lobbying_filings_raw: a9207661-cc36-4606-bde0-e13af4d0fd5e
This data as json
| filing_uuid | filing_type | registrant_id | registrant_name | client_id | client_name | filing_year | filing_period | received_date | is_amendment | is_no_activity | is_termination | raw_json | registrant_state | registrant_country | registrant_house_id | client_state | client_ppb_state | client_country | client_ppb_country | client_general_description | client_government_entity | affiliated_org_count | client_entity_id | client_government_unit_id | client_match_method | client_match_confidence | income_amount | expense_amount |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| a9207661-cc36-4606-bde0-e13af4d0fd5e | Q4 | 57830 | MARSHFIELD CLINIC HEALTH SYSTEM | 160408 | MARSHFIELD CLINIC HEALTH SYSTEM | 2017 | fourth_quarter | 2018-01-15T13:19:17.237000-05:00 | 0 | 0 | 0 | {"url": "https://lda.senate.gov/api/v1/filings/a9207661-cc36-4606-bde0-e13af4d0fd5e/", "filing_uuid": "a9207661-cc36-4606-bde0-e13af4d0fd5e", "filing_type": "Q4", "filing_type_display": "4th Quarter - Report", "filing_year": 2017, "filing_period": "fourth_quarter", "filing_period_display": "4th Quarter (Oct 1 - Dec 31)", "filing_document_url": "https://lda.senate.gov/filings/public/filing/a9207661-cc36-4606-bde0-e13af4d0fd5e/print/", "filing_document_content_type": "text/html", "income": null, "expenses": "80000.00", "expenses_method": "a", "expenses_method_display": "Method A - Reporting amounts using LDA definitions only", "posted_by_name": "Brent V. Miller", "dt_posted": "2018-01-15T13:19:17.237000-05:00", "termination_date": null, "registrant_country": "United States of America", "registrant_ppb_country": null, "registrant_address_1": "1000 NORTH OAK AVENUE", "registrant_address_2": null, "registrant_different_address": false, "registrant_city": "MARSHFIELD", "registrant_state": "WI", "registrant_zip": "54449", "registrant": {"id": 57830, "url": "https://lda.senate.gov/api/v1/registrants/57830/", "house_registrant_id": 35255, "name": "MARSHFIELD CLINIC HEALTH SYSTEM", "description": "Healthcare", "address_1": "1000 NORTH OAK AVENUE", "address_2": null, "address_3": null, "address_4": null, "city": "MARSHFIELD", "state": "WI", "state_display": "Wisconsin", "zip": "54449", "country": "US", "country_display": "United States of America", "ppb_country": "US", "ppb_country_display": "United States of America", "contact_name": "BRADLEY WOLTERS", "contact_telephone": "+1 202-321-5466", "dt_updated": "2026-01-22T15:42:25.952158-05:00"}, "client": {"id": 160408, "url": "https://lda.senate.gov/api/v1/clients/160408/", "client_id": 12, "name": "MARSHFIELD CLINIC HEALTH SYSTEM", "general_description": "Integrated health system serving northern Wisconsin", "client_government_entity": false, "client_self_select": true, "state": "WI", "state_display": "Wisconsin", "country": "US", "country_display": "United States of America", "ppb_state": "WI", "ppb_state_display": "Wisconsin", "ppb_country": "US", "ppb_country_display": "United States of America", "effective_date": "2019-02-01"}, "lobbying_activities": [{"general_issue_code": "MMM", "general_issue_code_display": "Medicare/Medicaid", "description": "Many aspects of the Affordable Care Act promote changes that are consistent with the mission of the Marshfield Clinic:\nExtends health insurance to the uninsured\nCalls for Value Based Purchasing for all providers \n\nThe following are key elements of the health policy agenda of the Marshfield Clinic Health System: \n\nMedicare Access and CHIP Reauthorization Act \nWith passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Medicare physician payments will transition to an incentive-based system based on value and accountability. Starting in 2019, Medicare physician payment will be based on the Merit-Based Incentive Payment System (MIPS). Physicians who perform well on quality, value and IT metrics will be rewarded with higher pay rates and those who perform poorly will face penalties. Because the language of the statute is not specific, the Centers for Medicare and Medicaid Services (CMS) is developing metrics that will be used to determine the bonus payments and penalties that will start in 2019. The proposed metrics simplify and consolidate the existing measurements employed under the Meaningful Use Incentive Program, the Physician Reporting System (PQRS), and the Value-Based Modifier (VBM) to streamline the reporting burden for physician practices. MIPS will then pay physicians based on four weighted performance categories: Quality, Advancing Care Information; Clinical Practice Improvement Activities; and Resource Use. Having a source of credible data as the foundation of CMS metrics is critical both to fair payment and maintaining access