Repeal of the Obamacare Bay State Boondoogle Act

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes. The Senate Committee on Health, Education, Labor and Pensions (HELP) June 26 passed the Lower Health Care Costs Act of 2019 (S.1895) Congress should act now to delay the Medicaid DSH cuts that are scheduled to go into effect Nov. 22.

Client expense: Not reported · Firm income: Not reported

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes. The Senate Committee on Health, Education, Labor and Pensions (HELP) June 26 passed the Lower Health Care Costs Act of 2019 (S.1895) Congress should act now to delay the Medicaid DSH cuts that are scheduled to go into effect Nov. 22.

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA)

Client expense: Not reported · Firm income: Not reported

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA)

Client expense: Not reported · Firm income: Not reported

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016

Client expense: Not reported · Firm income: Not reported

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor H.R. 3292, "Medicare IME Pool Act of 2015" H.R. 5273, "Helping Hospitals Improve Patient Care Act" H.R. 34, "21st Century Cures Act" - provisions related to Medicare payments to hospitals

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor H.R. 3292, "Medicare IME Pool Act of 2015" H.R. 5273, "Helping Hospitals Improve Patient Care Act" H.R. 34, "21st Century Cures Act" - provisions related to Medicare payments to hospitals

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor H.R. 3292, "Medicare IME Pool Act of 2015" H.R. 5273, "Helping Hospitals Improve Patient Care Act"

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor H.R. 3292, "Medicare IME Pool Act of 2015" H.R. 5273, "Helping Hospitals Improve Patient Care Act"

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- provided information regarding the geographic distribution of behavioral healthcare providers in Missouri - discussed performance improvement initiatives of Missouris small rural hospitals - promoted legislation to curb unnecessary data reporting to the CMS Hospital Compare website - promoted the passage of legislation concerning behavioral healthcare (H. R. 2646, S. 1945) - promoted Missouris participation in phase 2 of the Excellence In Mental Health Act - discussed the implications of fewer marketplace insurers serving the Missouri market in 2017 - promoted changes to the Medicare area wage index formula provided by S. 1135 and H. R. 1479 - expressed concerns regarding the role of CMS controlling the health care market through mandated participation in delivery model reform initiatives - expressed support for protecting the 340B drug discount program - promoted accountability for health information technology vendors as provided by sections of S. 2511 - provided information regarding Missouri hospital utilization and finances, in aggregate and by congressional district - provided information to a member of the Missouri congressional delegation regarding Medicare coverage of telemedicine services - at the request of a member of the Missouri congressional delegation , provided information regarding contact information for selected Missouri chief executive officers` - provided information to members of the Missouri delegation regarding CMS denial of an extension of the institutions for mental disease demonstration project - provided information to members of the congressional delegation regarding the need to adjust data used in CMSs star rating system to account for differences in patients sociodemographic status - provided information to a member of the Missouri congressional delegation regarding critical access hospitals in Missouri - provided information to members of the Missouri congressional delegation regarding CMSs basis for its recent actions to terminate a Missouri hospital from the Medicare program for failing to be primarily engaged in providing inpatient services - contacted a member the Missouri congressional delegation regarding a letter to CMS expressing concern about the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts - provided information to a member of the Missouri congressional delegation regarding advocacy on social media on the topic of abuse of opioids - contacted selected members of the Missouri delegation asking them to make contacts with legislative leaders and selected committee leaders regarding the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169 / S. 258: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. Provided education to members of Congress and their staff about the importance of adequate funding for the Hospital Preparedness Program. Worked with members of Congress and staff on proposals for combating the Zika virus and encouraged adequate funding of these plans. H.R. 2646 - Helping Families in Mental Health Crisis Act of 2016 - Would make a variety of sweeping changes to the mental health infrastructure and while also reforming provider outreach, community-based treatment options, and justice system reform. - Discussed with staff how THA support the overall direction this bill would take the mental health system, and encouraged the use of community care in reforming the way we address mental health issues. Encouraged congressional staff to approve the bill, but expressed concern for lack of funding. Without adequate funding, states cannot properly implement the programs in the legislation. S.524 Comprehensive Addiction and Recovery Act (CARA) - wound enact policies intended to re-engineer how health care providers, communities and the criminal justice system coordinates care to treat addiction. - Expressed support for the overall goals of the bill and the programs to be established by the legislation, but THA is concerned with the lack of funding in the legislation. Without funding, states and localities cannot adequately address and combat the opioid addiction crisis. H.R.5273 - Helping Hospitals Improve Patient Care Act of 2016 - Would provide some relief to hospitals in site-neutral payments, readmissions adjustments and other polices. Discussed with congressional staff about the bills limited impact to Texas hospitals in relation to hospital outpatient departments. Encouraged additional work in the Senate to help a broader range of hospitals who had their payment structure changed without notice. H.R.2745 - Standard Merger and Acquisition Reviews Through Equal Rules Act of 2015 - Would standardize the merger review process for the Department of Justice (DOJ) and Federal Trade Commission (FTC). Met with congressional staff on how the merger review process impacts hospital mergers and how this legislation would eliminate disparities between the two reviewing agencies. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. H.R.1343/S.688 - Would require CMS to take into account patients' sociodemographic status when imposing financial penalties for excessive hospital readmissions for Medicare patients. - Met with congressional staff on how socioeconomic status impacts health and the importance of this legislation, especially to large safety net hospitals. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225.

