Resident Physician Shortage Reduction Act of 2017

- S.1301/H.R.2267: The Resident Physician Shortage Reduction Act and all other efforts to increase funding for graduate medical education. -Funding for state Medicaid expansion and programs that allow for state Medicaid enhanced reimbursement for physician training at academic medical centers.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare physician payment; new/alternative payment models; Medicare coverage, including coverage policies pertaining to transcatheter aortic valve replacement, transcathether mitral valve repair, and ambulatory blood pressure monitoring; Medicare hospital payment; access to Medicare claims data; Ways & Means Committee hospital payment project; physician and hospital quality; electronic health record incentive program; clinical data registries; health care quality; medical imaging and prior authorization, including HR 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018; the Stark Law and the in-office ancillary services exception, including HR 4206/S 2051, the Medicare Care Coordination Improvement Act; Promoting Integrity in Medicare Act, HR 2066; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; HR 1155/S 1361, a bill to amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs; S 46, the Strengthening Medicare Intensive Cardiac Rehabilitation Programs Act of 2017; HR 3325/S 428, The Advancing Care for Exceptional Kids Act of 2017 (or ACE Kids Act), a bill to allow a state, at its option, to elect to provide medical assistance for items and services furnished to eligible children with medically complex conditions enrolled in a Medicaid Children's Care Coordination (MCCC) program; Senate Finance Committee chronic care project; graduate medical education policy including HR 2267/S 1301, Resident Physician Shortage Reduction Act of 2017; end of life care, including HR 2797/S 1334, the Patient Choice and Quality Care Act of 2017; Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA) implementation; oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; physician-owned hospital policy, including HR 1156/S 1133, the Patient Access to High Quality Care Act of 2017; Medicaid coverage and eligibility, including HR 829, Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017, HR 181, Close Annuity Loopholes in Medicaid Act, and HR 705, Verify Eligibility Coverage Act; HR 3163, Medicare Part B Home Infusion Services Temporary Transitional Payment Act; Affordable Care Act repeal/replace/reform efforts; HR 3767 and S 989, the Ensuring Childrens Access to Specialty Care Act of 2017; HR 3635, the Local Coverage Determination Clarification Act of 2017; Ways and Means Committee Medicare extenders policy/legislation.

Client expense: $480,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, White House Office

Opioid issues (S. 2680, the Opioid Crisis Response Act of 2018; H.R. 5176, Preventing Overdoses While in Emergency Rooms (POWER) Act; H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act; H.R. 5009, Jessies Law; H.R. 5818 / S. 2843, the Opioid Workforce Act; H.R. 5797, the IMD CARE Act; H.R. 6082/H.R. 5795, the Overdose Prevention and Patient Safety Act; S. 2905, Strengthening Partnerships to Prevent Opioid Abuse Act; S. 2460, Every Prescription Conveyed Securely Act; S. 2920, Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act; H.R. 5582, the Abuse Deterrent Access Act; H.R. 5685, the Medicare Opioid Safety Education Act; Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018; H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act; S. 2899, Caring Recovery for Infants and Babies Act; S. 2898, Medication-Assisted Treatment Improvement Act; S.2911, Enhancing Patient Access to Non-Opioid Treatment Options) Draft Protecting Patients from Surprise Medical Bills Act HIPAA policy in mental and behavioral health information sharing 21st Century Cures Act implementation Pandemic and All Hazards Preparedness Reauthorization, including Hospital Preparedness Program (S. 2852, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) of 2018) S.781/ HR 1876. Good Samaritan Health Professional Act of 2017 Health workforce reauthorizations (H.R. 959, the Title VIII Nursing Workforce Reauthorization Act; H.R. 3728, the Educating Medical Professionals and Optimizing Workforce Efficiency Readiness (EMPOWER) Act; H.R. 1676, the Palliative Care and Hospice Education and Training Act Liver allocation policy (H.R. 6458 National Organ Transplant Act Amendments of 2018; H.R. 6517 Fairness in Liver Allocation 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) 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 rule Evaluation and management coding and payment policy in physician fee schedule rule S. 2597 / H.R. 5385, Children's Hospital GME Support Reauthorization Act of 2018 Opioid funding (CARA implementation; S. 2004, Combating the Opioid Epidemic Act; H.R. 1892, Bipartisan Budget Act of 2018; Consolidated Appropriations Act, 2018) Behavioral health funding (H.R. 1892, Bipartisan Budget Act of 2018; Consolidated Appropriations Act, 2018; H.R. 6157) HR 6470 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019 H.R. 5645, the Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act Public Charge proposed rule Q4 Submitted Letters SUBJECT: DHS Docket No. USCIS-2010-0012, Inadmissibility on Public Charge Grounds; Proposed Rule SUBJECT: Docket No. FDA-2018-N-3272, Identifying the Root Causes of Drug Shortages and Finding Enduring Solutions SUBJECT: CMS-1701-P, Medicare Program: Medicare Shared Savings Program; Accountable Care Organizations Pathways to Success Proposed Rule SUBJECT: OIG-0803-N, Request for Information Regarding Anti-Kickback Statute and Beneficiary Inducements CMP SUBJECT: CMS-3346-P, Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction SUBJECT: Notice of Proposed Rulemaking, 340B Drug Pricing Program Ceiling Price and Manufacturer Civil Monetary Penalties Effective Date Change

