Critical Access Hospital Relief Act of 2015

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. The Coronavirus Aid, Relief, and Economic Security (CARES) Act.

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. The Coronavirus Aid, Relief, and Economic Security (CARES) Act.

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.

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.

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.

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

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

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.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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.

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: 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

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 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

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 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

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 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

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 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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support S 258 and HR 169, Critical Access Hospital Relief Act, a bill that would remove the 96-hour physician certification requirement as a condition of payment for critical access hospitals (CAHs); Support HR 293, a bill to exempt certain journals and text books used in continuing medical education (CME) from manufacturer transparency reporting requirements; Participated in the Hearing, Examining the 340B Drug Pricing Program and submitted testimony about the 340B program, a federal drug discount program to Subcommittee members who will review the functionality of the program to ensure it is meeting its intended goals; HR 6, 21st Century Cures, a bill that accelerates the discovery and development of cures, and also includes provisions addressing interoperability of health IT and would provide additional money to NIH and the FDA; Two midnight discussion with several members of Congress; Support, Advancing Telehealth Opportunities in Medicare Telehealth, submitted a letter outlining the benefits of telehealth and showcases successful hospital and health system efforts. It also outlines barriers to greater use of telehealth; Submitted letter pertaining to interoperabilty within the hospital communities; Support S. 599, Improving Access to Emergency Psychiatric Care Act of 2015, legislation easing the shortage of psychiatric beds and extend and expand the CMS emergency psychiatric demonstration project; Comments on H.R.1458, BACPAC Act of 2015, a bill to amend title XVIII of the Social Security Act to provide bundled payments for post-acute care services under parts A and B of Medicare, and submitted a statement for a hearing on HR 1458 (re bundled payments for post-acute and other post-hospital services); Discussed Equity of Care Issues with Members of Congress; Advocate for funding by working with the Office of the Assistant Secretary for Preparedness and Response (ASPR) and Hospital Preparedness Program staff on ensuring adequate Ebola hospital funding; Working with the Centers for Disease Control and Prevention (CDC) on ongoing Ebola-related issues and guidance; Working with the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA) to ensure that hospitals continue to be able to use blood glucose monitoring systems (BGMS) on hospitalized patients;Discussion of draft guidance on drug compounding and repackaging; Working with ASPR and CDC staff to define the impact of the Hospital Preparedness Program and Public Health Emergency Preparedness Program on improving health care system preparedness; Support efforts to advocate on Ebola within a discussion with FDA regarding impact on access to chest tubes regarding the Atrium Medical Corp and Maquet consent decree ; Advocate for regulatory approach in a discussion with White House staff regarding new initiative promoting bystander involvement in stopping hemorrhage in injured civilians; Attended a roundtable discussion on Opioid-related dependence, overdose, and death at HHS; Advocate for changes to The Care Planning Act, a bill that would provide for advanced illness care coordination services for Medicare beneficiaries; Support HR 2878 and 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; Support S.799/HR 1462, Protecting Our Infants Act of 2015, a bill to combat the rise of prenatal opioid abuse and neonatal abstinence syndrome; Discussed S.1349, a bill that amends title XVIII (Medicare) of the Social Security Act to require a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services to give each individual who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning treatment; Supported expansions to Medicare reimbursement for telehealth along with changes to the Health Care Connect Fund; Comments on S.1648, Rural Emergency Acute Care Hospital Act of 2015, a bill to amend title XVIII of the Social Security Act to create a sustainable future for rural healthcare. Urged that HHS refrain from finalizing a stage 3 meaningful use rule; Advocate for Appropriate Surveyor Guidance on Calculated Hospitals in discussion about member concerns regarding remarks of CMS official that were confusing during a health lawyers association webinar; Discussion with CMS staff regarding proposed rule on establishing market-based payments for clinical laboratory tests; Discussion to rescind the proposed 2 percent cut to CY 2016 outpatient PPS conversion factor; Support H.R.2948, Medicare Telehealth Parity Act of 2015, a bill to amend title XVIII (Medicare) of the Social Security Act to expand telehealth coverage in three phases; Support HR 2646, Helping Families in Mental Health Crisis Act of 2015,A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis; Support HR 1604, Veterans Mental Health Care Access Act, a bill that expands access to mental health services for veterans; Support H.R. 3183, The Veterans Health Care Freedom Act, a bill which makes significant improvements to the Veterans Choice Program; Support S 1189 The Conrad State 30 and Physician Access Act, a bill that reauthorizes the Conrad 30 and makes other changes to the program to improve patient access to care; Discussed quality measurement, meaningful use and Conditions of Participation; Conversation with CMS about the IOM Vital Signs report and how its recommendations could make quality measurement more meaningful; Spoke with CMS urging the Agency to correct the misimpression that was created statements made during a National Association of Medical Staff Specialists webinar by a CMS employee; Discussion with CMS about proposals contained in the Inpatient Psychiatric Facility PPS proposed rule urging CMS not to finalize two quality measures; Meeting at CMMI to discuss CCJR; Discuss S. 2141the Transparent Ratings on Usability and Security to Transform Information Technology Act of 2015, the TRUST Act, a bill that includes a definition of information blocking and a framework to assess interoperability of certified health IT (a health IT ratings program); Support S.1461 and H.R. 2878 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; Oppose S. 1648 Rural Emergency Acute Care Hospital ActTo establish an alternative payment model for CAHs and small, rural hospitals whereby they may transition to become a rural emergency hospital.; Oppose H.R. 3225 Save Rural Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to provide for enhanced payments to rural health care providers under the Medicare and Medicaid programs; Discuss S. 1945 Mental Health Reform Act of 2015, a bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis. It would reauthorize certain federal mental health programs, revise the IMD exclusion, reform SAMHSA, and study parity in mental health laws. Support S. 1893, The Mental Health Awareness and Improvement Act of 2015, a bill to reauthorize and improve programs related to mental health and substance use disorders; Letter asking for modifications to H.R. 3298 Medicare Post-Acute Care Value-Based Purchasing (PAC VBP) Act of 2015, the legislation would establish a value-based purchasing program for LTCHs, IRFs, SNFs and HH agencies. Worked to streamline and improve quality measures; Discussed how to implement the framework in the National Academy of Medicines Vital Signs report to streamline and focus quality measures used in Medicare programs; Discussed Opioid prescribing guidelines with the CDC to provide feedback on the opioid prescribing guidelines they were developing; Discussion with CMS regarding CAH designation status, negative impact of Insurance Consolidations on Medicare Advantage and for modifications to Comprehensive Care for Joint Replacement (CJR) model regarding aspects of the proposed rule; Discussion with CMS about the Emergency Preparedness final rule; Discussion with CMS regarding the 0.2 percent reduction to hospitals payments under the Inpatient Prospective Payment System (PPS); Support S. 524, the Johnson amendment and the Collins amendment, Comprehensive Addiction and Recovery Act of 2016, a bill to authorize the Attorney General to award grants to address the national epidemics of prescription opioid abuse and heroin use; Support H.R. 4499, Promoting Responsible Opioid Prescribing Act of 2016, a bill to amend title XVIII of the Social Security Act to remove consideration of certain pain-related issues from calculations under the Medicare hospital value-based purchasing program; Support S. 2220, The Healthy Maternity and Obstetric Medicine Act or Healthy MOM Act guarantees maternity coverage for women who are enrolled in the exchanges established under the Affordable Care Act, as well as women who are covered by individual and group insurance plans and federal employee health benefit plans; Comments to House Ways and Means and Senate Finance Committees on how to improve the physician self-referral (Stark) law; Urged CMS to delay the April 2016 release of the hospital star ratings on the Hospital Compare Website; Supported House and Senate letters urging CMS to delay release of hospital star ratings on the Hospital Compare Website; Support H.R. 4771, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act, a bill that would reduce health care costs and promote access to quality, affordable health care for all Americans; Letter to Senate HELP Committee draft legislation addressing health information technology (IT) and electronic health records (EHRs); Comments to CMS regarding addressing section 603 of the BBA of 2015 in regulation; Comments to House Energy & Commerce Committee regarding section 603 of the BBA of 2015 as well as site neutral payment policies in general; Statement for the record to House Energy & Commerce Committee on MACRA implementation; Statement for the record to Senate Finance Committee on MACRA implementation; Comments to the Senate Finance Committee Chronic Care document -Conversations with the CDC related to their opioid guidelines for chronic pain as well as a patient education piece about opioids; Discussions with CMS about CAH designation status Health Care Issues; Discussions with Rep. Hudson about H.R. 4365/ S. 2932, the Protecting Patient Access to Emergency Medications Act , a bill to amend the Controlled Substances Act with regard to the provision of emergency medical services; Support H.R. 4650 and S. 2108, Preserving Patient Access to Post-Acute Hospital Care Act of 2016, a bill to amend title XVIII of the Social Security Act to provide for an extension of certain Medicare long-term care hospital payment rules; Supported efforts to encourage Congress to send CMS letters on addressing the issue of colocation of facilities within a hospital; Discussions with Members of Congress on the potential implementation of Unique Device Identification on claims forms; Sponsored a Hill briefing on innovations in post-acute care;Supported House and Senate letters to CMS asking for flexibility when interpreting section 603 of the BBA of 2015 in regulation; Support HR 5547, the Health Care Price Transparency Promotion Act of 2016, a bill to require the sharing of health care price information; Support HR 5273, the Helping Hospitals Improve Patient Care Act of 2016, a bill to address outstanding issues with section 603 of the BBA of 2015 and provide for a socioeconomic adjustment to the Hospital Readmissions Reduction Program; Supported a letter to CMS on implementation of Sec. 603 of the Bipartisan Budget Acts site neutral cuts for off-campus HOPDs; Support H. res. 699 promoting minority health awareness and supporting the goals and ideals of National Minority Health Month in April 2016; Support H.R.4641 - a bill to provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication; Support H.R. 4982, the Examining Opioid Treatment Infrastructure Act of 2016, a bill which would require the Government Accountability Office (GAO) to evaluate and report on the capacity, availability and need for inpatient and outpatient treatment for opioid use disorders in the United States; Supports H.R. 3680, the Co-Prescribing to Reduce Overdoses Act of 2015, a bill would establish federal grants to carry out co-prescribing of overdose reversal drugs in areas experiencing significant numbers of opioid overdoses and deaths; Support H.R. 3691, the Improving Treatment for Pregnant and Postpartum Women Act of 2015, a bill that would reauthorize essential residential treatment programs for pregnant and postpartum women and provide grants to states to address the growing epidemic of infants suffering from opioid dependency; Support H.R. 4978, the Nurturing and Supporting Healthy Babies Act, a bill which would require a GAO evaluation of neonatal abstinence syndrome and the availability of treatment for this condition in the nations Medicaid programs; Support H.R. 4599, the Reducing Unused Medications Act of 2016, a bill to permit partial filling of schedule II prescriptions under specific circumstances; Support H.R. 4976, the Opioid Review Modernization Act of 2016, a bill which would provide for more stringent Food and Drug Administration review of new opioids without abuse-deterrent properties, recommendations for labeling of pediatric opioids, and recommendations for prescriber education; Support the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2016, a bill for achieving fair and sustainable drug pricing; Supporting full alignment of 42CFR substance use records confidentiality requirements with HIPAA privacy rule; Support S. 3173 EHR Regulatory Relief Act, a bill to amend title XVIII of the Social Security Act to provide for a 90-day EHR reporting period for the determination of whether an eligible professional or eligible hospital is a meaningful EHR user and to remove the all-or-nothing approach to meaningful use; Support for H.R. 5713, The Sustaining Healthcare Integrity and Fair Treatment Act of 2016, a bill that would extend 25% rule relief and provide targeted relief to certain LTCHs struggling to meet the new criteria standards; Support for H.R. 6174, the Closing Loopholes for Orphan Drugs Act, a bill to amend title III of the Public Health Service Act to limit the orphan drug exclusion under the drug discount program under section 340B of such title.

