Rural Hospital Access Act of 2017

H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015; American Health Care Act (H.R. 1625); health insurance marketplace; MACRA Implementation (H.R. 2); CAH funding issues' CHIP re authorization, Better Care Reconciliation Act (H.R. 1628); Rural Hospital Access Act (H.R. 1955/S. 872); Accelerating Access to Kids Care Act (S. 2415); ACE Kids Act (S. 298/H.R. 546); Bipartisan Budget Act of 2018; FY 2018 Consolidated Appropriations Act.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1892, Bipartisan Budget Act of 2018 Rural hospital policies (H.R. 741/S. 243, H.R. 1955/S. 872, S. 1130, straight policy extension of Medicare dependent hospital and low volume adjustment payments, H.R. 1892, Bipartisan Budget Act of 2018); H.R. 5678, Rural Emergency Medical Center (REMC) Act of 2018) Disproportionate share hospital payments (H.R. 1892, Bipartisan Budget Act of 2018; implementation of the S-10 worksheet) Hospital quality star ratings H.R. 2267 / S. 1301, Resident Physician Shortage Reduction Act H.R. 5818 / S. 2843, Opioid Workforce Act Telehealth payment (H.R. 1892, Bipartisan Budget Act of 2018; H.R. 6, SUPPORT for Patients and Communities Act) Stark law reform Hospital outpatient payment policy Site neutral payment policy included in outpatient prospective payment system proposed rule Physician fee schedule proposed rule Evaluation and management coding and payment proposal in physician fee schedule proposed rule 60 percent rule for inpatient rehab hospitals 25 percent rule for long term care hospitals S. 2597 / H.R. 5385, Children's Hospital GME Support Reauthorization Act of 2018 Opioid issues (incorporated under Health)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

FY19 Omnibus Appropriations Act FY18 research and development funding FY19 Defense Appropriations FY19 Labor/HHS/Education Appropriations FY19 MilCon/VA Appropriations FY19 Agriculture Appropriations HR 1955/ S. 872 - Rural Hospital Access Act HR 4508 - PROSPER Act/Higher Education Act Reauthorization

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B Drug Discount Program Resident Physician Shortage Reduction Act Graduate Medical Education Disproportionate Share Hospital payments Childrens Health Insurance Program Medicare Dependent Hospital Program (MDH) Medicaid Low Volume Payments (LV) H.R. 1955, S. 872 - Rural Hospital Access Act H.R. 2889, Closing Loopholes for Orphan Drugs Act Medicare Wage Index Federal Medical Assistance Percentage Extension Inpatient Prospective Payment System Outpatient Prospective Payment System Bad debt/charity care Hospital Outpatient Department payments H.R. 4392, Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems 340B Drug Discount program legislation H.R. 4710, 340B PAUSE Act S. 2453, Ensuring the Value of the 340B Program Act

Client expense: $90,000 · 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

H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015; American Health Care Act (H.R. 1625); health insurance marketplace; MACRA Implementation (H.R. 2); CAH funding issues' CHIP re authorization, Better Care Reconciliation Act (H.R. 1628); Rural Hospital Access Act (H.R. 1955/S. 872); Accelerating Access to Kids Care Act (S. 2415); ACE Kids Act (S. 298/H.R. 546); Bipartisan Budget Act of 2018; FY 2018 Consolidated Appropriations Act.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1892, Bipartisan Budget Act of 2018 Rural hospital policies (H.R. 741/S. 243, H.R. 1955/S. 872, S. 1130, straight policy extension of Medicare dependent hospital and low volume adjustment payments, H.R. 1892, Bipartisan Budget Act of 2018); H.R. 5678, Rural Emergency Medical Center (REMC) Act of 2018) Childrens Health Insurance Program (CHIP) (H.R. 3, Spending Cuts to Expired and Unnecessary Programs Act) Disproportionate share hospital payments (H.R. 1892, Bipartisan Budget Act of 2018; implementation of the S-10 worksheet) Hospital quality star ratings H.R. 2267 / S. 1301, Resident Physician Shortage Reduction Act H.R. 5818 / S. 2843, Opioid Workforce Act Medicaid Graduate Medical Education Transparency Act Telehealth payment (H.R. 1892, Bipartisan Budget Act of 2018) Stark law reform Hospital outpatient payment policy 60 percent rule for inpatient rehab hospitals 25 percent rule for long term care hospitals Graduate Nurse Education pilot program S. 2597 / H.R. 5385, Children's Hospital GME Support Reauthorization Act of 2018 Opioid issues (incorporated under Health)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B Drug Discount Program Resident Physician Shortage Reduction Act Graduate Medical Education Disproportionate Share Hospital payments Childrens Health Insurance Program Medicare Dependent Hospital Program (MDH) Medicaid Low Volume Payments (LV) H.R. 1955, S. 872 - Rural Hospital Access Act H.R. 2889, Closing Loopholes for Orphan Drugs Act Medicare Wage Index Federal Medical Assistance Percentage Extension Inpatient Prospective Payment System Outpatient Prospective Payment System Bad debt/charity care Hospital Outpatient Department payments H.R. 4392, Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems 340B Drug Discount program legislation H.R. 4710, 340B PAUSE Act S. 2453, Ensuring the Value of the 340B Program Act

