From: Kennedy, Tim [TKennedy@mmwr.

com] Sent: Thursday, September 23, 2010 1:44 PM To: HHS HealthInsurance (HHS) Cc: KarenGiaquinto@pmchealthsystem.org; llansdowne@pmchealthsystem.org Subject: waiver Attachments: ECOPY26N01_EXCHANGE_09232010-133432.PDF
To Whom it May Concern:

We look forward to a determination within the next 30 days. Please contact me should you have any questions or require additional information. Thank you. Timothy F. Kennedy Montgomery, McCracken, Walker & Rhoads, LLP 123 South Broad Street Philadelphia, PA 19109 ( : (215) 772-7584 7 : (215) 731-3953 *: tkennedy@mmwr.com www.mmwr.com

For more information on Circular 230 go to our website, www.mmwr.com, and click on Publications.

Co m

pl

et eC

Pursuant to applicable U.S. Treasury Regulations (Circular 230), we must advise you that this communication is not intended or written to be used, and cannot be used, by a recipient for avoiding tax penalties that may be imposed on the recipient under U.S. federal tax laws.

ol o

ra do .
POCONO MC:000001

file:///T|/CCIIO%20Waivers%20-%20Torres/DFOI%20Processing%20Team/Mike/Pocono%20Medical%20Center/waiver.htm[11/04/2011 3:25:24 PM]

co m

Attached please find an application for a waiver of the annual limits required by Section 2711 of the Public Health Services act as added by the Patient Protection and Affordable Care Act. This application is filed in connection with Pocono Medical Center's "Prescription Drug Program." We submit this application in accordance with the September 3, 2010 guidance memo from Steve Larsen, Director of Oversight, re "OCIIO Sub-Regulatory Guidance (OCIIO 2010-1): Process for Obtaining Waivers of the Annual Limits Requirements of PHS ActSection 2711."

ra do . ol o
Ex. 4 Ex. 4

co m
Ex. 4

et eC pl Co m

Ex. 4

Ex. 4 Ex. 4

Ex. 4

Ex. 4

Ex. 4

Ex. 4

Ex. 4 Ex. 4

POCONO MC:000002

Ex. 4

Co m

pl

et eC

ol o
POCONO MC:000003

ra do .

co m

Co m pl et eC ol o ra do . co m

POCONO MC:000004

From: Kennedy, Tim [TKennedy@mmwr.com] Sent: Friday, September 24, 2010 1:59 PM To: HHS HealthInsurance (HHS) Cc: KarenGiaquinto@pmchealthsystem.org Subject: FW: waiver (NEED AN ANSWER TO A QUESTION ASAP1?) Follow Up Flag: Follow up Flag Status: Red Attachments: ECOPY26N01_EXCHANGE_09232010-133432.PDF
To Whom it May Concern: Yesterday I sumbitted the attached Waiver Application. Today I have a question that must be answered ASAP. I called your (301) 492-4100 and Labrea Gary (sp?) mentioned that all questions must be emailed to this address.

Here is our Concern and Question:

QUESTION: We desperately need to know whether HHS will accept our waiver application as soon as possible but in no event later that 2 weeks from today. Is it possible to have our application EXPEDITED/ so that we can properly negotiate with the unions?

PLEASE LET ME KNOW. I can be reached at the bottom of this email. Thank you.

To Whom it May Concern:

Attached please find an application for a waiver of the annual limits required by Section 2711 of the Public Health Services act as added by the Patient Protection and Affordable Care Act. This application is filed in connection with Pocono Medical Center's "Prescription Drug Program." We submit this application in accordance with the September 3, 2010 guidance memo from Steve Larsen, Director of Oversight, re "OCIIO Sub-Regulatory Guidance (OCIIO 2010-1): Process for Obtaining Waivers of the Annual Limits Requirements of PHS ActSection 2711."

We look forward to a determination within the next 30 days. Please contact me should you have any questions or require additional information. Thank you. Timothy F. Kennedy Montgomery, McCracken, Walker & Rhoads, LLP 123 South Broad Street Philadelphia, PA 19109 ( : (215) 772-7584 7 : (215) 731-3953 *: tkennedy@mmwr.com
POCONO MC:000005

file:///T|/...ocono%20Medical%20Center/FW%20waiver%20(NEED%20AN%20ANSWER%20TO%20A%20QUESTION%20ASAP1).htm[11/04/2011 3:25:24 PM]

Co m

pl

From: Kennedy, Tim Sent: Thursday, September 23, 2010 1:44 PM To: healthinsurance@hhs.gov Cc: KarenGiaquinto@pmchealthsystem.org; llansdowne@pmchealthsystem.org Subject: waiver

et eC

ol o

ra do .

CONCERN: We are in the midst of union negotiations and it is difficult to negotiate in good faith until we know whether or not the annual limits must be removed or not as this will significantly affect costs, etc. all of which need to be known in order to negotiate properly.

co m

www.mmwr.com

Pursuant to applicable U.S. Treasury Regulations (Circular 230), we must advise you that this communication is not intended or written to be used, and cannot be used, by a recipient for avoiding tax penalties that may be imposed on the recipient under U.S. federal tax laws. For more information on Circular 230 go to our website, www.mmwr.com, and click on Publications.

Co m

pl

et eC

ol o
POCONO MC:000006

file:///T|/...ocono%20Medical%20Center/FW%20waiver%20(NEED%20AN%20ANSWER%20TO%20A%20QUESTION%20ASAP1).htm[11/04/2011 3:25:24 PM]

ra do .

co m

From: Botwinick, Alexandra (HHS/OCIIO) Sent: Friday, October 08, 2010 3:52 PM To: 'TKennedy@mmwr.com' Attachments: January 1 Approval Letter .pdf Mr. Kennedy,

Co m

pl

et eC

ol o

POCONO MC:000007

Alexandra Botwinick Office of Oversight HHS/OCIIO

alexandra.botwinick@hhs.gov

file:///T|/...0Torres/DFOI%20Processing%20Team/Mike/Pocono%20Medical%20Center/Waiver%20Approval%20Letter%2010-8-2010.htm[11/04/2011 3:25:25 PM]

ra do .

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Pocono Medical Center. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail with a copy to OCIIOOversight@hhs.gov. Please let me know if I can be of further assistance. Sincerely,

co m

Co m pl et eC ol o ra do . co m

POCONO MC:000008

Co m pl et eC ol o ra do . co m

POCONO MC:000009

From: Kennedy, Tim [TKennedy@mmwr.com] Sent: Friday, October 08, 2010 3:55 PM To: Botwinick, Alexandra (HHS/OCIIO) Cc: OCIIO Oversight Subject: RE: Follow Up Flag: Follow up Flag Status: Yellow

Confirming receipt. Thank you.

Mr. Kennedy,

alexandra.botwinick@hhs.gov

Co m

pl

Alexandra Botwinick Office of Oversight HHS/OCIIO

et eC

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Pocono Medical Center. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail with a copy to OCIIOOversight@hhs.gov. Please let me know if I can be of further assistance. Sincerely,

ol o

ra do .

file:///T|/...20Team/Mike/Pocono%20Medical%20Center/Confirmation%20of%20Receipt%20of%20Approval%20Letter%2010-8-2010.htm[11/04/2011 3:25:25 PM]

co m

From: Botwinick, Alexandra (HHS/OCIIO) [mailto:Alexandra.Botwinick@hhs.gov] Sent: Friday, October 08, 2010 3:52 PM To: Kennedy, Tim Subject:

POCONO MC:000010