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. Discussed with members of Congress and staff the implications, concerns with and the misguided policies in the proposed rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. H.R.5273 - Helping Hospitals Improve Patient Care Act of 2016 - Would provide some relief to hospitals in site-neutral payments, readmissions adjustments and other polices. Discussed with congressional staff about the bills limited impact to Texas hospitals in relation to hospital outpatient departments. Encouraged additional work in the Senate to help a broader range of hospitals that had their payment structure changed without notice. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor H.R. 3292, "Medicare IME Pool Act of 2015" Medicare payments to hospital outpatient departments H.R. 5273, "Helping Hospitals Improve Patient Care Act"

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor H.R. 3292, "Medicare IME Pool Act of 2015" Medicare payments to hospital outpatient departments H.R. 5273, "Helping Hospitals Improve Patient Care Act"

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169 / S. 258: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169 / S. 258: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor H.R. 3292, "Medicare IME Pool Act of 2015" Medicare payments to hospital outpatient departments

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor H.R. 3292, "Medicare IME Pool Act of 2015" Medicare payments to hospital outpatient departments

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policies Medicare hospital prospective payment system H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor Medicare payments to hospital outpatient departments

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. Provided education to members of Congress and their staff about the importance of adequate funding for the Hospital Preparedness Program. Worked with members of Congress and staff on proposals for combating the Zika virus and encouraged adequate funding of these plans. H.R.2745 - Standard Merger and Acquisition Reviews Through Equal Rules Act of 2015 - Would standardize the merger review process for the Department of Justice (DOJ) and Federal Trade Commission (FTC). Met with congressional staff on how the merger review process impacts hospital mergers and how this legislation would eliminate disparities between the two reviewing agencies. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R. 953 Comprehensive Addiction and Recovery Act - Discussed with congressional staff how hospitals are involved with treating and caring for opioid and other substance abuse patients. Discussed limitations and flexibility within current law and congressional proposals. S.2002 - Mental Health and Safe Communities Act of 2015 - Talked with Senate staff about the importance of adequate funding and coordination of care across multiple disciplines, including hospitals, law enforcement, judicial system, outpatient clinics, community-based treatment and more. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. H.R.1343/S.688 - Would require CMS to take into account patients' sociodemographic status when imposing financial penalties for excessive hospital readmissions for Medicare patients. - Met with congressional staff on how socioeconomic status impacts health and the importance of this legislation, especially to large safety net hospitals. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. H.R. 2646 - Helping Families in Mental Health Crisis Act of 2015 - Would make a variety of sweeping changes to the mental health infrastructure and while also reforming provider outreach, community-based treatment options, and justice system reform. - Discussed with staff how THA support the overall direction this bill would take the mental health system, and encouraged the use of community care in reforming the way we address mental health issues. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Provided education to Members of Congress and staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Educated members of congress and staff on the Medicare Area Wage Index. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. H.R.2156 - Medicare Audit Improvement Act of 2015 - Would replace the Recovery Audit Contractor (RAC) contingency fee structure with a flat fee to reduce the financial incentive for overzealous auditing practices; lowers payments for poor RAC performance; allows hospitals to rebill claims when appropriate; and requires RACs to base their inpatient claims decisions on only the information the physician had when treating the patient. - Discussed with congressional staff the burden the RACs put on hospitals and how RAC reform is necessary to improve efficiency and fairness. H.R. 2513 - PACE Act of 2015 - Would remove the prohibition on expansion of physician-owned hospitals. - Met with staff on the role these facilities play in the health care infrastructure compared to general acute care hospitals (treating healthier patients and less Medicare and Medicaid populations) and how physician-owned hospitals raise ethical concerns for cherry-picking patients and physician self-referral. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impact the 1115 waiver renewal as well as the safety net in the state. Provided information to members of Congress and their staff on physician-owned hospitals. Provided education to members of Congress and their staff about the importance of adequate funding for the Hospital Preparedness Program. H.R.1343/S.688 - Would require CMS to take into account patients' sociodemographic status when imposing financial penalties for excessive hospital readmissions for Medicare patients. - Met with congressional staff on how socioeconomic status impacts health and the importance of this legislation, especially to large safety net hospitals. Educated members of congress and staff on the Medicare Area Wage Index. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. H.R. 2513 - PACE Act of 2015 - Would remove the prohibition on expansion of physician-owned hospitals. - Met with staff on the role these facilities play in the health care infrastructure compared to general acute care hospitals (treating healthier patients and less Medicare and Medicaid populations) and how physician-owned hospitals raise ethical concerns for cherry-picking patients and physician self-referral. H.R. 2646 - Helping Families in Mental Health Crisis Act of 2015 - Would make a variety of sweeping changes to the mental health infrastructure and while also reforming provider outreach, community-based treatment options, and justice system reform. - Discussed with staff how THA support the overall direction this bill would take the mental health system, and encouraged the use of community care in reforming the way we address mental health issues. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor Hospitals Improvements for Payment (HIP) Act of 2014 H.R. 1343/S. 688, "Establishing Beneficiary Equity in the Hospital Readmissions Program Act" H.R. 1021, "Protecting the Integrity of Medicare Act" - provisions related to Medicare hospital payments and policy H.R. 3291, "Medicare Crosswalk Hospital Code Development Act" H.R. 3292, "Medicare IME Pool Act of 2015" H.R. 3288, "Strengthening DHS and Medicare through Subsidy Recapture and Payment Reform Act" Medicare payments to hospital outpatient departments

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor Hospitals Improvements for Payment (HIP) Act of 2014 H.R. 1343/S. 688, "Establishing Beneficiary Equity in the Hospital Readmissions Program Act" H.R. 3291, "Medicare Crosswalk Hospital Code Development Act" H.R. 3292, "Medicare IME Pool Act of 2015" H.R. 3288, "Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act" Medicare payments to hospital outpatient departments

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policies Medicare hospital prospective payment system H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor "Hospitals Improvements for Payment (HIP) Act of 2014" - provisions related to proposed hospital prospective payment system for short-term hospital stays H.R. 1021,"Protecting the Integrity of Medicare Act" - provisions related to Medicare hospital payments Medicare payments to hospital outpatient departments

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6, 21st Century Cures Act. H.R. 1314, Bipartisan Budget Act of 2015. H.R. 1343/S.688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015 H.R 1479, Repeal of the Obamacare Bay State Boondoggle Act. H.R. 2126, To prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code set standards. H.R. 2156, To amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program, and for other purposes. H.R.3018, Code-FLEX Act of 2015. S. 599, Improving Access to Emergency Psychiatric Care Act. S. 1461, A bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2015. S. 1648, Rural Emergency Acute Care Hospital Act. CMS-1613-FC, Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Physician-Owned Hospitals: Data Sources for Expansion Exception; Physician Certification of Inpatient Hospital Services; Medicare Advantage Organizations and Part D Sponsors: CMS-Identified Overpayments Associated with Submitted Payment Data, Final Rule. CMS-1621-P, Medicare Program: Medicare Clinical Diagnostic Laboratory Tests Payment System; Proposed Rule. CMS-3310-FC, Medicare and Medicaid Programs; Electronic Health Record Incentive Program, Stage 3; Final Rule Additional Comments. CMS-9937-P, Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017; Proposed Rule. EPA-HQ- RCRA-2007-0932; Management Standards for Hazardous Waste Pharmaceuticals; Proposed Rule. RIN Number 0945-AA02, Nondiscrimination in Health Programs and Activities; Proposed Rule. RIN 0906-AB08, 340B Drug Pricing Program Omnibus Guidance.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