Client expense: $90,000 · 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

Issues related to the pending expiration and current disallowance of funds under the 1115 Medicaid Transformation Waiver in Texas. HR 1892, Continuing Resolution for FY 2017 appropriations: delaying cuts to Medicaid Disproportionate Share Hospital payments; extending funding for the Childrens Health Insurance Program; extending funding for rural hospital programs. Rural Hospital Access Act of 2017 (S.872/H.R. 1955), permanently extending the Medicare Dependent Hospital program and Medicare Low Volume Hospital program. Responding to Senate Finance Committee and House Ways and Means Committee draft proposals to address expiring Medicare programs for rural hospitals. 2018 Medicare Outpatient Proposed Rule, provisions leading to payment cuts under the 340B program.

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE

340B Drug Discount Program Resident Physician Shortage Reduction Act Graduate Medical Education Disproportionate Share Hospital payments Childrens Health Insurance Program Medicare Dependent Hospital Program (MDH) Medicaid Low Volume Payments (LV) H.R. 1955, S. 872 - Rural Hospital Access Act H.R. 2889, Closing Loopholes for Orphan Drugs Act Medicare Wage Index Federal Medical Assistance Percentage Extension Inpatient Prospective Payment System Outpatient Prospective Payment System Bad debt/charity care Hospital Outpatient Department payments H.R. 4392, Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems 340B Drug Discount program legislation H.R. 4710, 340B PAUSE Act S. 2453, Ensuring the Value of the 340B Program Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1892, Bipartisan Budget Act of 2018 Rural hospital policies (H.R. 741/S. 243, H.R. 1955/S. 872, S. 1130, straight policy extension of Medicare dependent hospital and low volume adjustment payments, H.R. 1892, Bipartisan Budget Act of 2018) Disproportionate share hospital payments (H.R. 3921, HEALTHY KIDS Act; H.R. 3922, CHAMPIONING HEALTHY KIDS Act, H.R. 1892, Bipartisan Budget Act of 2018) H.R. 2267 / S. 1301, Resident Physician Shortage Reduction Act Telehealth payment (H.R. 1892, Bipartisan Budget Act of 2018) Chronic Care legislation (S. 870; H.R. 1892, Bipartisan Budget Act of 2018) Stark law reform (Stark Law Modernization Act; H.R. 1892, Bipartisan Budget Act of 2018) Hospital outpatient payment policy Bundled payment policies RAC reform 60 percent rule for inpatient rehab hospitals 25 percent rule for long term care hospitals Graduate Nurse Education pilot program Medicare extenders packages proposed in the U.S. House and U.S. Senate (including repeal of the outpatient therapy caps) (H.R. 1892, Bipartisan Budget Act of 2018) S. 2597 / H.R. 5385, Children's Hospital GME Support Reauthorization Act of 2018

Client expense: $90,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015; American Health Care Act (H.R. 1625); health insurance marketplace; MACRA Implementation (H.R. 2); CAH funding issues' CHIP re authorization, Better Care Reconciliation Act (H.R. 1628); Rural Hospital Access Act (H.R. 1955/S. 872); Accelerating Access to Kids Care Act (S. 2415); ACE Kids Act (S. 298/H.R. 546); Bipartisan Budget Act of 2018; FY 2018 Consolidated Appropriations Act.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