Client expense: $4,050,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Support S 258 and HR 169, Critical Access Hospital Relief Act, a bill that would remove the 96-hour physician certification requirement as a condition of payment for critical access hospitals (CAHs); Support HR 293, a bill to exempt certain journals and text books used in continuing medical education (CME) from manufacturer transparency reporting requirements; Participated in the Hearing, Examining the 340B Drug Pricing Program and submitted testimony about the 340B program, a federal drug discount program to Subcommittee members who will review the functionality of the program to ensure it is meeting its intended goals; HR 6, 21st Century Cures, a bill that accelerates the discovery and development of cures, and also includes provisions addressing interoperability of health IT and would provide additional money to NIH and the FDA; Two midnight discussion with several members of Congress; Support, Advancing Telehealth Opportunities in Medicare Telehealth, submitted a letter outlining the benefits of telehealth and showcases successful hospital and health system efforts. It also outlines barriers to greater use of telehealth; Submitted letter pertaining to interoperabilty within the hospital communities; Support S. 599, Improving Access to Emergency Psychiatric Care Act of 2015, legislation easing the shortage of psychiatric beds and extend and expand the CMS emergency psychiatric demonstration project; Comments on H.R.1458, BACPAC Act of 2015, a bill to amend title XVIII of the Social Security Act to provide bundled payments for post-acute care services under parts A and B of Medicare, and submitted a statement for a hearing on HR 1458 (re bundled payments for post-acute and other post-hospital services); Discussed Equity of Care Issues with Members of Congress; Advocate for funding by working with the Office of the Assistant Secretary for Preparedness and Response (ASPR) and Hospital Preparedness Program staff on ensuring adequate Ebola hospital funding; Working with the Centers for Disease Control and Prevention (CDC) on ongoing Ebola-related issues and guidance; Working with the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA) to ensure that hospitals continue to be able to use blood glucose monitoring systems (BGMS) on hospitalized patients;Discussion of draft guidance on drug compounding and repackaging; Working with ASPR and CDC staff to define the impact of the Hospital Preparedness Program and Public Health Emergency Preparedness Program on improving health care system preparedness; Support efforts to advocate on Ebola within a discussion with FDA regarding impact on access to chest tubes regarding the Atrium Medical Corp and Maquet consent decree ; Advocate for regulatory approach in a discussion with White House staff regarding new initiative promoting bystander involvement in stopping hemorrhage in injured civilians; Attended a roundtable discussion on Opioid-related dependence, overdose, and death at HHS; Advocate for changes to The Care Planning Act, a bill that would provide for advanced illness care coordination services for Medicare beneficiaries; Support HR 2878 and 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; Support S.799/HR 1462, Protecting Our Infants Act of 2015, a bill to combat the rise of prenatal opioid abuse and neonatal abstinence syndrome; Discussed S.1349, a bill that amends title XVIII (Medicare) of the Social Security Act to require a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services to give each individual who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning treatment; Supported expansions to Medicare reimbursement for telehealth along with changes to the Health Care Connect Fund; Comments on S.1648, Rural Emergency Acute Care Hospital Act of 2015, a bill to amend title XVIII of the Social Security Act to create a sustainable future for rural healthcare. Urged that HHS refrain from finalizing a stage 3 meaningful use rule; Advocate for Appropriate Surveyor Guidance on Calculated Hospitals in discussion about member concerns regarding remarks of CMS official that were confusing during a health lawyers association webinar; Discussion with CMS staff regarding proposed rule on establishing market-based payments for clinical laboratory tests; Discussion to rescind the proposed 2 percent cut to CY 2016 outpatient PPS conversion factor; Support H.R.2948, Medicare Telehealth Parity Act of 2015, a bill to amend title XVIII (Medicare) of the Social Security Act to expand telehealth coverage in three phases; Support HR 2646, Helping Families in Mental Health Crisis Act of 2015,A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis; Support HR 1604, Veterans Mental Health Care Access Act, a bill that expands access to mental health services for veterans; Support H.R. 3183, The Veterans Health Care Freedom Act, a bill which makes significant improvements to the Veterans Choice Program; Support S 1189 The Conrad State 30 and Physician Access Act, a bill that reauthorizes the Conrad 30 and makes other changes to the program to improve patient access to care; Discussed quality measurement, meaningful use and Conditions of Participation; Conversation with CMS about the IOM Vital Signs report and how its recommendations could make quality measurement more meaningful; Spoke with CMS urging the Agency to correct the misimpression that was created statements made during a National Association of Medical Staff Specialists webinar by a CMS employee; Discussion with CMS about proposals contained in the Inpatient Psychiatric Facility PPS proposed rule urging CMS not to finalize two quality measures; Meeting at CMMI to discuss CCJR; Discuss S. 2141the Transparent Ratings on Usability and Security to Transform Information Technology Act of 2015, the TRUST Act, a bill that includes a definition of information blocking and a framework to assess interoperability of certified health IT (a health IT ratings program); Support S.1461 and H.R. 2878 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; Oppose S. 1648 Rural Emergency Acute Care Hospital ActTo establish an alternative payment model for CAHs and small, rural hospitals whereby they may transition to become a rural emergency hospital.; Oppose H.R. 3225 Save Rural Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to provide for enhanced payments to rural health care providers under the Medicare and Medicaid programs; Discuss S. 1945 Mental Health Reform Act of 2015, a bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis. It would reauthorize certain federal mental health programs, revise the IMD exclusion, reform SAMHSA, and study parity in mental health laws. Support S. 1893, The Mental Health Awareness and Improvement Act of 2015, a bill to reauthorize and improve programs related to mental health and substance use disorders; Letter asking for modifications to H.R. 3298 Medicare Post-Acute Care Value-Based Purchasing (PAC VBP) Act of 2015, the legislation would establish a value-based purchasing program for LTCHs, IRFs, SNFs and HH agencies. Worked to streamline and improve quality measures; Discussed how to implement the framework in the National Academy of Medicines Vital Signs report to streamline and focus quality measures used in Medicare programs; Discussed Opioid prescribing guidelines with the CDC to provide feedback on the opioid prescribing guidelines they were developing; Discussion with CMS regarding CAH designation status, negative impact of Insurance Consolidations on Medicare Advantage and for modifications to Comprehensive Care for Joint Replacement (CJR) model regarding aspects of the proposed rule; Discussion with CMS about the Emergency Preparedness final rule; Discussion with CMS regarding the 0.2 percent reduction to hospitals payments under the Inpatient Prospective Payment System (PPS); Support S. 524, the Johnson amendment and the Collins amendment, Comprehensive Addiction and Recovery Act of 2016, a bill to authorize the Attorney General to award grants to address the national epidemics of prescription opioid abuse and heroin use; Support H.R. 4499, Promoting Responsible Opioid Prescribing Act of 2016, a bill to amend title XVIII of the Social Security Act to remove consideration of certain pain-related issues from calculations under the Medicare hospital value-based purchasing program; Support S. 2220, The Healthy Maternity and Obstetric Medicine Act or Healthy MOM Act guarantees maternity coverage for women who are enrolled in the exchanges established under the Affordable Care Act, as well as women who are covered by individual and group insurance plans and federal employee health benefit plans; Comments to House Ways and Means and Senate Finance Committees on how to improve the physician self-referral (Stark) law; Urged CMS to delay the April 2016 release of the hospital star ratings on the Hospital Compare Website; Supported House and Senate letters urging CMS to delay release of hospital star ratings on the Hospital Compare Website; Support H.R. 4771, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act, a bill that would reduce health care costs and promote access to quality, affordable health care for all Americans; Letter to Senate HELP Committee draft legislation addressing health information technology (IT) and electronic health records (EHRs); Comments to CMS regarding addressing section 603 of the BBA of 2015 in regulation; Comments to House Energy & Commerce Committee regarding section 603 of the BBA of 2015 as well as site neutral payment policies in general; Statement for the record to House Energy & Commerce Committee on MACRA implementation; Statement for the record to Senate Finance Committee on MACRA implementation; Comments to the Senate Finance Committee Chronic Care document -Conversations with the CDC related to their opioid guidelines for chronic pain as well as a patient education piece about opioids; Discussions with CMS about CAH designation status Health Care Issues; Discussions with Rep. Hudson about H.R. 4365/ S. 2932, the Protecting Patient Access to Emergency Medications Act , a bill to amend the Controlled Substances Act with regard to the provision of emergency medical services; Support H.R. 4650 and S. 2108, Preserving Patient Access to Post-Acute Hospital Care Act of 2016, a bill to amend title XVIII of the Social Security Act to provide for an extension of certain Medicare long-term care hospital payment rules; Supported efforts to encourage Congress to send CMS letters on addressing the issue of colocation of facilities within a hospital; Discussions with Members of Congress on the potential implementation of Unique Device Identification on claims forms; Sponsored a Hill briefing on innovations in post-acute care;Supported House and Senate letters to CMS asking for flexibility when interpreting section 603 of the BBA of 2015 in regulation; Support HR 5547, the Health Care Price Transparency Promotion Act of 2016, a bill to require the sharing of health care price information; Support HR 5273, the Helping Hospitals Improve Patient Care Act of 2016, a bill to address outstanding issues with section 603 of the BBA of 2015 and provide for a socioeconomic adjustment to the Hospital Readmissions Reduction Program; Supported a letter to CMS on implementation of Sec. 603 of the Bipartisan Budget Acts site neutral cuts for off-campus HOPDs; Support H. res. 699 promoting minority health awareness and supporting the goals and ideals of National Minority Health Month in April 2016; Support H.R.4641 - a bill to provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication; Support H.R. 4982, the Examining Opioid Treatment Infrastructure Act of 2016, a bill which would require the Government Accountability Office (GAO) to evaluate and report on the capacity, availability and need for inpatient and outpatient treatment for opioid use disorders in the United States; Supports H.R. 3680, the Co-Prescribing to Reduce Overdoses Act of 2015, a bill would establish federal grants to carry out co-prescribing of overdose reversal drugs in areas experiencing significant numbers of opioid overdoses and deaths; Support H.R. 3691, the Improving Treatment for Pregnant and Postpartum Women Act of 2015, a bill that would reauthorize essential residential treatment programs for pregnant and postpartum women and provide grants to states to address the growing epidemic of infants suffering from opioid dependency; Support H.R. 4978, the Nurturing and Supporting Healthy Babies Act, a bill which would require a GAO evaluation of neonatal abstinence syndrome and the availability of treatment for this condition in the nations Medicaid programs; Support H.R. 4599, the Reducing Unused Medications Act of 2016, a bill to permit partial filling of schedule II prescriptions under specific circumstances; Support H.R. 4976, the Opioid Review Modernization Act of 2016, a bill which would provide for more stringent Food and Drug Administration review of new opioids without abuse-deterrent properties, recommendations for labeling of pediatric opioids, and recommendations for prescriber education; Support the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2016, a bill for achieving fair and sustainable drug pricing; Supporting full alignment of 42CFR substance use records confidentiality requirements with HIPAA privacy rule.