to medical services in rural areas. CMS will be refining the metrics perpetually throughout the lifespan of this program. Challenges to fair reimbursement persist under the current Medicare fee schedule, which remains the foundation of the reimbursement system, particularly in regard to the valuation of primary care and the geographic adjustment of physician wages. These challenges must be addressed. Adequate funding for CMS to implement and maintain this new system is critical to patient care, provider education and acceptance of the new program and its long term success. \n\nMCHS also supported MACRA provisions that extended funding for the Childrens Health Insurance Program and provided $7.2 billion to community health centers over the next 2 years, postponed cuts in payments to hospitals that treat large numbers of low-income patients; and extended provisions that funded geographic adjustment of the physician work, therapy services and payments for rural hospitals.\n\nMedicare Advantage \n\nThe Medicare Advantage program provides a full-risk, capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. \n\nThe Medicare Advantage Benchmark Cap - ACA SEC. 3201. (b) (4) By authorizing Quality Incentive Payments for MA plans with star ratings of 4 stars and above, Congress made a significant policy change towards value-based purchasing in the MA program. If a plan is eligible for a Quality Incentive Payment, it receives it in the form of a 5 percent increase to its benchmark. However, Congress also authorized a new methodology for calculating benchmarks, and mandated that benchmarks under the new methodology cannot be greater than what they would have been under the old benchmark methodology. This is the benchmark cap. The benchmark cap reduces or even eliminates Quality Incentive Payments. \n\nThe policy issue is that the cap weakens the incentive for plans to attain higher star ratings and undermines the shift towards paying for performance in the MA program. We do not think that Congress intended to take away with one provision (the cap) the significant policy change towards paying for value that it enacted in the ACA. This change will have a significant negative impact on Medicare Advantage beneficiaries. CMS has indicated that it wants to remove the cap administratively, and we believe that HHS and CMS have the discretionary authority under law to make the necessary changes. If HHS and CMS do not make the change, then a statutory change will be necessary in the 115th Congress. The benchmark cap costs Medicare Advantage enrollees in Security Health Plans population more than $25 more in their monthly premium.\n\nGraduate Medical Education\n\nMCHS is concerned about having a sufficient supply of primary care physicians to meet the demands of an expanding and aging population. This is doubly true for patients and health systems in rural settings. Currently only about 10% of physicians practice in rural areas while 25% of the population resides there. While 36% allopathic residents and 50% osteopathic residents who are trained in a rural residency end up practicing in a rural area, only 4% of the residency training actually occurs in rural areas. Currently there are more US medical students graduating from medical school than there are GME slots. An increase in GME primary care training positions is essential to maintaining high-quality, accessible, and cost efficient care. \n\nTeaching hospitals in rural locations provide an environment for residents to learn and faculty to serve as educators, providers and researchers. These roles advance the broad mission of preparing each generation of physicians, provide critical patient care and specialized services, often to the disadvantaged, facilitate the discovery of new therapies and treatments, and enable residents to acclimate to the rural setting. As new payment and delivery models emphasize primary care to improve patient outcomes and reduce costs, and as more care shifts to outpatient settings, teaching faculty and residency programs must increase access to ambulatory residency rotations to serve Americans who live in areas with an under-supply of primary care physicians including Geriatrics and Psychiatry. The purpose and value of residency training in clinical settings and the financial support needed to sustain physician education will only increase as the U.S. population lives longer with more complex health conditions. To ensure GME can meet the future needs of the newly insured and aging population, Congress must commit to the consistent GME funding and lift Medicares limit on funded residency positions. We support the Teaching Health Center funding in the Medicare Access and CHIP Reauthorization ACT (MACRA) for Community Health Centers but request you extend funding beyond 2017.