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 MMM

16. Specific lobbying issues

Patient Protection and Affordable Care Act, Maintain the Medicaid maintenance of effort (MOE) provisions; HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal
reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; Legislation which would amend the Social Security Act to ensure that the full cost of certain provider taxes are considered allowable costs for purposes of Medicare reimbursements to CAHs; Urging congress to establish patient and facility criteria to distinguish LTACHs from other care settings; Raising concerns about CMS flawed methodology that overstate the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use;
Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to structure the development of the regulation to implement ACOs prior to release of the proposed rule; Obtaining change in language for Medicare conditions of participation related to governing board requirements to eliminate an unnecessary requirement for separate boards or separate meetings of the board for individual hospitals that are part of a system; Urging CMS not to adopt a burdensome notice requirement in the Medicare conditions of participation related to the grievance process; Urging CMS to update, streamline, and modernize the Medicare conditions of participation.

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

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

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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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

HR 1 Full Year Continuing Appropriations Act 2011, making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011; HR 2 Repealing the Job-Killing Health Care Law Act, to repeal the job-killing health care law and health care-related provisions in the Health Care and Education Reconciliation Act of 2010; HR 4 Small Business Paperwork Mandate Elimination Act of 2011, offsets the cost of 1099 repeal
by increasing the maximum amount of tax subsidy to be repaid if a persons (or familys) income exceeds 400% of poverty;
HR 5 and S 218 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act, to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; Reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA) P.L. 109-417, Emergency Preparedness; HRes 9 Instructing four committees to produce legislation to replace the health reform law and to include a permanent fix to the SGR; S 296 Preserving Access to Life-Saving Medications Act, to amend the Federal Food, Drug, and Cosmetic Act to provide the Food and Drug Administration with improved capacity to prevent drug shortages; HR 705 The Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011, to amend the Internal Revenue Code of 1986 to repeal the expansion of information reporting requirements to payments made to corporations, payments for property and other gross proceeds, and rental property expense payments; HR 1213 To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges; HR 1217 To repeal the Prevention and Public Health Fund; S 539 Behavioral Health Information Technology Act of 2011, a bill to amend the Public Health Services Act and the Social Security Act to extend health information technology assistance eligibility to behavioral health, mental health, and substance abuse professionals and facilities; S 668 Health Care Bureaucrats Elimination Act, a bill to remove unelected, unaccountable bureaucrats from seniors' personal health decisions by repealing the Independent Payment Advisory Board; Allow hospitals to claim the full cost of provider taxes as allowable costs; Ensure CAHs are paid at least 101 percent of costs by Medicare Advantage plans; Ensure that the Centers for Medicare & Medicaid Services (CMS) appropriately addresses the issue of direct supervision for outpatient therapeutic services for rural hospitals and CAHs; Ensure rural hospitals and CAHs have adequate reimbursement for certified registered nurse anesthetist and stand-by services; Exempt CAHs from the Independent Payment Advisory Board; Extend expiring provisions; Provide small, rural hospitals with cost-based reimbursement for outpatient laboratory services and ambulance services; Provide CAHs bed size flexibility; Reinstate CAH necessary provider status; Remove unreasonable restrictions on CAHs ability to rebuild; Discussions on a bill to credit some observation status days to 3 day inpatient hospital stays; Worked with HHS on establishing the Partnership for Patients Program to improve patient safety activities in hospitals.

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), Food & Drug Administration (FDA), Health & Human Services - Dept of (HHS)

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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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 LBR

16. Specific lobbying issues

S 217, HR 972 The Secret Ballot Protection Act, makes it an unfair labor practice under the NLRA for an employer to recognize a union that has not been selected via secret ballot and unlawful for a union that has not been chosen as the employees' exclusive rep-resentative in a secret ballot election conducted by the NLRB to cause or attempt to cause an employer to recognize or bargain with it; OFCCPs regulatory reach to cover hospitals that participate in TRICARE FEHBP as in-network providers as federal subcontractor

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

U.S. HOUSE OF REPRESENTATIVES, U.S. SENATE

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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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 LAW

16. Specific lobbying issues

Elimination of Legal/regulatory barriers to clinical integration, antitrust, Stark, anti-kickback, and CMPs.

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

U.S. HOUSE OF REPRESENTATIVES, U.S. SENATE

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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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 BUD

16. Specific lobbying issues

HR 1, HJ Res 44, and HJRes 48 Budget, additional 2011 Appropriations Amendments; HR1255 Government Shutdown Prevention Act of 2011, to prevent a shutdown of the government of the United States; Maintain funding the Childrens Hospitals Graduate Medical Education program.

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

U.S. HOUSE OF REPRESENTATIVES, U.S. SENATE, White House Office

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