Lobbying Disclosure Act of 1995 (Section 5) - All Filers Are Required to Complete This Page

9. Check if this filing amends a previously filed version of this report

LOBBYING ACTIVITY. Select as many codes as necessary to reflect the general issue areas in which the registrant engaged in lobbying on behalf of the client during the reporting period. Using a separate page for each code, provide information as requested. Add additional page(s) as needed.

15. General issue area code HCR

16. Specific lobbying issues

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps,
provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients.

Health Coverage: Guarantee all Americans access to health coverage; create tax credits to subsidize coverage for low income persons to buy into the Federal Employees Health Benefits Plan (FEHBP); create new options for small businesses to buy into group coverage based on the FEHBP; expand Medicaid and SCHIP; support state experimentation.

Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the SCHIP program with additional funding to assure adequate coverage of all eligible children; target increases in Medicare payments for primary care physicians; target incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home; provide subsidies for newly unemployed workers to obtain COBRA coverage; provide temporary Medicaid coverage to laid-off workers; increase funding for community health centers; provide substantial funds for the Prevention and Wellness Fund to fight preventable chronic diseases; support healthcare research and quality programs to compare the effectiveness of different medical treatments funded by Medicare, Medicaid and CHIP; support existing work being done by public and private sector partnerships on HIT policy, standards and certification; H.R. 1, the American Recovery and Reinvestment Act.

Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula.

Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care; restore the 20/220 loan deferment pathway (S.646).

Healthcare in the FY2010 Budget: Account for the costs of preventing Medicare physician pay cuts under the Sustainable Growth Rate formula; address the negative impact of Medicare payment cuts on small physician practices; support the concept of dedicating funding for health care reform; support funding for physicians to acquire health information technology (HIT) to be used in a meaningful way; note concerns about penalties that would reduce baseline payments to physicians not using certified HIT systems beginning in 2015; support a policy reserve fund for physician payment reform, as reported out of the House Committee on the Budget, including the language to ensure primary care receives appropriate compensation.

Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety.

Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268, provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation.

Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation:

Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government.

Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis.

Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions.

Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation.

17. House(s) of Congress and Federal agencies Check if None

U.S. HOUSE OF REPRESENTATIVES, U.S. SENATE, Centers For Medicare and Medicaid Services (CMS), Health & Human Services - Dept of (HHS), President of the U.S.

18. Name of each individual who acted as a lobbyist in this issue area

19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None

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Information Update Page - Complete ONLY where registration information has changed.

20. Client new address

21. Client new principal place of business (if different than line 20)

22. New General description of client’s business or activities

LOBBYIST UPDATE

23. Name of each previously reported individual who is no longer expected to act as a lobbyist for the client

ISSUE UPDATE

24. General lobbying issue that no longer pertains

AFFILIATED ORGANIZATIONS

25. Add the following affiliated organization(s)

Internet Address:

26. Name of each previously reported organization that is no longer affiliated with the registrant or client

FOREIGN ENTITIES

27. Add the following foreign entities:

28. Name of each previously reported foreign entity that no longer owns, or controls, or is affiliated with the registrant, client or affiliated organization