\n\nGeographic Adjustment of Physician Payments\n\nRecent findings by the Institute of Medicine (IOM) and the Medicare Payment Advisory Commission have demonstrated significant shortcomings in the data utilized to geographically adjust physician payments. The IOM and MedPAC studies have confirmed that the data sources currently relied upon for geographic adjustment bear no correlation to physician earnings. CMS officials have admitted that the proxies utilized for the purpose of geographic adjustment have never been validated, and there never has been a new data source utilized in the twenty years since the fee schedule was implemented. MedPAC data show that the geographic adjustment reference occupations predict earnings of rural physicians to be 25-30% less than physicians in metropolitan areas. MedPAC data show that earnings of primary care physicians in rural areas are, in fact, 13% higher than physicians in metropolitan areas. Since there is no statistical basis of support for disparities in payment we strongly recommend that Congress require CMS to correct this inequity immediately. These corrections are necessary to assure the credibility of the changes enacted in MACRA.\n\n\n\nTelemedicine in Medicare \n\nChanges to Medicare law and regulation are needed to improve equity in access for Medicare beneficiaries to services delivered via TeleHealth. Medicare beneficiaries should be allowed to receive services in telemedicine sites located in urban areas. The necessary changes would remove restrictions on originating sites by removing the rural requirement and the list of originating sites and allowing any certified Medicare facility to provide the services; current requirements that physician must bill for services from the originating site should be removed; restrictions on eligible practitioners should be removed to allow all Medicare approved practitioners to provide telemedicine services; and there should be no restrictions on which Medicare services may be provided through telemedicine. We recommend that the Medicare requirement for non-MSA geographic location of the patient be expanded to allow all Medicare certified organizations as originating sites regardless of rural or metropolitan statistical area designation. \n\n\nIn addition, MCHS supports the CONNECT for Health Act that contains a provision which would permit Medicare Advantage plans to use telehealth or remote patient monitoring technologies to provide basic Medicare benefits, without the restrictions that limit originating sites, geographic locations, store-and-forward technologies, and types of health care provider. We believe that telehealth is a different way of delivering an already covered service, and that Medicare should treat remote access technologies as an alternative modality or complementary means of providing clinical services, and not a service itself. In other words, telehealth should not be seen as simply a supplement or complement to face-to-face encounters. Patients increasingly expect their health plans to provide the access to services and convenience that remote technologies facilitate. These technologies can increase communication between providers and patients, enhance care coordination, and help physicians and patients work together to treat illness and maintaining health.\n\nOral Health Coverage for the Medically Compromised and at Risk Populations There is sufficient data that demonstrates oral health impacts the systemic health of the patient and in doing can reduce the cost of care. Linkages that encourage patient compliance, patient education, provider education, and bi-directional referral and surveillance should be incented and compensated. Shared savings demonstrations should be developed for health systems and co-pay incentives developed for patients engaging in and complying with such inter-disciplinary care.\n\n\nProtecting Access to Medicare Act of 2014 (PAMA)\nPAMA includes reforms to the Clinical Lab Fee Schedule (CLFS). This rule for PAMA requires reporting of Clinical lab prices and volumes. MCHS requested a delay in the reporting, and changes to expand the definition of applicable lab to represent the true market of all laboratories; requested greater transparency of calculations; more time to allow for gathering data and implementation. \n\nFlexibility in coverage of care that saves long term costs: Marshfield Clinic Health System has been a leader in providing care in alternative settings that saves cost, maintains quality and improves patient experience. Programs such as our comfort and recovery suites cut approximately a third of the costs vs hospitalization. Marshfield Clinic Health System would advocate