HR 1955/S 872 - Rural Hospital Access Act Disproportionate Share Hospital allocation reductions 340B drug discount program Childrens Health Insurance Program Medicaid DSH HR 1892- Bipartisan Budget Act of 2018 FY2019 Appropriations

Client expense: $10,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.872/HR 1955 Rural Hospital Access Act of 2017 340B drug discount program HR 1892

Client expense: $10,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for relief from Medicaid Disproportionate Share Hospital (DSH) reductions Support for full funding for Childrens Health Insurance Program Support for reinstatement of Cost Sharing Reduction payments and policies to stabilize health insurance markets Support for retroactive extension of Medicare Dependent Hospital program and Low Volume payment adjustment as well as legislation to make these policies permanent (Rural Hospital Access Act of 2017 (S. 872/H.R. 1955)) Support for Graduate Medical Education (GME) funding and the Resident Physician Shortage Reduction Act (S. 1301/H.R. 2267) Support for National Institutes of Health (NIH) funding Support for moratorium on enforcement of direct supervision requirements for certain outpatient therapeutic services and for removing the 96-hour physician certification requirement as a condition of payment for Critical Access Hospitals Support for changes to Medicare Volume Decrease Adjustment calculation Support for correction of erroneous reductions of GME residency positions Opposition to 340B program reductions in Centers for Medicare and Medicaid Services (CMS) 2018 Outpatient Prospective Payment System proposed rule [CMS-1678-P] and support for legislation (H.R. 4392) to halt these payment cuts Opposition to Medicare site-neutral payment reductions in CMS 2018 Physician Fee Schedule proposed rule [CMS-1676-P]

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Rural Hospital Regulatory Act of 2017 (HR 741 & S 243) Medicaid DSH Payments Children's Health Insurance Program Medicare Dependent Hospital Extender (S 872/HR 1955) Enhanced Low Volume Adjustment Extender (S 872/HR 1955) Protecting Access to Rural Therapy Services Act

Client expense: $150,000 · Firm income: Not reported

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

Rural Hospital Regulatory Relief Act of 2017 (HR 741. S 243) 340B Drug Pricing Program Medicaid DSH Payments Children's Health Insurance Program Medicare Dependent Hospital Extender (S 872/HR 1955) Enhanced low-volume Adjustment Extender (S 872/HR 1955) Protecting Access to Rural Therapy Services Act

Client expense: $150,000 · Firm income: Not reported

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

Bipartisan Budget Act (HR 1892) Children's Health Insurance Program Enhanced low-volume Adjustment Extender (S. 872/HR. 1955)

Client expense: $150,000 · Firm income: Not reported

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

H.R. 1156/S.1133 "Patient Access to Higher Quality Health Care Act of 2017" - Oppose efforts to repeal certain provisions relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. Bad Debt Payments to Hospitals - Lawmakers have proposed lowering the amount of Medicare Bad Debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. Oppose any effort to lower such payments. H.R. 1955/S. 872 - "Rural Hospital Access Act of 2017" - Advocate for the extension of the Medicare Dependent Hospital (MDH) and current Low-Volume Hospital (LVH) programs. Oppose any additional site neutral cuts. Sequestration - Against extending the Medicare sequester and oppose Medicare sequester increase and extension as an offset. Support access to affordable prescription drugs. Medicaid DSH - Advocate for a two year delay of the Medicaid DSH cuts. H.R. 2556/S.1016 "CONNECT for Health Act of 2017" - Support programs to encourage and properly reimburse telemedicine. Market Stabilization - Support efforts to fund Cost Sharing Reductions. Children's Health Insurance Plans (CHIP) - Support an appropriate extension of the CHIP program. H.R. 849 - "Protecting Seniors Access to Medicare Act" - Advocated in support of bill which would repeal the Independent Payment Advisory Board (IPAB).