Client expense: $4,690,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688, H.R. 5273/H.R. 34 - 21st Century Cures Act) Medicare audit contractor program reforms (H.R. 2156, S. 2368) Rural hospital policies (H.R. 663 / S. 332, H.R. 169/S. 258, H.R. 1611/S. 257, S. 1461/H.R. 2878, H.R. 5164, H.R. 5613, CAH cost-based reimbursement) Telehealth, interoperability, health information technology (H.R. 6/H.R. 34 - 21st Century Cures Act, S. 2511, S. 2484/H.R. 4442) Post-Acute Care policies (H.R. 3298), home health prior authorization S. 2108, H.R. 5713 Health Care and Medicaid financing reform (Better Way white paper, Empowering Patients First Act, Patient CARE Act, H.R. 5284/S. 2985) Graduate Medical Education policy (H.R. 2124, S. 1148, H.R 3292, H.R. 6333) HR 976, HR 2513 DSH payment Bundled payment programs Clinical lab payment policy MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies (H.R. 5273/H.R. 34 - 21st Century Cures Act) Stark Law reforms H.R. 4428, H.R. 6399 Star Ratings Medicare Part B drug payment model Medicare Advantage policy

Client expense: $70,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Critical Access Hospital Relief Act (S. 258; H.R. 169) Support for flexibility in implementation of Section 603 of site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74). Protecting 340B Drug Pricing Program in regulatory and legislative proposals Urging further flexibility in proposed rule [CMS-5517-P] to implement Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Support for Rural Hospital Access

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Plans for repeal and replacement of the Affordable Care Act and its impacts to access to care and payments to hospitals, specifically cuts to hospital payments under the ACA that allowed for greater coverage for individuals Revised 21st Century Cures bill (includes the hospital provisions, including demo project and direct supervision of outpatient therapies for 2016) Regulatory reform for hospitals including many of the issues addressed in the following legislation: Critical Access Hospital (CAH) Relief Act of 2015 (S. 258/H.R. 169) Protecting Access to Rural Therapy Services (PARTS) Act (S. 257/H.R. 1611) Rural Hospital Access Act of 2015 (S. 332/H.R. 663) Community Hospital Demonstration Extension Act of 2015 (S. 607/H.R. 672) Act to Reform Recover Audit Contractors (RACs) (H.R. 2156) Rural Emergency Acute Care Hospital (REACH) Act (S. 1648) Save Rural Hospitals Act (H.R. 3225) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Direct Supervision 2016 Extension of Moratorium (S.3129/H.R. 5613); and H.R. 5614 for permanent moratorium Rural Hospital Regulatory Relief Act (H.R. 5164) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5273) Implementation of MACRA Concerns with implementation of Sec. 603 site-neutral reductions to Iowa hospitals and the CMS interpretation of the legislation in the outpatient prospective payment system proposed rule Concern with Hospital star ratings, and Hospital Quality Rating Transparency Act of 2016 (HR 5927) Iowa's proposed state plan amendment to incorporate intergovernmental transfers Significant concerns with Iowa's proposed transition to Medicaid managed care MedPAC recommendations for cuts to hospital payments avoiding site-neutral cuts recovery audit contractor (RAC) program and needed transparency and changes protecting critical access hospital funding and necessary provider status rural hospitals and access to care in Iowa encouraging value-based purchasing hospital acquired conditions and other quality measures Medicare formula and Iowa's payment compared to payments to other states Iowa hospital's economic impact to communities and the state beneficiary access throughout Iowa and threats from regulatory burdens and changes importance of 340B program to Iowa's hospitals Changes to the definition of patient in the 340B guidance and impact on Iowa hospitals Hospital outpatient department grandfathering provision to include currently planned facilities and acquisitions at time of enactment of H.R.1314 - Bipartisan Budget Act of 2015 (covered in revised and passed 21st Century Cures bill)

Client expense: $70,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

Support for provisions in 21st Century Cures Act (H.R. 34), including establishment of a socio-economic status (SES) risk adjuster for the Medicare Readmissions Reduction Program; changes to site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74) and flexibility in implementation of Section 603 of the law; non-enforcement of the direct supervision rules for CAHs; NIH, mental health, and opioid crisis provisions and funding Protecting 340B Drug Pricing Program in regulatory and legislative proposals Support for changes to liver transplant allocation system Urging modifications to Hospital Compare Star Rating System Support for Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act (H.R. 2745) Addressing concerns related to the Physician Quality Reporting System (PQRS) and reporting mechanisms Encouraging Committees of jurisdiction to examine overlap in Merit-based Incentive Payment System and Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) Urging further flexibility in proposed rule [CMS-5517-P] to implement Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Opposition to redistribution of Medicare DSH payments proposed in FFY 2017 Inpatient Prospective Payment System (IPPS) rule [CMS-1655-P] Support for Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Support for Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Support for Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Support for Protecting Access to Rural Therapies Act (H.R. 1611/S. 257) Support for Resident Physician Shortage Reduction Act of 2015 (H.R. 2124/ S. 1148) Support for Medicare Audit Improvement Act of 2015 (H.R. 2156) Support for Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Support for Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Support for emergency funding to address Zika outbreak Encouraging Administration to engage hospital and health system field in discussions to address cybersecurity challenges.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Helping Hospitals Improve Patient Care Act (HR 5273) Affordable Care Act Site Neutral payments Resident Physician Shortage Reduction Act of 2015, S. 1148/H.R. 2124 340B Program Medicare DSH Critical Access Hospital Relief Act, H.R. 169/S. 258 Protecting Access to Rural Therapy Services Act (S. 257/H.R. 1611) Medicare Graduate Medical Education Program CMS Home Health Pre-Claim Demonstration

