R.1206, Access to Professional Health Insurance Advisors Act (Rogers) agent commissions, medical loss ratios H.R. 1943, Health Insurance Industry Fair Competition Act (DeFazio) changes to McCarran-Ferguson Act H.R. 2077, MLR Repeal Act (Price) medical loss ratios H.R. 2645, Medigap Medical Loss Ratio Improvement Act (Stark) MLRs for Medigap policies H.R. 2958, Federal Employee Short-Term Disability Insurance Act (Holmes Norton) disability program for federal employees H.R. 5838, Health Insurance Industry Antitrust Enforcement Act (Conyers) changes to McCarran-Ferguson Act S. 137, Health Insurance Rate Review Act (Feinstein) rate review S. 159, Confidence in Long-Term Care Insurance Act (Kohl) LTC insurance reforms S. 1416, Medigap Medical Loss Ratio Improvement Act (Kerry) MLRs for Medigap policies S. 1500, Ensure Children Have Health Care Act (Murkowski/Enzi) enrollment period for child-only policies S. 2068, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 2288, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 3229, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) -- model disclosure form for marketing long-term care insurance policies S. 3230, Long-Term Care Integrity Act (Klobuchar) -- claims dispute resolution procedures S. 3271, Equal Access to Medicare Options Act (Kerry) Medigap provisions, MA enrollment provisions Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; issues related to genetic nondiscrimination; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; and other issues relating to health care reform implementation.
H.R.369, Health Savings and Affordability Act (Austria) HSA improvements H.R. 436, Health Care Cost Reduction Act (Paulsen) HSA, HRA, FSA provisions, ACA provisions H.R. 450, Restoring Assistance for Families' and Seniors' Health Expenses Act (Reichert) repeal of HSA and FSA restrictions 16. Specific Lobbying Issues (continued): H.R. 524, Restoring Consumer-driven Health Care Act (Quayle) repeal of HSA restrictions H.R. 605, Patients' Freedom to Choose Act (Paulsen) repeal of HSA and FSA restrictions H.R. 1004, Health Flexible Spending Arrangements Improvements Act (Boustany) -- distribution of unused amounts from a Health FSA H.R. 1370, Repeal of ACA Premium Tax (Boustany) H.R. 2010, Family and Retirement Health Investment Act (Paulsen) HSA and FSA improvements H.R. 2529, Restoring Access to Medication Act (Jenkins) use of HSA funds and FSA funds to purchase OTC medications H.R. 5842, Restoring Access to Medication Act (Jenkins) use of HSA, HRA, and FSA funds for over-the-counter medications H.R. 5858, Health Savings Accounts Improvements Act (Herger) HSA provisions H.R. 6005, Long-Term Care and Retirement Security Act (Courtney) tax incentives for purchase of LTC insurance, consumer protections H.R. 5651, FDA Reform Act (Upton) pharmaceutical, medical device issues S. 312, Patients' Freedom to Choose Act (Hutchison) repeal of HSA and FSA restrictions S. 1098, Family and Retirement Health Investment Act (Hatch) HSA and FSA improvements S. 1368, Restoring Access to Medication Act (Roberts) use of HSA funds and FSA funds to purchase OTC medications S. 1880, Jobs and Premium Protection Act (Barrasso) repeal of health insurance premium tax S. 2516, the FDA Safety and Innovation Act (Harkin) pharmaceutical, medical device issues S. 3187, the FDA Safety and Innovation Act (Harkin) pharmaceutical, medical device issues Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate, W-2 reporting requirements, and other issues relating to health care reform implementation.
H.R. 979, FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act (Lynch) FEHBP prescription drugs H.R.1946, Preserving Hometown Independent Pharmacies Act (Marino) antitrust exemption for independent pharmacies H.R. 3988, Generic Drug and Biosimilar User Fee Act (Murphy/Pitts/Waxman) FDA user fee programs 16. Specific Lobbying Issues (continued): H.R. 3995, Protecting Consumer Access to Generic Drugs Act (Rush) pay-for-delay settlements H.R. 5651, FDA Reform Act (Upton) pharmaceutical, medical device issues S. 27, Preserve Access to Affordable Generics Act (Kohl) pay-for-delay settlements S. 2193, Ensuring Safe Medical Devices for Patients (Merkley) FDA oversight of medical devices S. 2516, the FDA Safety and Innovation Act (Harkin) pharmaceutical, medical device issues S. 3187, the FDA Safety and Innovation Act (Harkin) pharmaceutical, medical device issues S. 2002, Online Pharmacy Safety Act (Feinstein) establishes standards for on-line pharmacies Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; and issues relating to access for investigational drugs; and other issues relating to health care reform implementation.