Client expense: $630,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, 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 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

Outreach and monitoring related to health, Medicaid and Medicare issues. H.R. 277, American Health Care Reform Act of 2017. H.R. 1955, Rural Hospital Access Act of 2017.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Outreach and monitoring related to health, Medicaid and Medicare issues. H.R. 277, American Health Care Reform Act of 2017. H.R. 1955, Rural Hospital Access Act of 2017.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative monitoring and outreach on issues related to TORT Reform Health IT. H.R. 2843, Medicaid and CHIP Quality Improvement Act of 2017. S. 1317, Medicaid and CHIP Quality Improvement Act of 2017. H.R. 1955, Rural Hospital Access Act of 2017. S. 872, Rural Hospital Access Act of 2017. H.R. 1, An Act to provide for reconciliation pursuant to titles II and V of the concurrent resolution on the budget for fiscal year 2018.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative monitoring and outreach on issues related to Medicaid and Medicare. H.R. 2843, Medicaid and CHIP Quality Improvement Act of 2017. S. 1317, Medicaid and CHIP Quality Improvement Act of 2017. H.R. 1955, Rural Hospital Access Act of 2017. S. 872, Rural Hospital Access Act of 2017. H.R. 1, An Act to provide for reconciliation pursuant to titles II and V of the concurrent resolution on the budget for fiscal year 2018.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitoring and outreach on issues related to TORT Reform Health IT. H.R. 2628, Stabilize Medicaid and CHIP Coverage Act. S. 1227, Stabilize Medicaid and CHIP Coverage Act of 2017. H.R. 1955, Rural Hospital Access Act of 2017. S. 872, Rural Hospital Access Act of 2017.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitoring and outreach on issues related to Medicare and Medicaid. H.R. 2628, Stabilize Medicaid and CHIP Coverage Act. S. 1227, Stabilize Medicaid and CHIP Coverage Act of 2017. H.R. 1955, Rural Hospital Access Act of 2017. S. 872, Rural Hospital Access Act of 2017.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B Drug Discount Program Resident Physician Shortage Reduction Act Graduate Medical Education Disproportionate Share Hospital payments Childrens Health Insurance Program Medicare Dependent Hospital Program (MDH) Medicaid Low Volume Payments (LV) H.R. 1955, S. 872 - Rural Hospital Access Act H.R. 2889, Closing Loopholes for Orphan Drugs Act Medicare Wage Index Federal Medical Assistance Percentage Extension Inpatient Prospective Payment System Outpatient Prospective Payment System Bad debt/charity care Hospital Outpatient Department payments H.R. 4392, Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems 340B Drug Discount program legislation H.R. 4710, 340B PAUSE Act

Client expense: $90,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Rural hospital policies (H.R. 741/S. 243, H.R. 1955/S. 872, S. 1130, straight policy extension of Medicare dependent hospital and low volume adjustment payments) Disproportionate share hospital payments (H.R. 3921, HEALTHY KIDS Act; H.R. 3922, CHAMPIONING HEALTHY KIDS Act) H.R. 2267 / S. 1301, Resident Physician Shortage Reduction Act Telehealth payment Chronic Care legislation (S. 870) Stark law reform (Stark Law Modernization Act) Hospital outpatient payment policy Bundled payment policies RAC reform 60 percent rule for inpatient rehab hospitals 25 percent rule for long term care hospitals Graduate Nurse Education pilot program Medicare extenders packages proposed in the U.S. House and U.S. Senate (including repeal of the outpatient therapy caps)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1156/S.1133 "Patient Access to Higher Quality Health Care Act of 2017" - Oppose efforts to repeal certain provisions relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. Bad Debt Payments to Hospitals - Lawmakers have proposed lowering the amount of Medicare Bad Debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. Oppose any effort to lower such payments. H.R. 1955/S. 872 - "Rural Hospital Access Act of 2017" - Advocate for the extension of the Medicare Dependent Hospital (MDH) and current Low-Volume Hospital (LVH) programs. Oppose any additional site neutral cuts. Sequestration - Against extending the Medicare sequester and oppose Medicare sequester increase and extension as an offset. Support access to affordable prescription drugs. Medicare DSH - Mitigate the impact of the IPPS proposed Medicare DSH redistribution in the FY18 proposed rule. Medicaid DSH - Advocate for a two year delay of the Medicaid DSH cuts. H.R. 2556/S.1016 "CONNECT for Health Act of 2017" - Support programs to encourage and properly reimburse telemedicine. Market Stabilization - Support efforts to fund Cost Sharing Reductions. Children's Health Insurance Plans (CHIP) - Support an appropriate extension of the CHIP program. H.R. 849 - "Protecting Seniors Access to Medicare Act" - Advocated in support of bill which would repeal the Independent Payment Advisory Board (IPAB).