Client expense: $317,828 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Social Security Administration (SSA)

Medicare-Graduate Medical Education; HRSA THCGME Program; Advancing Medical Resident Training in Community Hospitals Act of 2017, H.R. 4552/S. 1291; Restoring Rural Residencies Act, S. 455; Resident Physician Shortage Act of 2017, H.R. 2267/S. 1301; Opioid Workforce Act of 2018, H.R. 5818/S. 2843; Rural Physician Workforce Production Act of 2018, S. 3014; Advancing Medical Resident Training in Community Hospitals Act of 2018, H.R. 6056; Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, H.R. 6; Advancing Medical Resident Training in Community Hospitals Act, H.R. 284; Creating Access to Residency Education (CARE) Act of 2018, H.R. 7233

Client expense: $60,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare-Graduate Medical Education; HRSA THCGME Program; Advancing Medical Resident Training in Community Hospitals Act of 2017, H.R. 4552/S. 1291; Restoring Rural Residencies Act, S. 455; Resident Physician Shortage Act of 2017, H.R. 2267/S. 1301; Substance Use Disorder Workforce Loan Repayment Act of 2018, H.R. 5102/S. 2524; Opioid Workforce Act of 2018, H.R. 5818/S. 2843; Building a Health Care Workforce for the Future Act, H.R. 2574/S. 3095; Rural Physician Workforce Production Act of 2018, S. 3014; Advancing Medical Resident Training in Community Hospitals Act of 2018, H.R. 6056; Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, H.R. 6; Advancing Medical Resident Training in Community Hospitals Act, H.R. 284

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

Government targets: HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE

Medicare-Graduate Medical Education; HRSA THCGME Program; Advancing Medical Resident Training in Community Hospitals Act, H.R. 284/S. 1291; Restoring Rural Residencies Act, S. 455; Resident Physician Shortage Act of 2017, H.R. 2267/S. 1301; Training the Next Generation of Primary Care Doctors Act of 2017, H.R. 3394/S. 1754.; Substance Use Disorder Workforce Loan Repayment Act of 2018 (H.R. 5102/S. 2524); Opioid Workforce Act of 2018, H.R. 5818/S. 2843