for the opportunity to use these programs for any patient, but due to regulatory barriers cannot (e.g. Medicaid beneficiaries).", "foreign_entity_issues": "", "lobbyists": [{"lobbyist": {"id": 37946, "prefix": "mr", "prefix_display": "MR.", "first_name": "BRENT", "nickname": null, "middle_name": "V", "last_name": "MILLER", "suffix": null, "suffix_display": null}, "covered_position": null, "new": false}], "government_entities": [{"id": 136, "name": "Centers For Medicare and Medicaid Services (CMS)"}, {"id": 34, "name": "Health & Human Services, Dept of (HHS)"}, {"id": 2, "name": "HOUSE OF REPRESENTATIVES"}, {"id": 253, "name": "Medicare Payment Advisory Commission (MedPAC)"}, {"id": 1, "name": "SENATE"}, {"id": 42, "name": "Veterans Affairs, Dept of (VA)"}]}, {"general_issue_code": "BUD", "general_issue_code_display": "Budget/Appropriations", "description": "BUD (Budget and Appropriations)\nWe requested inclusion of Community Health Center funding, Childrens Health Insurance Program funding, and Medicare extenders with the Continuing resolutions filed as a stopgap for federal funding. \n\nNational Farm Safety\nSupport for occupational safety and health funding for Fiscal Year 2017 and 2018. The National Institute for Occupational Safety and Health (NIOSH) is the primary federal agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury. NIOSH provides leadership to avert workplace illness, injury, disability, and death and supports programs to improve the health and safety of workers. NIOSH funds the National Childrens Center for Rural and Agricultural Health and Safety. Marshfield Clinic urges support for this important program.\nAmeriCorps Funding\nWe supported continued Funding of the AmeriCorps program in fiscal year 2017 and 2018.\n\nMarket Stability in budget reconciliation legislation and in tax bill\nHR 1628, the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BRCA) will result in a large number of individuals covered under the Affordable Care Act (ACA) with preexisting conditions to lose the necessary coverage to maintain their health. MCHS recommended opposition to the AHCA, BRCA, and any changes to the coverage afforded by the ACA. The changes proposed under the AHCA and BRCA will undermine what works in the ACA without improving on the circumstances, coverage and care of Wisconsin residents in the individual and small group market. \n\nWe urged Congress to take steps to improve and repair health coverage in the areas where the ACA was falling short, and to also maintain the gains that the ACA has provided to assure that no one, especially those near poverty, fall through the cracks:\n\nStabilizing the market - Regulatory relief offered earlier this year by Secretary Tom Price at HHS gave health insurers tools to better manage their ACA individual population, but those reforms didnt go far enough to fully stabilize the market. We believe that the suggestions below will improve the ACA and ensure coverage for vulnerable populations.\na. Cost sharing reduction payments - SHPs ACA individual population is heavily reliant on the cost sharing reduction (CSR) subsides paid monthly to help our members lower their out-of-pocket costs. Nearly half of the total enrollment in SHPs ACA products is eligible and enrolled in this important program. We recommend that Congress should fully fund CSR payments to health insurance carriers for 2018 and beyond and allow states that have already reached their filing deadline to reopen carriers bids to allow for an adjustment to rates.\nb. Extension of the reinsurance program - The transitional reinsurance program established by the ACA helped to hold down premiums in 2014, 2015 and 2016. Our Plans experience shows that premiums would have been nearly 20 percent higher in 2014 and 6 percent higher in 2015, had this program not been in effect. We recommend that Congress create a reinsurance program similar to the program that expired in 2017 to stabilize premiums in the ACA individual market for the long term.\nc. Continuous coverage provision - The ACA provisions that provide for a three-month grace period and avoid tax penalties has created a perverse incentive for enrollees to stay insured for just enough time to avoid the penalty. We recommend that Congress should create a continuous enrollment provision or late enrollment penalty similar to Medicares Part B and Part D to incentivize 12 month enrollment in the ACA individual market.\nd. Risk adjustment program enhancements - We recommend that HHS risk adjustment program should pay carriers a capitation for members whose risk scores exceed a certain predefined value. Lower-than-current future rate increases would reduce expenditures for the advanced premium tax credits.