Client expense: $170,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE

Support S 258 and HR 169, Critical Access Hospital Relief Act, a bill that would remove the 96-hour physician certification requirement as a condition of payment for critical access hospitals (CAHs); Support HR 293, a bill to exempt certain journals and text books used in continuing medical education (CME) from manufacturer transparency reporting requirements; Participated in the Hearing, Examining the 340B Drug Pricing Program and submitted testimony about the 340B program, a federal drug discount program to Subcommittee members who will review the functionality of the program to ensure it is meeting its intended goals; HR 6, 21st Century Cures, a bill that accelerates the discovery and development of cures, and also includes provisions addressing interoperability of health IT and would provide additional money to NIH and the FDA; Two midnight discussion with several members of Congress; Support, Advancing Telehealth Opportunities in Medicare Telehealth, submitted a letter outlining the benefits of telehealth and showcases successful hospital and health system efforts. It also outlines barriers to greater use of telehealth; Submitted letter pertaining to interoperabilty within the hospital communities; Support S. 599, Improving Access to Emergency Psychiatric Care Act of 2015, legislation easing the shortage of psychiatric beds and extend and expand the CMS emergency psychiatric demonstration project; Comments on H.R.1458, BACPAC Act of 2015, a bill to amend title XVIII of the Social Security Act to provide bundled payments for post-acute care services under parts A and B of Medicare, and submitted a statement for a hearing on HR 1458 (re bundled payments for post-acute and other post-hospital services); Discussed Equity of Care Issues with Members of Congress; Advocate for funding by working with the Office of the Assistant Secretary for Preparedness and Response (ASPR) and Hospital Preparedness Program staff on ensuring adequate Ebola hospital funding; Working with the Centers for Disease Control and Prevention (CDC) on ongoing Ebola-related issues and guidance; Working with the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA) to ensure that hospitals continue to be able to use blood glucose monitoring systems (BGMS) on hospitalized patients;Discussion of draft guidance on drug compounding and repackaging; Working with ASPR and CDC staff to define the impact of the Hospital Preparedness Program and Public Health Emergency Preparedness Program on improving health care system preparedness; Support efforts to advocate on Ebola within a discussion with FDA regarding impact on access to chest tubes regarding the Atrium Medical Corp and Maquet consent decree ; Advocate for regulatory approach in a discussion with White House staff regarding new initiative promoting bystander involvement in stopping hemorrhage in injured civilians; Attended a roundtable discussion on Opioid-related dependence, overdose, and death at HHS; Advocate for changes to The Care Planning Act, a bill that would provide for advanced illness care coordination services for Medicare beneficiaries; Support HR 2878 and 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; Support S.799/HR 1462, Protecting Our Infants Act of 2015, a bill to combat the rise of prenatal opioid abuse and neonatal abstinence syndrome; Discussed S.1349, a bill that amends title XVIII (Medicare) of the Social Security Act to require a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services to give each individual who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning treatment; Supported expansions to Medicare reimbursement for telehealth along with changes to the Health Care Connect Fund; Comments on S.1648, Rural Emergency Acute Care Hospital Act of 2015, a bill to amend title XVIII of the Social Security Act to create a sustainable future for rural healthcare. Urged that HHS refrain from finalizing a stage 3 meaningful use rule; Advocate for Appropriate Surveyor Guidance on Calculated Hospitals in discussion about member concerns regarding remarks of CMS official that were confusing during a health lawyers association webinar; Discussion with CMS staff regarding proposed rule on establishing market-based payments for clinical laboratory tests; Discussion to rescind the proposed 2 percent cut to CY 2016 outpatient PPS conversion factor; Support H.R.2948, Medicare Telehealth Parity Act of 2015, a bill to amend title XVIII (Medicare) of the Social Security Act to expand telehealth coverage in three phases; Support HR 2646, Helping Families in Mental Health Crisis Act of 2015,A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis; Support HR 1604, Veterans Mental Health Care Access Act, a bill that expands access to mental health services for veterans; Support H.R. 3183, The Veterans Health Care Freedom Act, a bill which makes significant improvements to the Veterans Choice Program; Support S 1189 The Conrad State 30 and Physician Access Act, a bill that reauthorizes the Conrad 30 and makes other changes to the program to improve patient access to care; Discussed quality measurement, meaningful use and Conditions of Participation; Conversation with CMS about the IOM Vital Signs report and how its recommendations could make quality measurement more meaningful; Spoke with CMS urging the Agency to correct the misimpression that was created statements made during a National Association of Medical Staff Specialists webinar by a CMS employee; Discussion with CMS about proposals contained in the Inpatient Psychiatric Facility PPS proposed rule urging CMS not to finalize two quality measures; Meeting at CMMI to discuss CCJR; Discuss S. 2141the Transparent Ratings on Usability and Security to Transform Information Technology Act of 2015, the TRUST Act, a bill that includes a definition of information blocking and a framework to assess interoperability of certified health IT (a health IT ratings program); Support S.1461 and H.R. 2878 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; Oppose S. 1648 Rural Emergency Acute Care Hospital ActTo establish an alternative payment model for CAHs and small, rural hospitals whereby they may transition to become a rural emergency hospital.; Oppose H.R. 3225 Save Rural Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to provide for enhanced payments to rural health care providers under the Medicare and Medicaid programs; Discuss S. 1945 Mental Health Reform Act of 2015, a bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis. It would reauthorize certain federal mental health programs, revise the IMD exclusion, reform SAMHSA, and study parity in mental health laws. Support S. 1893, The Mental Health Awareness and Improvement Act of 2015, a bill to reauthorize and improve programs related to mental health and substance use disorders; Letter asking for modifications to H.R. 3298 Medicare Post-Acute Care Value-Based Purchasing (PAC VBP) Act of 2015, the legislation would establish a value-based purchasing program for LTCHs, IRFs, SNFs and HH agencies. Worked to streamline and improve quality measures; Discussed how to implement the framework in the National Academy of Medicines Vital Signs report to streamline and focus quality measures used in Medicare programs; Discussed Opioid prescribing guidelines with the CDC to provide feedback on the opioid prescribing guidelines they were developing; Discussion with CMS regarding CAH designation status, negative impact of Insurance Consolidations on Medicare Advantage and for modifications to Comprehensive Care for Joint Replacement (CJR) model regarding aspects of the proposed rule; Discussion with CMS about the Emergency Preparedness final rule; Discussion with CMS regarding the 0.2 percent reduction to hospitals payments under the Inpatient Prospective Payment System (PPS); Support S. 524, the Johnson amendment and the Collins amendment, Comprehensive Addiction and Recovery Act of 2016, a bill to authorize the Attorney General to award grants to address the national epidemics of prescription opioid abuse and heroin use; Support H.R. 4499, Promoting Responsible Opioid Prescribing Act of 2016, a bill to amend title XVIII of the Social Security Act to remove consideration of certain pain-related issues from calculations under the Medicare hospital value-based purchasing program; Support S. 2220, The Healthy Maternity and Obstetric Medicine Act or Healthy MOM Act guarantees maternity coverage for women who are enrolled in the exchanges established under the Affordable Care Act, as well as women who are covered by individual and group insurance plans and federal employee health benefit plans; Comments to House Ways and Means and Senate Finance Committees on how to improve the physician self-referral (Stark) law; Urged CMS to delay the April 2016 release of the hospital star ratings on the Hospital Compare Website; Supported House and Senate letters urging CMS to delay release of hospital star ratings on the Hospital Compare Website; Support H.R. 4771, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act, a bill that would reduce health care costs and promote access to quality, affordable health care for all Americans; Letter to Senate HELP Committee draft legislation addressing health information technology (IT) and electronic health records (EHRs); Comments to CMS regarding addressing section 603 of the BBA of 2015 in regulation; Comments to House Energy & Commerce Committee regarding section 603 of the BBA of 2015 as well as site neutral payment policies in general; Statement for the record to House Energy & Commerce Committee on MACRA implementation; Statement for the record to Senate Finance Committee on MACRA implementation; Comments to the Senate Finance Committee Chronic Care document -Conversations with the CDC related to their opioid guidelines for chronic pain as well as a patient education piece about opioids; Discussions with CMS about CAH designation status Health Care Issues; Discussions with Rep. Hudson about H.R. 4365/ S. 2932, the Protecting Patient Access to Emergency Medications Act , a bill to amend the Controlled Substances Act with regard to the provision of emergency medical services; Support H.R. 4650 and S. 2108, Preserving Patient Access to Post-Acute Hospital Care Act of 2016, a bill to amend title XVIII of the Social Security Act to provide for an extension of certain Medicare long-term care hospital payment rules; Supported efforts to encourage Congress to send CMS letters on addressing the issue of colocation of facilities within a hospital; Discussions with Members of Congress on the potential implementation of Unique Device Identification on claims forms; Sponsored a Hill briefing on innovations in post-acute care;Supported House and Senate letters to CMS asking for flexibility when interpreting section 603 of the BBA of 2015 in regulation; Support HR 5547, the Health Care Price Transparency Promotion Act of 2016, a bill to require the sharing of health care price information; Support HR 5273, the Helping Hospitals Improve Patient Care Act of 2016, a bill to address outstanding issues with section 603 of the BBA of 2015 and provide for a socioeconomic adjustment to the Hospital Readmissions Reduction Program; Supported a letter to CMS on implementation of Sec. 603 of the Bipartisan Budget Acts site neutral cuts for off-campus HOPDs; Support H. res. 699 promoting minority health awareness and supporting the goals and ideals of National Minority Health Month in April 2016; Support H.R.4641 - a bill to provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication; Support H.R. 4982, the Examining Opioid Treatment Infrastructure Act of 2016, a bill which would require the Government Accountability Office (GAO) to evaluate and report on the capacity, availability and need for inpatient and outpatient treatment for opioid use disorders in the United States; Supports H.R. 3680, the Co-Prescribing to Reduce Overdoses Act of 2015, a bill would establish federal grants to carry out co-prescribing of overdose reversal drugs in areas experiencing significant numbers of opioid overdoses and deaths; Support H.R. 3691, the Improving Treatment for Pregnant and Postpartum Women Act of 2015, a bill that would reauthorize essential residential treatment programs for pregnant and postpartum women and provide grants to states to address the growing epidemic of infants suffering from opioid dependency; Support H.R. 4978, the Nurturing and Supporting Healthy Babies Act, a bill which would require a GAO evaluation of neonatal abstinence syndrome and the availability of treatment for this condition in the nations Medicaid programs; Support H.R. 4599, the Reducing Unused Medications Act of 2016, a bill to permit partial filling of schedule II prescriptions under specific circumstances; Support H.R. 4976, the Opioid Review Modernization Act of 2016, a bill which would provide for more stringent Food and Drug Administration review of new opioids without abuse-deterrent properties, recommendations for labeling of pediatric opioids, and recommendations for prescriber education; Support the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2016, a bill for achieving fair and sustainable drug pricing; Supporting full alignment of 42CFR substance use records confidentiality requirements with HIPAA privacy rule; Support S. 3173 EHR Regulatory Relief Act, a bill to amend title XVIII of the Social Security Act to provide for a 90-day EHR reporting period for the determination of whether an eligible professional or eligible hospital is a meaningful EHR user and to remove the all-or-nothing approach to meaningful use; Support for H.R. 5713, The Sustaining Healthcare Integrity and Fair Treatment Act of 2016, a bill that would extend 25% rule relief and provide targeted relief to certain LTCHs struggling to meet the new criteria standards; Support for H.R. 6174, the Closing Loopholes for Orphan Drugs Act, a bill to amend title III of the Public Health Service Act to limit the orphan drug exclusion under the drug discount program under section 340B of such title.