H.R. 170: Rural Health Care Provider Relief Act of 2015 S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act H.R. 169 / S. 258: Critical Access Hospital Relief Act of 2015 H.R. 270: Flexibility in Health IT Reporting Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 H.R. 2878 / S. 1461: Would implement a one-year moratorium on enforcement of the supervision requirements for outpatient therapeutic services H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act H.R. 1314: Bipartisan Budget Act of 2015

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor Hospitals Improvements for Payment (HIP) Act of 2014 H.R. 1343/S. 688, "Establishing Beneficiary Equity in the Hospital Readmissions Program Act" H.R. 1021, "Protecting the Integrity of Medicare Act" - provisions related to Medicare hospital payments and policy H.R. 3291, "Medicare Crosswalk Hospital Code Development Act" H.R. 3292, "Medicare IME Pool Act of 2015" H.R. 3288, "Strengthening DHS and Medicare through Subsidy Recapture and Payment Reform Act"

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor Hospitals Improvements for Payment (HIP) Act of 2014 H.R. 1343/S. 688, "Establishing Beneficiary Equity in the Hospital Readmissions Program Act" H.R. 3291, "Medicare Crosswalk Hospital Code Development Act" H.R. 3292, "Medicare IME Pool Act of 2015" H.R. 3288, "Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act"

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policies Medicare hospital prospective payment system H.R. 1479, Mandating state specific budget neutrality for the rural area wage index floor "Hospitals Improvements for Payment (HIP) Act of 2014" - provisions related to proposed hospital prospective payment system for short-term hospital stays H.R. 1021,"Protecting the Integrity of Medicare Act" - provisions related to Medicare hospital payments

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 170: Rural Health Care Provider Relief Act of 2015 S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act H.R. 169 / S. 258: Critical Access Hospital Relief Act of 2015 H.R. 270: Flexibility in Health IT Reporting Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 H.R. 2652: Protecting Patients and Physicians Against Coding Act of 2015 H.R. 2247: Increasing Clarity for Doctors by Transitioning Effectively Now Act H.R. 2126: Cutting Costly Codes Act of 2015 H.R. 2878 / S. 1461: Would implement a one-year moratorium on enforcement of the supervision requirements for outpatient therapeutic services H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