\ne. Federal funding for enrollee outreach - Health insurance and the subsidies available to help area residents afford coverage is a complex and confusing topic. We recommend that navigator services should be re-instated and funds prioritized to rural areas for community outreach.\n\nHR 1628 the Better Care Reconciliation Act -- MCHS expressed reservations about the Better Care Reconciliation Act (BCRA) as currently written. \n\nChallenges of serving rural Wisconsin . We serve about 1 million residents in our rural area Subsidization of health coverage for low income Wisconsinites has helped mainstream tens of thousands into traditional commercial coverage through the Health Insurance Marketplace. This has been vital to the health of our patients enabling us to educate patients and include them in prevention programs. \n\nImpact of the Better Care Reconciliation Act\n\n-Tax credits are income based, but only up to 350% of the FPL versus 400% as in the ACA. The impact of this is significant to the population we serve.\n-Cost sharing subsides are eliminated as of 2020. This will mean increases in out-of-pocket expenses for those under 250% of FPL of thousands of dollars.\n-The benchmark plan will be lowered to 58% actuarial value (currently at 70%). That reduction will substantially lower the amount of tax credit people will be eligible for and will likely make most plans unaffordable for those under 250% FPL.\n\nWhile the House of Representatives did acknowledge the divide between expansion and non-expansion states, the House-passed bill came up far short of providing true equity and fairness in the system. The Senate BCRA has not improved on the equity of the formula, and in the most basic analysis, taxes paid in Wisconsin will go to fund expansion in other States. We requested fairness for Medicaid payments throughout the States, including Wisconsin.", "foreign_entity_issues": "", "lobbyists": [{"lobbyist": {"id": 37946, "prefix": "mr", "prefix_display": "MR.", "first_name": "BRENT", "nickname": null, "middle_name": "V", "last_name": "MILLER", "suffix": null, "suffix_display": null}, "covered_position": null, "new": false}], "government_entities": [{"id": 136, "name": "Centers For Medicare and Medicaid Services (CMS)"}, {"id": 34, "name": "Health & Human Services, Dept of (HHS)"}, {"id": 2, "name": "HOUSE OF REPRESENTATIVES"}, {"id": 253, "name": "Medicare Payment Advisory Commission (MedPAC)"}, {"id": 1, "name": "SENATE"}, {"id": 42, "name": "Veterans Affairs, Dept of (VA)"}]}, {"general_issue_code": "INS", "general_issue_code_display": "Insurance", "description": "INS (Insurance)\nMarket Stability in budget reconciliation legislation\nHR 1628, the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BRCA) will result in a large number of individuals covered under the Affordable Care Act (ACA) with preexisting conditions to lose the necessary coverage to maintain their health. MCHS recommended opposition to the AHCA, BRCA, and any changes to the coverage afforded by the ACA. The changes proposed under the AHCA and BRCA will undermine what works in the ACA without improving on the circumstances, coverage and care of Wisconsin residents in the individual and small group market. \n\nWe urged Congress to take steps to improve and repair health coverage in the areas where the ACA was falling short, and to also maintain the gains that the ACA has provided to assure that no one, especially those near poverty, fall through the cracks:\n\nStabilizing the market - Regulatory relief offered earlier this year by Secretary Tom Price at HHS gave health insurers tools to better manage their ACA individual population, but those reforms didnt go far enough to fully stabilize the market. We believe that the suggestions below will improve the ACA and ensure coverage for vulnerable populations.\na. Cost sharing reduction payments - SHPs ACA individual population is heavily reliant on the cost sharing reduction (CSR) subsides paid monthly to help our members lower their out-of-pocket costs. Nearly half of the total enrollment in SHPs ACA products is eligible and enrolled in this important program. We recommend that Congress should fully fund CSR payments to health insurance carriers for 2018 and beyond and allow states that have already reached their filing deadline to reopen carriers bids to allow for an adjustment to rates.\nb. Extension of the reinsurance program - The transitional reinsurance program established by the ACA helped to hold down premiums in 2014, 2015 and 2016. Our Plans experience shows that premiums would have been nearly 20 percent higher in 2014 and 6 percent higher in 2015, had this program not been in effect. We recommend that Congress create a reinsurance program similar to the program that expired in 2017 to stabilize premiums in the ACA individual market for the long term.