Client expense: $4,970,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

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

Support S 258 and HR 169, Critical Access Hospital Relief Act, a bill that would remove the 96-hour physician certification requirement as a condition of payment for critical access hospitals (CAHs); Support HR 293, a bill to exempt certain journals and text books used in continuing medical education (CME) from manufacturer transparency reporting requirements; Participated in the Hearing, Examining the 340B Drug Pricing Program and submitted testimony about the 340B program, a federal drug discount program to Subcommittee members who will review the functionality of the program to ensure it is meeting its intended goals; HR 6, 21st Century Cures, a bill that accelerates the discovery and development of cures, and also includes provisions addressing interoperability of health IT and would provide additional money to NIH and the FDA; Two midnight discussion with several members of Congress; Support, Advancing Telehealth Opportunities in Medicare Telehealth, submitted a letter outlining the benefits of telehealth and showcases successful hospital and health system efforts. It also outlines barriers to greater use of telehealth; Submitted letter pertaining to interoperabilty within the hospital communities; Support S. 599, Improving Access to Emergency Psychiatric Care Act of 2015, legislation easing the shortage of psychiatric beds and extend and expand the CMS emergency psychiatric demonstration project; Comments on H.R.1458, BACPAC Act of 2015, a bill to amend title XVIII of the Social Security Act to provide bundled payments for post-acute care services under parts A and B of Medicare, and submitted a statement for a hearing on HR 1458 (re bundled payments for post-acute and other post-hospital services); Discussed Equity of Care Issues with Members of Congress; Advocate for funding by working with the Office of the Assistant Secretary for Preparedness and Response (ASPR) and Hospital Preparedness Program staff on ensuring adequate Ebola hospital funding; Working with the Centers for Disease Control and Prevention (CDC) on ongoing Ebola-related issues and guidance; Working with the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA) to ensure that hospitals continue to be able to use blood glucose monitoring systems (BGMS) on hospitalized patients;Discussion of draft guidance on drug compounding and repackaging; Working with ASPR and CDC staff to define the impact of the Hospital Preparedness Program and Public Health Emergency Preparedness Program on improving health care system preparedness; Support efforts to advocate on Ebola within a discussion with FDA regarding impact on access to chest tubes regarding the Atrium Medical Corp and Maquet consent decree ; Advocate for regulatory approach in a discussion with White House staff regarding new initiative promoting bystander involvement in stopping hemorrhage in injured civilians; Attended a roundtable discussion on Opioid-related dependence, overdose, and death at HHS; Advocate for changes to The Care Planning Act, a bill that would provide for advanced illness care coordination services for Medicare beneficiaries; Support HR 2878 and 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; Support S.799/HR 1462, Protecting Our Infants Act of 2015, a bill to combat the rise of prenatal opioid abuse and neonatal abstinence syndrome; Discussed S.1349, a bill that amends title XVIII (Medicare) of the Social Security Act to require a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services to give each individual who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning treatment; Supported expansions to Medicare reimbursement for telehealth along with changes to the Health Care Connect Fund; Comments on S.1648, Rural Emergency Acute Care Hospital Act of 2015, a bill to amend title XVIII of the Social Security Act to create a sustainable future for rural healthcare. Urged that HHS refrain from finalizing a stage 3 meaningful use rule; Advocate for Appropriate Surveyor Guidance on Calculated Hospitals in discussion about member concerns regarding remarks of CMS official that were confusing during a health lawyers association webinar; Discussion with CMS staff regarding proposed rule on establishing market-based payments for clinical laboratory tests; Discussion to rescind the proposed 2 percent cut to CY 2016 outpatient PPS conversion factor; Support H.R.2948, Medicare Telehealth Parity Act of 2015, a bill to amend title XVIII (Medicare) of the Social Security Act to expand telehealth coverage in three phases; Support HR 2646, Helping Families in Mental Health Crisis Act of 2015,A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis; Support HR 1604, Veterans Mental Health Care Access Act, a bill that expands access to mental health services for veterans; Support H.R. 3183, The Veterans Health Care Freedom Act, a bill which makes significant improvements to the Veterans Choice Program; Support S 1189 The Conrad State 30 and Physician Access Act, a bill that reauthorizes the Conrad 30 and makes other changes to the program to improve patient access to care; Discussed quality measurement, meaningful use and Conditions of Participation; Conversation with CMS about the IOM Vital Signs report and how its recommendations could make quality measurement more meaningful; Spoke with CMS urging the Agency to correct the misimpression that was created statements made during a National Association of Medical Staff Specialists webinar by a CMS employee; Discussion with CMS about proposals contained in the Inpatient Psychiatric Facility PPS proposed rule urging CMS not to finalize two quality measures; Meeting at CMMI to discuss CCJR; Discuss S. 2141the Transparent Ratings on Usability and Security to Transform Information Technology Act of 2015, the TRUST Act, a bill that includes a definition of information blocking and a framework to assess interoperability of certified health IT (a health IT ratings program); Support S.1461 and H.R. 2878 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; Oppose S. 1648 Rural Emergency Acute Care Hospital ActTo establish an alternative payment model for CAHs and small, rural hospitals whereby they may transition to become a rural emergency hospital.; Oppose H.R. 3225 Save Rural Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to provide for enhanced payments to rural health care providers under the Medicare and Medicaid programs; Discuss S. 1945 Mental Health Reform Act of 2015, a bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis. It would reauthorize certain federal mental health programs, revise the IMD exclusion, reform SAMHSA, and study parity in mental health laws. Support S. 1893, The Mental Health Awareness and Improvement Act of 2015, a bill to reauthorize and improve programs related to mental health and substance use disorders; Letter asking for modifications to H.R. 3298 Medicare Post-Acute Care Value-Based Purchasing (PAC VBP) Act of 2015, the legislation would establish a value-based purchasing program for LTCHs, IRFs, SNFs and HH agencies. Worked to streamline and improve quality measures; Discussed how to implement the framework in the National Academy of Medicines Vital Signs report to streamline and focus quality measures used in Medicare programs; Discussed Opioid prescribing guidelines with the CDC to provide feedback on the opioid prescribing guidelines they were developing; Discussion with CMS regarding CAH designation status, negative impact of Insurance Consolidations on Medicare Advantage and for modifications to Comprehensive Care for Joint Replacement (CJR) model regarding aspects of the proposed rule; Discussion with CMS about the Emergency Preparedness final rule; Discussion with CMS regarding the 0.2 percent reduction to hospitals payments under the Inpatient Prospective Payment System (PPS); Support S. 524, the Johnson amendment and the Collins amendment, Comprehensive Addiction and Recovery Act of 2016, a bill to authorize the Attorney General to award grants to address the national epidemics of prescription opioid abuse and heroin use; Support H.R. 4499, Promoting Responsible Opioid Prescribing Act of 2016, a bill to amend title XVIII of the Social Security Act to remove consideration of certain pain-related issues from calculations under the Medicare hospital value-based purchasing program; Support S. 2220, The Healthy Maternity and Obstetric Medicine Act or Healthy MOM Act guarantees maternity coverage for women who are enrolled in the exchanges established under the Affordable Care Act, as well as women who are covered by individual and group insurance plans and federal employee health benefit plans; Comments to House Ways and Means and Senate Finance Committees on how to improve the physician self-referral (Stark) law; Urged CMS to delay the April 2016 release of the hospital star ratings on the Hospital Compare Website; Supported House and Senate letters urging CMS to delay release of hospital star ratings on the Hospital Compare Website; Support H.R. 4771, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act, a bill that would reduce health care costs and promote access to quality, affordable health care for all Americans; Letter to Senate HELP Committee draft legislation addressing health information technology (IT) and electronic health records (EHRs); Comments to CMS regarding addressing section 603 of the BBA of 2015 in regulation; Comments to House Energy & Commerce Committee regarding section 603 of the BBA of 2015 as well as site neutral payment policies in general; Statement for the record to House Energy & Commerce Committee on MACRA implementation; Statement for the record to Senate Finance Committee on MACRA implementation; Comments to the Senate Finance Committee Chronic Care document -Conversations with the CDC related to their opioid guidelines for chronic pain as well as a patient education piece about opioids; Discussions with CMS about CAH designation status Health Care Issues; Discussions with Rep. Hudson about H.R. 4365/ S. 2932, the Protecting Patient Access to Emergency Medications Act , a bill to amend the Controlled Substances Act with regard to the provision of emergency medical services; Support H.R. 4650 and S. 2108, Preserving Patient Access to Post-Acute Hospital Care Act of 2016, a bill to amend title XVIII of the Social Security Act to provide for an extension of certain Medicare long-term care hospital payment rules; Supported efforts to encourage Congress to send CMS letters on addressing the issue of colocation of facilities within a hospital; Discussions with Members of Congress on the potential implementation of Unique Device Identification on claims forms; Sponsored a Hill briefing on innovations in post-acute care;Supported House and Senate letters to CMS asking for flexibility when interpreting section 603 of the BBA of 2015 in regulation; Support HR 5547, the Health Care Price Transparency Promotion Act of 2016, a bill to require the sharing of health care price information; Support HR 5273, the Helping Hospitals Improve Patient Care Act of 2016, a bill to address outstanding issues with section 603 of the BBA of 2015 and provide for a socioeconomic adjustment to the Hospital Readmissions Reduction Program; Supported a letter to CMS on implementation of Sec. 603 of the Bipartisan Budget Acts site neutral cuts for off-campus HOPDs; Support H. res. 699 promoting minority health awareness and supporting the goals and ideals of National Minority Health Month in April 2016; Support H.R.4641 - a bill to provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication; Support H.R. 4982, the Examining Opioid Treatment Infrastructure Act of 2016, a bill which would require the Government Accountability Office (GAO) to evaluate and report on the capacity, availability and need for inpatient and outpatient treatment for opioid use disorders in the United States; Supports H.R. 3680, the Co-Prescribing to Reduce Overdoses Act of 2015, a bill would establish federal grants to carry out co-prescribing of overdose reversal drugs in areas experiencing significant numbers of opioid overdoses and deaths; Support H.R. 3691, the Improving Treatment for Pregnant and Postpartum Women Act of 2015, a bill that would reauthorize essential residential treatment programs for pregnant and postpartum women and provide grants to states to address the growing epidemic of infants suffering from opioid dependency; Support H.R. 4978, the Nurturing and Supporting Healthy Babies Act, a bill which would require a GAO evaluation of neonatal abstinence syndrome and the availability of treatment for this condition in the nations Medicaid programs; Support H.R. 4599, the Reducing Unused Medications Act of 2016, a bill to permit partial filling of schedule II prescriptions under specific circumstances; Support H.R. 4976, the Opioid Review Modernization Act of 2016, a bill which would provide for more stringent Food and Drug Administration review of new opioids without abuse-deterrent properties, recommendations for labeling of pediatric opioids, and recommendations for prescriber education; Support the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2016, a bill for achieving fair and sustainable drug pricing; Supporting full alignment of 42CFR substance use records confidentiality requirements with HIPAA privacy rule; Support S. 3173 EHR Regulatory Relief Act, a bill to amend title XVIII of the Social Security Act to provide for a 90-day EHR reporting period for the determination of whether an eligible professional or eligible hospital is a meaningful EHR user and to remove the all-or-nothing approach to meaningful use; Support for H.R. 5713, The Sustaining Healthcare Integrity and Fair Treatment Act of 2016, a bill that would extend 25% rule relief and provide targeted relief to certain LTCHs struggling to meet the new criteria standards; Support for H.R. 6174, the Closing Loopholes for Orphan Drugs Act, a bill to amend title III of the Public Health Service Act to limit the orphan drug exclusion under the drug discount program under section 340B of such title.