Client expense: $40,000 · Firm income: Not reported

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impact the 1115 waiver renewal as well as the safety net in the state. Provided information to members of Congress and their staff on physician-owned hospitals. Provided education to members of Congress and their staff about the importance of adequate funding for the Hospital Preparedness Program. Provided education to Members of Congress and their staff about health insurance coverage expansion options in the state of Texas. 340B Drug Pricing Program - Educated staff on the 340B Drug Pricing Program and how hospitals are involved. Discussed recently released guidance from HRSA on the program and how changes to the definition of patient and qualified entity, are of concern to the hospitals in Texas, especially in relation to the states ban on the corporate practice of medicine. Trade Adjustment Assistance Program -Discussed with staff how THA cannot support the use of Medicare to pay for the trade adjustment assistance program, as was proposed in the trade promotion authority legislation. H.R.1343/S.688 - Would require CMS to take into account patients' sociodemographic status when imposing financial penalties for excessive hospital readmissions for Medicare patients. - Met with congressional staff on how socioeconomic status impacts health and the importance of this legislation, especially to large safety net hospitals. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. H.R. 2513 - PACE Act of 2015 - Would remove the prohibition on expansion of physician-owned hospitals. - Met with staff on the role these facilities play in the health care infrastructure compared to general acute care hospitals (treating healthier patients and less Medicare and Medicaid populations) and how physician-owned hospitals raise ethical concerns for cherry-picking patients and physician self-referral. H.R.3291 - Medicare Crosswalk Hospital Code Development Act of 2015 - Would create a Healthcare Common Procedure Classification System (HCPCS) version of MS-DRGs that will serve as a guide to connecting the inpatient and outpatient coding and payment systems for implementing site-neutral payments. - Educated staff on why the hospital industry cannot support site-neutral payments, as these policies do not take in to account a variety of factors that influence why a procedure is performed in a specific setting. H.R. 2646 - Helping Families in Mental Health Crisis Act of 2015 - Would make a variety of sweeping changes to the mental health infrastructure and while also reforming provider outreach, community-based treatment options, and justice system reform. - Discussed with staff how THA support the overall direction this bill would take the mental health system, and encouraged the use of community care in reforming the way we address mental health issues. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. H.R.1343/S.688 - Would require CMS to take into account patients' sociodemographic status when imposing financial penalties for excessive hospital readmissions for Medicare patients. - Met with congressional staff on how socioeconomic status impacts health and the importance of this legislation, especially to large safety net hospitals. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. H.R.2156 - Medicare Audit Improvement Act of 2015 - Would replace the Recovery Audit Contractor (RAC) contingency fee structure with a flat fee to reduce the financial incentive for overzealous auditing practices; lowers payments for poor RAC performance; allows hospitals to rebill claims when appropriate; and requires RACs to base their inpatient claims decisions on only the information the physician had when treating the patient. - Discussed with congressional staff the burden the RACs put on hospitals and how RAC reform is necessary to improve efficiency and fairness. H.R. 2513 - PACE Act of 2015 - Would remove the prohibition on expansion of physician-owned hospitals. - Met with staff on the role these facilities play in the health care infrastructure compared to general acute care hospitals (treating healthier patients and less Medicare and Medicaid populations) and how physician-owned hospitals raise ethical concerns for cherry-picking patients and physician self-referral. H.R.3288 - Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Would shift disproportionate share hospital (DSH) program payments to a lump sum, rather than per discharge add-on payments and increases DSH in states that have not expanded Medicaid. - Explained to congressional staff and members of Congress that hospitals would benefit from the bi-weekly payments proposed in this bill because there would be less delay in cash flow, but also expressed concerns for the offset proposed for the DHS pool for non-expansion states. This ACA subsidy recapture offset is an easy target to be cut in the future when Congress needs to find savings or a means to pay for another program in the future. H.R.3291 - Medicare Crosswalk Hospital Code Development Act of 2015 - Would create a Healthcare Common Procedure Classification System (HCPCS) version of MS-DRGs that will serve as a guide to connecting the inpatient and outpatient coding and payment systems for implementing site-neutral payments. - Educated staff on why the hospital industry cannot support site-neutral payments, as these policies do not take in to account a variety of factors that influence why a procedure is performed in a specific setting. H.R.3292 - Medicare IME Pool Act of 2015 - Would give teaching hospital a lump-sum payment to reimburse indirect medical education (IME) costs, instead of paying the hospital an additional percentage based on each inpatient case. - Discussed with congressional staff how the methodology proposed in HR3292 is redistributive and could benefit some hospitals in Texas while hurting others. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10); general content. Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, FY 2016 (S.1695); provisions related to prescription drug prices. Advancing Care for Exceptional Kids Act of 2015 (H.R. 546/S.298); provisions related to the care of medically complex pediatric patients. Repeal of the Obamacare Bay State Boondoogle Act (H.R. 1479); general issues related to legislative scope. Establishing Beneficiary Equity in the Hospital Readmission Program Act (S. 688/H.R. 1343); provisions related to hospital reimbursements. Issues related to Medicare cancer payment policy. Issues related to Two-Midnights admission policy. Stark Administrative Simplification Act of 2015 (H.R.776); provisions related to physician referrals. Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (S.971); provisions related to patient care. Issues related to electronic health records and their interoperability and transparency. General issues related to ICD-10 implementation

Client expense: $190,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE