We assisted Congressional staff in developing the concept of "disproportionate share hospital" (DSH) adjustments under Medicare and Medicaid as a means of compensating safety net hospitals for delivering care to the uninsured. Since that time, Medicaid and Medicare DSH have become indispensable sources of financial support for these hospitals. Not only did we help write the original legislation, but we have been "at the table" for virtually every legislative and regulatory modification of these programs throughout their history, including the most recent changes enacted in the Medicare Prescription Drug, Improvement, and Modernization Act (MMA).

Working within a broad coalition of pharmaceutical companies and patient and consumer advocacy groups, we devised and implemented a comprehensive legislative strategy to gain Medicare coverage of certain self-injectable drugs. We identified and worked closely with Congressional sponsors, garnered the support of a critical mass of Congressional allies (including the committee chairman) and drafted the legislative language that ultimately was incorporated into the MMA.

We developed a demonstration grant program within the Department of Health and Human Services designed to assist safety net providers caring for the uninsured. Seizing on one paragraph of general language in the President's budget, we developed what is now known as the Healthy Communities Access Program (HCAP). We formed a "safety net coalition" of national advocacy groups to lobby for appropriations for a demonstration program to fund the concept. In a very tight fiscal environment, we have secured over $250 million for the program.

We led a coalition of providers in securing Congressional repeal of Medicare's consolidated billing requirements under Part B in skilled nursing homes.

We led multiple efforts to secure and protect coverage, reimbursement and coding under Medicare for new medical technologies and pharmaceutical products at the national, regional and local levels.

We were retained by the U.S. Department of Health and Human Services Office for Civil Rights to prepare two guidance documents designed to help institutional and small health care providers navigate the challenges of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The documents are published on OCR's HIPAA guidance web site.