Client expense: $4,050,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Funding for 340B Drug Pricing Program Critical Access Hospital Relief Act (S. 258; H.R. 169) Support for changes to site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74) and flexibility in implementation of Section 603 of the law. Protecting 340B Drug Pricing Program in regulatory and legislative proposals Support for Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act (H.R. 2745) Encouraging Committees of jurisdiction to examine overlap in Merit-based Incentive Payment System and Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) Urging further flexibility in proposed rule [CMS-5517-P] to implement Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Support for Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Support for Medicare Audit Improvement Act of 2015 (H.R. 2156) Support for Two-Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688, H.R. 5273) Medicare audit contractor program reforms (H.R. 2156, S. 2368) Rural hospital policies (H.R. 663 / S. 332, H.R. 169/S. 258, H.R. 1611/S. 257, S. 1461/H.R. 2878, H.R. 5164, H.R. 5613, CAH cost-based reimbursement) Telehealth, interoperability, health information technology (H.R. 6, S. 2511, S. 2484/H.R. 4442) Post-Acute Care policies (H.R. 3298), home health prior authorization S. 2108, H.R. 5713 Graduate Medical Education policy (H.R. 2124, S. 1148, H.R 3292) HR 976, HR 2513 DSH payment Bundled payment programs Clinical lab payment policy MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies (H.R. 5273) Stark Law reforms H.R. 4428 Star Ratings Medicare Part B drug payment model Medicare Advantage

Client expense: $70,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Helping Hospitals Improve Patient Care Act (HR 5273) Site Neutral payments Resident Physician Shortage Reduction Act of 2015, S. 1148/H.R. 2124 340B Program Medicare DSH Critical Access Hospital Relief Act, H.R. 169/S. 258 Protecting Access to Rural Therapy Services Act (S. 257/H.R. 1611) Medicare Graduate Medical Education Program CMS Home Health Pre-Claim Demonstration

Client expense: $120,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE

Support for changes to site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74) and flexibility in implementation of Section 603 of the law. Protecting 340B Drug Pricing Program in regulatory and legislative proposals Support for changes to liver transplant allocation system 21st Century Cures Act (H.R. 6) and Senate HELP Committee provisions related to interoperability and information blocking Urging modifications to Hospital Compare Star Rating System Support for National Institutes of Health funding Support for Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act (H.R. 2745) Addressing concerns related to the Physician Quality Reporting System (PQRS) and reporting mechanisms Encouraging Committees of jurisdiction to examine overlap in Merit-based Incentive Payment System and Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) Urging further flexibility in proposed rule [CMS-5517-P] to implement Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Opposition to redistribution of Medicare DSH payments proposed in FFY 2017 Inpatient Prospective Payment System (IPPS) rule [CMS-1655-P] Support for Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Support for Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Support for Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Support for Protecting Access to Rural Therapies Act (H.R. 1611/S. 257) Support for Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) and inclusion of similar provision in Helping Hospitals Improve Patient Care Act (H.R. 5273) Support for Resident Physician Shortage Reduction Act of 2015 (H.R. 2124/ S. 1148) Support for Medicare Audit Improvement Act of 2015 (H.R. 2156) Support for Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Support for Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Support for emergency funding to address Zika outbreak Support for authorization of new programs as well as increased funding to improve and expand access to mental health treatment services and substance use disorders. Encouraging Administration to engage hospital and health system field in discussions to address cybersecurity challenges.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Helping Hospitals Improve Patient Care Act (HR 5273) Site Neutral payments Resident Physician Shortage Reduction Act of 2015, S. 1148/H.R. 2124 340B Program Medicare DSH Critical Access Hospital Relief Act, H.R. 169/S. 258 Protecting Access to Rural Therapy Services Act (S. 257/H.R. 1611) Medicare Graduate Medical Education Program CMS Home Health Pre-Claim Demonstration

Client expense: $120,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE

Critical Access Hospital (CAH) Relief Act of 2015 (S. 258/H.R. 169) Protecting Access to Rural Therapy Services (PARTS) Act (S. 257/H.R. 1611) Rural Hospital Access Act of 2015 (S. 332/H.R. 663) Community Hospital Demonstration Extension Act of 2015 (S. 607/H.R. 672) Act to Reform Recover Audit Contractors (RACs) (H.R. 2156) Rural Emergency Acute Care Hospital (REACH) Act (S. 1648) Save Rural Hospitals Act (H.R. 3225) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Direct Supervision 2016 Extension of Moratorium (S.3129/H.R. 5613); and H.R. 5614 for permanent moratorium Rural Hospital Regulatory Relief Act (H.R. 5164) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5273) Proposed rule on implementation of MACRA Proposed FY2017 Hospice Wage Index Comments regarding the HHS budget proposal to change payment of CAH from 101% to 100% of costs Concerns with implementation of Sec. 603 site-neutral reductions to Iowa hospitals and the CMS interpretation of the legislation in the outpatient prospective payment system proposed rule Concern with Hospital star ratings, and Hospital Quality Rating Transparency Act of 2016 (HR 5927) Significant concerns with Iowa's proposed transition to Medicaid managed care Medicare reduction proposals in President Obama's budget released 2015 MedPAC recommendations for cuts to hospital payments avoiding site-neutral cuts recovery audit contractor (RAC) program and needed transparency and changes protecting critical access hospital funding and necessary provider status rural hospitals and access to care in Iowa encouraging value-based purchasing hospital acquired conditions and other quality measures Medicare formula and Iowa's payment compared to payments to other states Iowa hospital's economic impact to communities and the state beneficiary access throughout Iowa and threats from regulatory burdens and changes importance of 340B program to Iowa's hospitals Changes to the definition of patient in the 340B guidance and impact on Iowa hospitals Extension of sequestration against Medicare and the inclusion of the "site neutral" hospital outpatient department payment change in H.R.1314 - Bipartisan Budget Act of 2015 Hospital outpatient department grandfathering provision to include currently planned facilities and acquisitions at time of enactment of H.R.1314 - Bipartisan Budget Act of 2015 Concerns about processing and preauthorization, access to care issues with the Veteran's Choice program.