Client expense: $710,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

Issues related to the pending expiration and current disallowance of funds under the 1115 Medicaid Transformation Waiver in Texas. Opposing the implementation of cuts to Medicaid Disproportionate Share Hospital payments. The Keep Kids Insurance Dependable and Secure KIDS Act of 2017 (S.1827) and Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017, Healthy Kids Act (HR 3921): advocating for the extension of funding for the CHIP program. Rural Hospital Access Act of 2017 (S.872/H.R. 1955), permanently extending the Medicare Dependent Hospital program and Medicare Low Volume Hospital program. Responding to Senate Finance Committee and House Ways and Means Committee draft proposals to address expiring Medicare programs for rural hospitals. 2018 Medicare Outpatient Proposed Rule, provisions leading to payment cuts under the 340B program.

Client expense: Not reported · Firm income: $50,000

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

Issues related to the pending expiration and current disallowance of funds under the 1115 Medicaid Transformation Waiver in Texas. Opposing the implementation of cuts to Medicaid Disproportionate Share Hospital payments. The Keep Kids Insurance Dependable and Secure KIDS Act of 2017 (S.1827) and Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017, Healthy Kids Act (HR 3921): advocating for the extension of funding for the CHIP program. Rural Hospital Access Act of 2017 (S.872/H.R. 1955), permanently extending the Medicare Dependent Hospital program and Medicare Low Volume Hospital program. 2018 Medicare Outpatient Proposed Rule, provisions leading to payment cuts under the 340B program.

Client expense: Not reported · Firm income: $50,000

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

Issues related to the pending expiration and current disallowance of funds under the 1115 Medicaid Transformation Waiver in Texas. Opposing the implementation of cuts to Medicaid Disproportionate Share Hospital payments. The Keep Kids Insurance Dependable and Secure KIDS Act of 2017 (S.1827) and Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017, Healthy Kids Act (HR 3921): advocating for the extension of funding for the CHIP program. Rural Hospital Access Act of 2017 (S.872/H.R. 1955), permanently extending the Medicare Dependent Hospital program and Medicare Low Volume Hospital program. 2018 Medicare Outpatient Proposed Rule, provisions leading to payment cuts under the 340B program.

Client expense: Not reported · Firm income: $50,000

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

H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015; American Health Care Act (H.R. 1625); health insurance marketplace; MACRA Implementation (H.R. 2); CAH funding issues' CHIP re authorization, Better Care Reconciliation Act (H.R. 1628); Rural Hospital Access Act (H.R. 1955/S. 872).

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), 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

Medicare Dependent Hospitals; Low-Volume Adjustment; S. 872/H.R. 1955, Rural Hospital Access Act of 2017, all sections; H.R. 1628/S. xxx, American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy-Heller-Johnson, all provisions impacting health care coverage/funding in Medicaid and on the federal marketplace; Cost-sharing reduction payments; S. 243/H.R. 741, Protecting Access to Rural Therapy Services (PARTS) Act/Rural Hospital Regulatory Relief Act of 2017, all sections; H.R. 3922, Championing Health Kids Act, all provisions relating to CHIP extension and Medicaid DSH; CAH swing bed reimbursement; H.R. 4552/S. 1291, Advancing Medical Resident Training in Community Hospitals Act of 2017, all provisions relating to graduate medical education; hospital outpatient department reimbursements

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B; Medicare Dependent Hospitals; Low-Volume Adjustment; S. 872/H.R. 1955, Rural Hospital Access Act of 2017, all sections; H.R. 1628/S. xxx, American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy-Heller-Johnson, all provisions impacting health care coverage/funding in Medicaid and on the federal marketplace; Cost-sharing reduction payments; S. 243/H.R. 741, Protecting Access to Rural Therapy Services (PARTS) Act/Rural Hospital Regulatory Relief Act of 2017, all sections; H.R. 3922, Championing Health Kids Act, all provisions relating to CHIP extension and Medicaid DSH; 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, all provisions relating to 340B; CAH swing bed reimbursement; H.R. 4552/S. 1291, Advancing Medical Resident Training in Community Hospitals Act of 2017, all provisions relating to graduate medical education; hospital outpatient department reimbursements

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.872/HR 1955 Rural Hospital Access Act of 2017 340B drug discount program

Client expense: $7,800 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1955/S 872 - Rural Hospital Access Act Graham-Cassidy-Heller-Johnson Health Care Reconciliation Bill HR 3921 Healthy Kids Act S. 1827 KIDS Act of 2017 Disproportionate Share Hospital allocation reductions Tax Cuts and Jobs Act - HR1 340B drug discount program