Filing targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
H.R. 5, HEALTH Act (Gingrey) IPAB repeal, medical liability reform, McCarran-Ferguson H.R. 452, Medicare Decisions Accountability Act (Roe) IPAB repeal, medical liability reform, McCarran-Ferguson H.R.611 -- BEST PRACTICES Act (Rush) data security 16. Specific Lobbying Issues (continued): H.R. 1173, Fiscal Responsibility and Retirement Security Act (Boustany) National Clearinghouse for LTC Information H.R. 1409, Quality Health Care Coalition Act (Conyers) antitrust exemption for physicians H.R. 1707, Data Accountability and Trust Act (Rush) data security H.R. 1841, Data Accountability and Trust Act (Stearns) data security H.R. 2576, (Black) eligibility for health care assistance H.R. 2577, Secure and Fortify Electronic Data Act (Bono Mack) data security H.R. 2676, Small Business Health Relief Act (Schweikert) repeal of premium tax and other ACA provisions S. 1049, Small Business Health Relief Act (Kyl) repeal of premium tax and other ACA provisions S. 1099, HEALTH Act (Blunt) medical liability reform S. 1151, Personal Data Privacy and Security Act (Leahy) privacy, data security S. 1207, Data Security and Breach Notification Act (Pryor) data security S. 1408, Data Breach Notification Act (Feinstein) data security S. 1535, Personal Data Protection and Breach Accountability Act (Blumenthal) data security S. 2111, Cyber Crime Protection Security Act (Leahy) privacy Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets, identifiers including the health plan identifier, enforcement; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; transition from the similarly sized subscriber group (SSSG) requirement to an MLR; OPM data warehouse; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues related to genetics and genetic nondiscrimination; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; review of rates for reasonableness; health insurance exchanges; preexisting condition insurance plans; accountable care organizations; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to privacy, security, and other regulation of the Internet and electronic commerce; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; health insurance web portal requirements; dependent coverage; summary of benefits and coverage disclosures; and other issues relating to health care reform implementation. 18. Lobbyists (continued): K. Callahan: Ross (March 2005- January 2012); Research Assistant, Senator Tim Johnson (October 2001 March 2005). G. Gierer: Legislative Correspondent, Senator Dodd (May 1997 - December 1999); Staff Assistant, Representative DeLauro (March 1996-May 1997). D. Mott-Bronson: (June 1998 - September 2002); Democratic Professional Staff Member, House International Relations Committee, Representative McKinney (September 2002 December 2002).
Payroll Tax Cut Continuation Act (Camp) Medicare physician payment, extension of QI and TMA programs, budget offsets H.R. 4254, Medicare Advantage Program Integrity Act (Stark) MA payment changes S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation 16. Specific Lobbying Issues (continued) S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans S. 1931, Temporary Tax Holiday and Government Reduction Act (Heller) budget offsets S. 1944, Middle Class Tax Cut Act (Casey) budget offsets S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) incentives for wellness and prevention Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including; risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to Medigap coverage. 18. Lobbyists (continued): K. Callahan: Ross (March 2005- January 2012); Research Assistant, Senator Tim Johnson (October 2001 March 2005). D. Mott-Bronson: (June 1998 - September 2002); Democratic Professional Staff Member, House International Relations Committee, Representative McKinney (September 2002 December 2002).
H.R. 63, Long-Term Care Insurance Reform Act (Doggett) LTC insurance reforms H.R. 111, Breast Cancer Patient Protection Act (DeLauro) minimum hospital stays for mastectomy patients H.R. 346, Health Care Choice Act (Pearce ) national marketplace for individual coverage 16. Specific Lobbying Issues (continued): H.R.371, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 416, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1050, Small Business Health Fairness Act (Johnson) association health plans H.R. 1150, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R.1206, Access to Professional Health Insurance Advisors Act (Rogers) agent commissions, medical loss ratios H.R. 1943, Health Insurance Industry Fair Competition Act (DeFazio) changes to McCarran-Ferguson Act H.R. 2077, MLR Repeal Act (Price) medical loss ratios H.R. 2645, Medigap Medical Loss Ratio Improvement Act (Stark) MLRs for Medigap policies H.R. 2958, Federal Employee Short-Term Disability Insurance Act (Holmes Norton) disability program for federal employees S. 137, Health Insurance Rate Review Act (Feinstein) rate review S. 159, Confidence in Long-Term Care Insurance Act (Kohl) LTC insurance reforms S. 1416, Medigap Medical Loss Ratio Improvement Act (Kerry) MLRs for Medigap policies S. 1500, Ensure Children Have Health Care Act (Murkowski/Enzi) enrollment period for child-only policies S. 2068, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; issues related to genetic nondiscrimination; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; and other issues relating to health care reform implementation. 18. Lobbyists (continued): K. Callahan: Ross (March 2005- January 2012); Research Assistant, Senator Tim Johnson (October 2001 March 2005). G. Gierer: Legislative Correspondent, Senator Dodd (May 1997 - December 1999); Staff Assistant, Representative DeLauro (March 1996-May 1997). D. Mott-Bronson: (June 1998 - September 2002); Democratic Professional Staff Member, House International Relations Committee, Representative McKinney (September 2002 December 2002).
H.R.369, Health Savings and Affordability Act (Austria) HSA improvements H.R. 450, Restoring Assistance for Families' and Seniors' Health Expenses Act (Reichert) repeal of HSA and FSA restrictions H.R. 524, Restoring Consumer-driven Health Care Act (Quayle) repeal of HSA restrictions 16. Specific Lobbying Issues (continued): H.R. 605, Patients' Freedom to Choose Act (Paulsen) repeal of HSA and FSA restrictions H.R. 1370, Repeal of ACA Premium Tax (Boustany) H.R. 2010, Family and Retirement Health Investment Act (Paulsen) HSA and FSA improvements H.R. 2529, Restoring Access to Medication Act (Jenkins) use of HSA funds and FSA funds to purchase OTC medications S. 312, Patients' Freedom to Choose Act (Hutchison) repeal of HSA and FSA restrictions S. 1098, Family and Retirement Health Investment Act (Hatch) HSA and FSA improvements S. 1368, Restoring Access to Medication Act (Roberts) use of HSA funds and FSA funds to purchase OTC medications S. 1880, Jobs and Premium Protection Act (Barrasso) health insurance premium tax Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer coverage mandate, W-2 reporting requirements, and other issues relating to health care reform implementation. 18. Lobbyists (continued): K. Callahan: Ross (March 2005- January 2012); Research Assistant, Senator Tim Johnson (October 2001 March 2005). G. Gierer: Legislative Correspondent, Senator Dodd (May 1997 - December 1999); Staff Assistant, Representative DeLauro (March 1996-May 1997).
Filing targets: Administration on Aging, Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office