Client expense: $70,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), 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 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

Critical Access Hospital (CAH) Relief Act of 2015 (S. 258/H.R. 169) Protecting Access to Rural Therapy Services (PARTS) Act (S. 257/H.R. 1611) Rural Hospital Access Act of 2015 (S. 332/H.R. 663) Community Hospital Demonstration Extension Act of 2015 (S. 607/H.R. 672) Act to Reform Recover Audit Contractors (RACs) (H.R. 2156) Rural Emergency Acute Care Hospital (REACH) Act (S. 1648) Save Rural Hospitals Act (H.R. 3225) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Direct Supervision 2016 Extension of Moratorium (S.3129/H.R. 5613) Rural Hospital Regulatory Relief Act (H.R. 5164) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Proposed rule on implementation of MACRA Proposed FY2017 Hospice Wage Index Comments regarding the HHS budget proposal to change payment of CAH from 101% to 100% of costs Significant concerns with Iowa's proposed transition to Medicaid managed care Medicare reduction proposals in President Obama's budget released 2015 MedPAC recommendations for cuts to hospital payments avoiding site-neutral cuts recovery audit contractor (RAC) program and needed transparency and changes protecting critical access hospital funding and necessary provider status rural hospitals and access to care in Iowa encouraging value-based purchasing hospital acquired conditions and other quality measures Medicare formula and Iowa's payment compared to payments to other states Iowa hospital's economic impact to communities and the state beneficiary access throughout Iowa and threats from regulatory burdens and changes importance of 340B program to Iowa's hospitals sustainable growth rate fix and impact on hospitals in Iowa Meaningful use in EHR Changes to the definition of patient in the 340B guidance and impact on Iowa hospitals Extension of sequestration against Medicare and the inclusion of the "site neutral" hospital outpatient department payment change in H.R.1314 - Bipartisan Budget Act of 2015 Clarifying amendment to hospital outpatient department grandfathering provision to include currently planned facilities and acquisitions at time of enactment of H.R.1314 - Bipartisan Budget Act of 2015 Concerns about processing and preauthorization, access to care issues with the Veteran's Choice program.

Client expense: $80,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

Support S 258 and HR 169, Critical Access Hospital Relief Act, a bill that would remove the 96-hour physician certification requirement as a condition of payment for critical access hospitals (CAHs); Support HR 293, a bill to exempt certain journals and text books used in continuing medical education (CME) from manufacturer transparency reporting requirements; Participated in the Hearing, Examining the 340B Drug Pricing Program and submitted testimony about the 340B program, a federal drug discount program to Subcommittee members who will review the functionality of the program to ensure it is meeting its intended goals; HR 6, 21st Century Cures, a bill that accelerates the discovery and development of cures, and also includes provisions addressing interoperability of health IT and would provide additional money to NIH and the FDA; Two midnight discussion with several members of Congress; Support, Advancing Telehealth Opportunities in Medicare Telehealth, submitted a letter outlining the benefits of telehealth and showcases successful hospital and health system efforts. It also outlines barriers to greater use of telehealth; Submitted letter pertaining to interoperabilty within the hospital communities; Support S. 599, Improving Access to Emergency Psychiatric Care Act of 2015, legislation easing the shortage of psychiatric beds and extend and expand the CMS emergency psychiatric demonstration project; Comments on H.R.1458, BACPAC Act of 2015, a bill to amend title XVIII of the Social Security Act to provide bundled payments for post-acute care services under parts A and B of Medicare, and submitted a statement for a hearing on HR 1458 (re bundled payments for post-acute and other post-hospital services); Discussed Equity of Care Issues with Members of Congress; Advocate for funding by working with the Office of the Assistant Secretary for Preparedness and Response (ASPR) and Hospital Preparedness Program staff on ensuring adequate Ebola hospital funding; Working with the Centers for Disease Control and Prevention (CDC) on ongoing Ebola-related issues and guidance; Working with the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA) to ensure that hospitals continue to be able to use blood glucose monitoring systems (BGMS) on hospitalized patients;Discussion of draft guidance on drug compounding and repackaging; Working with ASPR and CDC staff to define the impact of the Hospital Preparedness Program and Public Health Emergency Preparedness Program on improving health care system preparedness; Support efforts to advocate on Ebola within a discussion with FDA regarding impact on access to chest tubes regarding the Atrium Medical Corp and Maquet consent decree ; Advocate for regulatory approach in a discussion with White House staff regarding new initiative promoting bystander involvement in stopping hemorrhage in injured civilians; Attended a roundtable discussion on Opioid-related dependence, overdose, and death at HHS; Advocate for changes to The Care Planning Act, a bill that would provide for advanced illness care coordination services for Medicare beneficiaries; Support HR 2878 and 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; Support S.799/HR 1462, Protecting Our Infants Act of 2015, a bill to combat the rise of prenatal opioid abuse and neonatal abstinence syndrome; Discussed S.1349, a bill that amends title XVIII (Medicare) of the Social Security Act to require a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services to give each individual who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning treatment; Supported expansions to Medicare reimbursement for telehealth along with changes to the Health Care Connect Fund; Comments on S.1648, Rural Emergency Acute Care Hospital Act of 2015, a bill to amend title XVIII of the Social Security Act to create a sustainable future for rural healthcare. Urged that HHS refrain from finalizing a stage 3 meaningful use rule; Advocate for Appropriate Surveyor Guidance on Calculated Hospitals in discussion about member concerns regarding remarks of CMS official that were confusing during a health lawyers association webinar; Discussion with CMS staff regarding proposed rule on establishing market-based payments for clinical laboratory tests; Discussion to rescind the proposed 2 percent cut to CY 2016 outpatient PPS conversion factor; Support H.R.2948, Medicare Telehealth Parity Act of 2015, a bill to amend title XVIII (Medicare) of the Social Security Act to expand telehealth coverage in three phases; Support HR 2646, Helping Families in Mental Health Crisis Act of 2015,A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis; Support HR 1604, Veterans Mental Health Care Access Act, a bill that expands access to mental health services for veterans; Support H.R. 3183, The Veterans Health Care Freedom Act, a bill which makes significant improvements to the Veterans Choice Program; Support S 1189 The Conrad State 30 and Physician Access Act, a bill that reauthorizes the Conrad 30 and makes other changes to the program to improve patient access to care; Discussed quality measurement, meaningful use and Conditions of Participation; Conversation with CMS about the IOM Vital Signs report and how its recommendations could make quality measurement more meaningful; Spoke with CMS urging the Agency to correct the misimpression that was created statements made during a National Association of Medical Staff Specialists webinar by a CMS employee; Discussion with CMS about proposals contained in the Inpatient Psychiatric Facility PPS proposed rule urging CMS not to finalize two quality measures; Meeting at CMMI to discuss CCJR; Discuss S. 2141the Transparent Ratings on Usability and Security to Transform Information Technology Act of 2015, the TRUST Act, a bill that includes a definition of information blocking and a framework to assess interoperability of certified health IT (a health IT ratings program); Support S.1461 and H.R. 2878 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; Oppose S. 1648 Rural Emergency Acute Care Hospital ActTo establish an alternative payment model for CAHs and small, rural hospitals whereby they may transition to become a rural emergency hospital.; Oppose H.R. 3225 Save Rural Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to provide for enhanced payments to rural health care providers under the Medicare and Medicaid programs; Discuss S. 1945 Mental Health Reform Act of 2015, a bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis. It would reauthorize certain federal mental health programs, revise the IMD exclusion, reform SAMHSA, and study parity in mental health laws. Support S. 1893, The Mental Health Awareness and Improvement Act of 2015, a bill to reauthorize and improve programs related to mental health and substance use disorders; Letter asking for modifications to H.R. 3298 Medicare Post-Acute Care Value-Based Purchasing (PAC VBP) Act of 2015, the legislation would establish a value-based purchasing program for LTCHs, IRFs, SNFs and HH agencies. Worked to streamline and improve quality measures; Discussed how to implement the framework in the National Academy of Medicines Vital Signs report to streamline and focus quality measures used in Medicare programs; Discussed Opioid prescribing guidelines with the CDC to provide feedback on the opioid prescribing guidelines they were developing; Discussion with CMS regarding CAH designation status, negative impact of Insurance Consolidations on Medicare Advantage and for modifications to Comprehensive Care for Joint Replacement (CJR) model regarding aspects of the proposed rule; Discussion with CMS about the Emergency Preparedness final rule; Discussion with CMS regarding the 0.2 percent reduction to hospitals payments under the Inpatient Prospective Payment System (PPS); Support S. 524, the Johnson amendment and the Collins amendment, Comprehensive Addiction and Recovery Act of 2016, a bill to authorize the Attorney General to award grants to address the national epidemics of prescription opioid abuse and heroin use; Support H.R. 4499, Promoting Responsible Opioid Prescribing Act of 2016, a bill to amend title XVIII of the Social Security Act to remove consideration of certain pain-related issues from calculations under the Medicare hospital value-based purchasing program; Support S. 2220, The Healthy Maternity and Obstetric Medicine Act or Healthy MOM Act guarantees maternity coverage for women who are enrolled in the exchanges established under the Affordable Care Act, as well as women who are covered by individual and group insurance plans and federal employee health benefit plans; Comments to House Ways and Means and Senate Finance Committees on how to improve the physician self-referral (Stark) law; Urged CMS to delay the April 2016 release of the hospital star ratings on the Hospital Compare Website; Supported House and Senate letters urging CMS to delay release of hospital star ratings on the Hospital Compare Website; Support H.R. 4771, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act, a bill that would reduce health care costs and promote access to quality, affordable health care for all Americans; Letter to Senate HELP Committee draft legislation addressing health information technology (IT) and electronic health records (EHRs); Comments to CMS regarding addressing section 603 of the BBA of 2015 in regulation; Comments to House Energy & Commerce Committee regarding section 603 of the BBA of 2015 as well as site neutral payment policies in general; Statement for the record to House Energy & Commerce Committee on MACRA implementation; Statement for the record to Senate Finance Committee on MACRA implementation; Comments to the Senate Finance Committee Chronic Care document -Conversations with the CDC related to their opioid guidelines for chronic pain as well as a patient education piece about opioids; Discussions with CMS about CAH designation status Health Care Issues; Discussions with Rep. Hudson about H.R. 4365/ S. 2932, the Protecting Patient Access to Emergency Medications Act , a bill to amend the Controlled Substances Act with regard to the provision of emergency medical services; Support H.R. 4650 and S. 2108, Preserving Patient Access to Post-Acute Hospital Care Act of 2016, a bill to amend title XVIII of the Social Security Act to provide for an extension of certain Medicare long-term care hospital payment rules; Supported efforts to encourage Congress to send CMS letters on addressing the issue of colocation of facilities within a hospital; Discussions with Members of Congress on the potential implementation of Unique Device Identification on claims forms; Sponsored a Hill briefing on innovations in post-acute care;Supported House and Senate letters to CMS asking for flexibility when interpreting section 603 of the BBA of 2015 in regulation; Support HR 5547, the Health Care Price Transparency Promotion Act of 2016, a bill to require the sharing of health care price information; Support HR 5273, the Helping Hospitals Improve Patient Care Act of 2016, a bill to address outstanding issues with section 603 of the BBA of 2015 and provide for a socioeconomic adjustment to the Hospital Readmissions Reduction Program; Supported a letter to CMS on implementation of Sec. 603 of the Bipartisan Budget Acts site neutral cuts for off-campus HOPDs; Support H. res. 699 promoting minority health awareness and supporting the goals and ideals of National Minority Health Month in April 2016; Support H.R.4641 - a bill to provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication; Support H.R. 4982, the Examining Opioid Treatment Infrastructure Act of 2016, a bill which would require the Government Accountability Office (GAO) to evaluate and report on the capacity, availability and need for inpatient and outpatient treatment for opioid use disorders in the United States; Supports H.R. 3680, the Co-Prescribing to Reduce Overdoses Act of 2015, a bill would establish federal grants to carry out co-prescribing of overdose reversal drugs in areas experiencing significant numbers of opioid overdoses and deaths; Support H.R. 3691, the Improving Treatment for Pregnant and Postpartum Women Act of 2015, a bill that would reauthorize essential residential treatment programs for pregnant and postpartum women and provide grants to states to address the growing epidemic of infants suffering from opioid dependency; Support H.R. 4978, the Nurturing and Supporting Healthy Babies Act, a bill which would require a GAO evaluation of neonatal abstinence syndrome and the availability of treatment for this condition in the nations Medicaid programs; Support H.R. 4599, the Reducing Unused Medications Act of 2016, a bill to permit partial filling of schedule II prescriptions under specific circumstances; Support H.R. 4976, the Opioid Review Modernization Act of 2016, a bill which would provide for more stringent Food and Drug Administration review of new opioids without abuse-deterrent properties, recommendations for labeling of pediatric opioids, and recommendations for prescriber education; Support the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2016, a bill for achieving fair and sustainable drug pricing; Supporting full alignment of 42CFR substance use records confidentiality requirements with HIPAA privacy rule.