\nc. Continuous coverage provision - The ACA provisions that provide for a three-month grace period and avoid tax penalties has created a perverse incentive for enrollees to stay insured for just enough time to avoid the penalty. We recommend that Congress should create a continuous enrollment provision or late enrollment penalty similar to Medicares Part B and Part D to incentivize 12 month enrollment in the ACA individual market.\nd. Risk adjustment program enhancements - We recommend that HHS risk adjustment program should pay carriers a capitation for members whose risk scores exceed a certain predefined value. Lower-than-current future rate increases would reduce expenditures for the advanced premium tax credits.\ne. Federal funding for enrollee outreach - Health insurance and the subsidies available to help area residents afford coverage is a complex and confusing topic. We recommend that navigator services should be re-instated and funds prioritized to rural areas for community outreach.\n\nHR 1628 the Better Care Reconciliation Act -- MCHS expressed reservations about the Better Care Reconciliation Act (BCRA) as currently written. \n\nChallenges of serving rural Wisconsin . We serve about 1 million residents in our rural area Subsidization of health coverage for low income Wisconsinites has helped mainstream tens of thousands into traditional commercial coverage through the Health Insurance Marketplace. This has been vital to the health of our patients enabling us to educate patients and include them in prevention programs. \n\nImpact of the Better Care Reconciliation Act\n\n-Tax credits are income based, but only up to 350% of the FPL versus 400% as in the ACA. The impact of this is significant to the population we serve.\n-Cost sharing subsides are eliminated as of 2020. This will mean increases in out-of-pocket expenses for those under 250% of FPL of thousands of dollars.\n-The benchmark plan will be lowered to 58% actuarial value (currently at 70%). That reduction will substantially lower the amount of tax credit people will be eligible for and will likely make most plans unaffordable for those under 250% FPL.\n\nWhile the House of Representatives did acknowledge the divide between expansion and non-expansion states, the House-passed bill came up far short of providing true equity and fairness in the system. The Senate BCRA has not improved on the equity of the formula, and in the most basic analysis, taxes paid in Wisconsin will go to fund expansion in other States. We asked for fairness for Medicaid payments throughout the States, including Wisconsin.", "foreign_entity_issues": "", "lobbyists": [{"lobbyist": {"id": 37946, "prefix": "mr", "prefix_display": "MR.", "first_name": "BRENT", "nickname": null, "middle_name": "V", "last_name": "MILLER", "suffix": null, "suffix_display": null}, "covered_position": null, "new": false}], "government_entities": [{"id": 136, "name": "Centers For Medicare and Medicaid Services (CMS)"}, {"id": 34, "name": "Health & Human Services, Dept of (HHS)"}, {"id": 2, "name": "HOUSE OF REPRESENTATIVES"}, {"id": 253, "name": "Medicare Payment Advisory Commission (MedPAC)"}, {"id": 1, "name": "SENATE"}, {"id": 42, "name": "Veterans Affairs, Dept of (VA)"}]}, {"general_issue_code": "TAX", "general_issue_code_display": "Taxation/Internal Revenue Code", "description": "TAX\n\nPrivate Activity Bonds We opposed the elimination of private activity bonds and advance refunding bonds contained in H.R. 1, the Tax Cuts and Jobs Act. \n\nHealth Provisions\n\nIndividual Mandate Penalties We opposed to the repeal of the individual mandate. The Senate bill effectively repeals the Affordable Care Act individual mandate by eliminating the tax penalty in 2019. Eliminating the mandate without implementing an alternative means to drive enrollment among healthy individuals will likely result in a deterioration of the risk pool due to lower coverage rates among healthier individuals. Refunding Cost Sharing Reductions is needed but must also be coupled with other mechanisms such as a federally funded reinsurance program, to assure stability of the exchanges. If the individual mandate is repealed, these alternative stabilization programs could mitigate some of the resulting premium increases, leading to a stable market.