Client expense: $7,800 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Affordable Care Act Implementation Budget Reconciliation Act of 2017 (HR 1628 - Affordable Care Act Repeal & Replace Rural Hospital Regulatory Relief Act of 2017 (HR 741. S 243) 340B Program Medicare DSH Payments Medicaid DSH Payments Children's Health Insurance Program Medicare Dependent Hospital Extender (S 872/HR 1955) Enhanced low-volume Adjustment Extender (S 872/HR 1955)

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), Health Resources & Services Administration (HRSA), SENATE

Affordable Care Act Implementation Budget Reconciliation Act of 2017 (HR 1628) - Affordable Care Act Repeal & Replace Site Neutral Payments Rural Hospital Regulatory Act of 2017 (HR 741 & S 243) Medicare DSH Payments Medicaid DSH Payments Children's Health Insurance Program Medicare Dependent Hospital Extender (S 872/HR 1955) Enhanced Low Volume Adjustment Extender (S 872/HR 1955) Protecting Access to Rural Therapy Services Act

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), Health Resources & Services Administration (HRSA), SENATE

Rural hospital policies (H.R. 741/S. 243, H.R. 1955/S. 872, S. 1130) H.R. 1130 / S. 397 - Fair Medicare Hospital Payments Act of 2017 Disproportionate share hospital payments (HEALTHY KIDS Act) H.R. 2267 / S. 1301, Resident Physician Shortage Reduction Act Telehealth payment Chronic Care legislation (S. 870) Stark law reform (Stark Law Modernization Act) Socioeconomic adjustment Bundled payment Hospital outpatient payment policy RAC reform Home health pre-claim review 25 percent rule 60 percent rule Meaningful use

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B; S. 872/H.R. 1955, Rural Hospital Access Act of 2017, all sections; H.R. 1628/S. xxx, American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy-Heller-Johnson, all provisions impacting health care coverage/funding in Medicaid and on the federal marketplace; S. 243/H.R. 741, Protecting Access to Rural Therapy Services (PARTS) Act, all sections; funding for Hospital Preparedness Program; CHIP extension; hospital outpatient department reimbursements

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 872/H.R. 1955, Rural Hospital Access Act of 2017, all sections; H.R. 1628/S. xxx, American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy-Heller-Johnson, all provisions impacting health care coverage/funding in Medicaid and on the federal marketplace; S. 243/H.R. 741, Protecting Access to Rural Therapy Services (PARTS) Act, all sections; CHIP extension; hospital outpatient department reimbursements; regulatory relief within Medicare

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1156/S.1133 "Patient Access to Higher Quality Health Care Act of 2017" - Oppose efforts to repeal certain provisions relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. Bad Debt Payments to Hospitals - Lawmakers have proposed lowering the amount of Medicare Bad Debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. Oppose any effort to lower such payments. H.R. 1955/S. 872 - "Rural Hospital Access Act of 2017" - Advocate for the extension of the Medicare Dependent Hospital (MDH) and current Low-Volume Hospital (LVH) programs. Oppose any additional site neutral cuts. Sequestration - Against extending the Medicare sequester and oppose Medicare sequester increase and extension as an offset. Price Transparency - Advocate for meaningful price transparency for consumers by ensuring they have access to out of pocket price information. H.R. 1628 "American Health Care Act/Better Care Reconciliation Act" - Expressed significant concern with revised Senate legislation. Opposed loss of coverage. Advocated for appropriate Medicaid payment and appropriate flexibility and restoration of hospital Medicare cuts if Affordable Care Act is repealed. H.R. 3173 "Stark Administrative Simplification Act" and H.R. 3178 "Medicare Part B Improvement Act" - Discussions regarding reforms to physician self-referral law. Support access to affordable prescription drugs. Medicare DSH - Mitigate the impact of the IPPS proposed Medicare DSH redistribution in the FY18 proposed rule. Medicaid DSH - Advocate for a two year delay of the Medicaid DSH cuts. H.R. 2556/S.1016 "CONNECT for Health Act of 2017" - Support programs to encourage and properly reimburse telemedicine. Market Stabilization - Support efforts to fund Cost Sharing Reductions. Children's Health Insurance Plans (CHIP) - Support an appropriate extension of the CHIP program.

Client expense: $760,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office