Client expense: $4,690,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Opposing Medicare and Medicaid Payment reductions, including those to Graduate Medical Education (H.R. 3292, the Medicare IME Pool Act of 2015), bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) payments, CAH payments, IPPS coding offset, rural hospital payments, hospital outpatient department (HOPD) clinics, and sequestration. Support for changes to site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74) and flexibility in implementation of Section 603 of the law. Protecting 340B Drug Pricing Program in regulatory and legislative proposals Support for changes to liver transplant allocation system 21st Century Cures Act (H.R. 6) and Senate HELP Committee provisions related to interoperability and information blocking Urging release of funding for Ebola preparedness and treatment Urging modifications to Hospital Compare Star Rating System Support for National Institutes of Health funding Support for Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act (H.R. 2745) Addressing concerns related to the Physician Quality Reporting System (PQRS) and reporting mechanisms Encouraging Committees of jurisdiction to examine overlap in Merit-based Incentive Payment System and Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) Urging further flexibility in proposed rule [CMS-5517-P] to implement Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Opposition to redistribution of Medicare DSH payments proposed in FFY 2017 Inpatient Prospective Payment System (IPPS) rule [CMS-1655-P] Support for Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Support for Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Support for Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Support for Protecting Access to Rural Therapies Act (H.R. 1611/S. 257) Support for Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) and inclusion of similar provision in Helping Hospitals Improve Patient Care Act (H.R. 5273) Support for Resident Physician Shortage Reduction Act of 2015 (H.R. 2124/ S. 1148) Support for Medicare Audit Improvement Act of 2015 (H.R. 2156) Support for Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Support for Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Support for Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Support for emergency funding to address Zika outbreak Support for authorization of new programs as well as increased funding to improve and expand access to mental health treatment services and substance use disorders. Encouraging Administration to engage hospital and health system field in discussions to address cybersecurity challenges.

Client expense: $140,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), 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.

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. 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

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage; issues related to reimbursement H.R. 1343, S. 688 Establishing Beneficiary Equity in the Hospital Readmissions Program Act S. 257 Protecting Access to Rural Therapy Services (PARTS) Act; provisions related to direct supervision H.R. 169, S. 258 Critical Access Hospital Relief Act; provisions related to 96-hour certification requirement H.R. 546, S. 298 ACE Kids Act H.R. 3292- Medicare IME Pool Act of 2015; Graduate Medical Education

Client expense: Not reported · Firm income: $6,150

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage program; issues related to reimbursements H.R. 1343, S. 688 Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 257 Protecting Access to Rural Therapy Services (PARTS) Act; provisions related to direct supervision H.R. 169, S.258 Critical Access Hospital Relief Act; provisions related to 96-hour certification requirement H.R. 546, S. 298 ACE Kids Act H.R. 3292- Medicare IME Pool Act of 2015; Graduate Medical Education

Client expense: Not reported · Firm income: $37,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage program; issues related to reimbursements H.R. 1343, S. 688 Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 257 Protecting Access to Rural Therapy Services (PARTS) Act; provisions related to direct supervision at Critical Access Hospitals H.R. 169, S.258 Critical Access Hospital Relief Act; provisions related to 96-hour certification requirement H.R. 546, S. 298 ACE Kids Act H.R. 3292- Medicare IME Pool Act of 2015; Graduate Medical Education

Client expense: $67,312 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Helping Hospitals Improve Patient Care Act (HR 5273) Medicare Funding in the Federal Budget Site Neutral payments Resident Physician Shortage Reduction Act of 2015, S. 1148/H.R. 2124 340B Program Medicare Audit Improvement Act, H.R. 2156 Medicaid DSH Cuts Two Midnight Rule Coordination and Improvement Act Critical Access Hospital Relief Act, H.R. 169/S. 258 Protecting Access to Rural Therapy Services Act (S. 257/H.R. 1611) Medicare Graduate Medical Education Program

Client expense: $120,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688, H.R. 5273) Medicare audit contractor program reforms (H.R. 2156, S. 2368) Rural hospital policies (H.R. 663 / S. 332, H.R. 169/S. 258, H.R. 1611/S. 257, S. 1461/H.R. 2878, H.R. 5164) Telehealth, interoperability, health information technology (H.R. 6, S. 2511, S. 2484/H.R. 4442) Post-Acute Care policies, home health prior authorization Graduate Medical Education policy (H.R. 2124, S. 1148, H.R 3292) DSH payment Clinical lab payment policy MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies (H.R. 5273) Stark Law reforms H.R. 4428 Star Ratings Medicaid Managed Care rule Medicare Part B drug payment model Medicare Advantage

Client expense: $70,000 · 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 H.R. 5164: Rural Hospital Regulatory Relief Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Save Rural Hospitals Act (H.R.3225) Funding for 340B Drug Pricing Program Critical Access Hospital Relief Act (S. 258; H.R. 169) Support for Medicare and Medicaid Payment reductions, including Graduate Medical Education Support for Resident Physician Shortage Act of 2015 (S. 1148; H.R. 2124) Opposing Medicare and Medicaid Payment reductions, including those to Graduate Medical Education (H.R. 3292, the Medicare IME Pool Act of 2015), bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) payments, CAH payments, IPPS coding offset, rural hospital payments, hospital outpatient department (HOPD) clinics, and sequestration. Support for changes to site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74) and flexibility in implementation of Section 603 of the law. Protecting 340B Drug Pricing Program in regulatory and legislative proposals Support for Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) and inclusion of similar provision in Helping Hospitals Improve Patient Care Act (H.R. 5273) Support for Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act (H.R. 2745) Addressing concerns related to the Physician Quality Reporting System (PQRS) and reporting mechanisms Encouraging Committees of jurisdiction to examine overlap in Merit-based Incentive Payment System and Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) Urging further flexibility in proposed rule [CMS-5517-P] to implement Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Opposition to redistribution of Medicare DSH payments proposed in FFY 2017 Inpatient Prospective Payment System (IPPS) rule [CMS-1655-P] Support for Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Support for Medicare Audit Improvement Act of 2015 (H.R. 2156) Support for Two-Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082)

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), 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