\n\nDeduction of Medical Expenses We opposed the repeal of the itemized deduction for Medical Expenses included in the House Bill. This provision would adversely affect those individuals who experience a high-cost medical event. While this is a small percentage of the population every year, these individuals are the most vulnerable to medical bankruptcies, which are difficult both for the individual and the community that must absorb the costs.", "foreign_entity_issues": "", "lobbyists": [{"lobbyist": {"id": 37946, "prefix": "mr", "prefix_display": "MR.", "first_name": "BRENT", "nickname": null, "middle_name": "V", "last_name": "MILLER", "suffix": null, "suffix_display": null}, "covered_position": null, "new": false}], "government_entities": [{"id": 136, "name": "Centers For Medicare and Medicaid Services (CMS)"}, {"id": 34, "name": "Health & Human Services, Dept of (HHS)"}, {"id": 2, "name": "HOUSE OF REPRESENTATIVES"}, {"id": 253, "name": "Medicare Payment Advisory Commission (MedPAC)"}, {"id": 1, "name": "SENATE"}, {"id": 42, "name": "Veterans Affairs, Dept of (VA)"}]}, {"general_issue_code": "HCR", "general_issue_code_display": "Health Issues", "description": "HCR (Health Issues)\nNational Farm Safety\n\nSupport for occupational safety and health funding for Fiscal Year 2015. The National Institute for Occupational Safety and Health (NIOSH) is the primary federal agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury. NIOSH provides leadership to avert workplace illness, injury, disability, and death and supports programs to improve the health and safety of workers. NIOSH funds the National Childrens Center for Rural and Agricultural Health and Safety. Marshfield Clinic urges support for this important program.\nAccountability in Drug Pricing \nMCHS and Security health Plan have supported the FAIR Drug Pricing Act Introduced by U.S. Senators Tammy Baldwin (D-WI) and John McCain (R-AZ) and U.S. Representative Jan Schakowsky (D-IL). The legislation takes the first step in addressing skyrocketing prescription drug prices by requiring transparency for pharmaceutical corporations that plan to increase drug prices.", "foreign_entity_issues": "", "lobbyists": [{"lobbyist": {"id": 37946, "prefix": "mr", "prefix_display": "MR.", "first_name": "BRENT", "nickname": null, "middle_name": "V", "last_name": "MILLER", "suffix": null, "suffix_display": null}, "covered_position": null, "new": false}], "government_entities": [{"id": 136, "name": "Centers For Medicare and Medicaid Services (CMS)"}, {"id": 34, "name": "Health & Human Services, Dept of (HHS)"}, {"id": 2, "name": "HOUSE OF REPRESENTATIVES"}, {"id": 253, "name": "Medicare Payment Advisory Commission (MedPAC)"}, {"id": 1, "name": "SENATE"}, {"id": 42, "name": "Veterans Affairs, Dept of (VA)"}]}, {"general_issue_code": "VET", "general_issue_code_display": "Veterans", "description": "VHA (Veterans Affairs)\nVA Choice program \n\nWe have asked for assistance to resolve administrative problems with Health Net Federal Services in the VA Choice program.", "foreign_entity_issues": "", "lobbyists": [{"lobbyist": {"id": 37946, "prefix": "mr", "prefix_display": "MR.", "first_name": "BRENT", "nickname": null, "middle_name": "V", "last_name": "MILLER", "suffix": null, "suffix_display": null}, "covered_position": null, "new": false}], "government_entities": [{"id": 136, "name": "Centers For Medicare and Medicaid Services (CMS)"}, {"id": 34, "name": "Health & Human Services, Dept of (HHS)"}, {"id": 2, "name": "HOUSE OF REPRESENTATIVES"}, {"id": 253, "name": "Medicare Payment Advisory Commission (MedPAC)"}, {"id": 1, "name": "SENATE"}, {"id": 42, "name": "Veterans Affairs, Dept of (VA)"}]}, {"general_issue_code": "MED", "general_issue_code_display": "Medical/Disease Research/Clinical Labs", "description": "MED (Medical Disease Research/ Clinical Labs)\nProtecting Access to Medicare Act of 2014 (PAMA)\nPAMA includes reforms to the Clinical Lab Fee Schedule (CLFS). This rule for PAMA requires reporting of Clinical lab prices and volumes. MCHS requested a delay in the reporting, and changes to expand the definition of applicable lab to represent the true market of all laboratories; requested greater transparency of calculations; more time to allow for gathering data and implementation.", "foreign_entity_issues": "", "lobbyists": [{"lobbyist": {"id": 37946, "prefix": "mr", "prefix_display": "MR.", "first_name": "BRENT", "nickname": null, "middle_name": "V", "last_name": "MILLER", "suffix": null, "suffix_display": null}, "covered_position": null, "new": false}], "government_entities": [{"id": 136, "name": "Centers For Medicare and Medicaid Services (CMS)"}, {"id": 34, "name": "Health & Human Services, Dept of (HHS)"}, {"id": 2, "name": "HOUSE OF REPRESENTATIVES"}, {"id": 253, "name": "Medicare Payment Advisory Commission (MedPAC)"}, {"id": 1, "name": "SENATE"}, {"id": 42, "name": "Veterans Affairs, Dept of (VA)"}]}], "conviction_disclosures": [], "foreign_entities": [], "affiliated_organizations": []} | WI | US | 35255 | WI | WI | US | US | Integrated health system serving northern Wisconsin | 0 | 0 | 80000.0 |