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare-Graduate Medical Education; HRSA THCGME Program; Advancing Medical Resident Training in Community Hospitals Act, H.R. 284/S. 1291; Restoring Rural Residencies Act, S. 455; Resident Physician Shortage Act of 2017, H.R. 2267/S. 1301; Training the Next Generation of Primary Care Doctors Act of 2017, H.R. 3394/S. 1754.; Substance Use Disorder Workforce Loan Repayment Act of 2018 (H.R. 5102/S. 2524)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support H.R. 741/ S. 243 Rural Hospital Regulatory Relief Act of 2017, a bill that amends title XVIII (Medicare) of the Social Security Act to permanently extend the application by the Centers for Medicare & Medicaid Services of an instruction against the enforcement of certain physician supervision requirements with respect to outpatient therapeutic services in critical access hospitals and small rural hospitals; Support H.R. 807/ S. 253 Medicare Access to Rehabilitation Services Act of 2017, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; Discussion about the Electronic Clinical Quality Measure Reporting: advocating for an extension of the reporting deadline to increase hospitals ability to meet requirements in the Hospital Inpatient Quality Reporting program and the Medicare EHR Incentive Program;Requested clarification from CMS about providing care to justice-involved individuals and receiving Medicaid/Medicare reimbursement for such care to Made efforts in support of clarifying that hospitals may have designated units to care for patients in the custody of law enforcement/correctional institutions and may receive Medicaid reimbursement for care provided in such units; Support S. 872/ HR 1955Rural Hospital Access Act of 2017, a bill to amend title XVIII of the Social Security Act to make permanent the extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support S 1301/ HR 2267, Resident Physician Shortage Reduction Act of 2017, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose H.R. 1628 American Health Care Act / Better Care Reconciliation Act, a bill that would repeal and replace much of the Affordable Care Act, including repealing Medicaid expansion and the advanced premium tax credits for the purchase of coverage on the Health Insurance Marketplaces; Support S 1334/ HR 2797Patient Choices and Quality Care Act of 2017, a bill to provide for advanced illness care coordination services for Medicare beneficiaries; Urged the Administration to cancel Stage 3 of meaningful use by removing the 2018 start date from the regulation. The Administration also should institute a 90- day reporting period in every future year of the program, and gather input from stakeholders on ways to further reduce the burden of the meaningful use program from current requirements; Review S. 1169/ HR 2687, Medicaid Coverage for Addiction Recovery Expansion Act, a bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities; Review HR 2509 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Urged CMS to rescind the 25% Rule and instead rely on the site-neutral payment policy to bring transformative change to the LTCH field; Discussion with CMS about direct supervision of outpatient therapeutic services; Support HR 3120, a bill to amend title XVIII of the Social Security Act to reduce the volume of future electronic health record-related significant hardship requests; Discussed with Congress potential offsets to pay for CHIP and other Medicare extender legislation; Support straight extensions of the Medicare-dependent hospital and enhanced low-volume adjustment program; Support eliminating the reductions to Medicaid payments for DSH in fiscal years 2018 and 2019; Urged CMS to eliminate a duplicative budget-neutrality adjustment (BNA) being applied to Medicare payments for LTCH site-neutral cases, an unwarranted 5.1 percent cut. Urged CMS to permanently eliminate the LTCH 25% Rule policy; support The Limited Repeal of the IMD Exclusion for Adult Medicaid Beneficiaries with Substance Use Disorder Act, which would improve access to needed substance use disorder (SUD)treatment services for millions of Americans.

Client expense: $5,460,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), 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

Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor federal and legislative activity related to Medicare Reimbursement. Monitor federal issues and legislation associated with health care policy. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of 21st Century Cures Act (P.L. 114-255). H.J. Res. 143, Continuing appropriations for fiscal year 2019. (P.L. 115-298) H.R. 6, SUPPORT for Patients and Communities Act. (P.L. 115-271) H.R. 849, Protecting Seniors' Access to Medicare Act of 2017. H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act. H.R. 1316, Prescription Drug Price Transparency Act. H.R. 1628, American Health Care Act of 2017. H.R. 1703, Medical Product Communications Act of 2017. H.R. 1898, To improve access to, and utilization of, bone mass measurement benefits. H.R. 1920, To amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes. H.R.2077, Restoring the Patient's Voice Act of 2017. H.R. 2141, Conrad State 30 and Physician Access Reauthorization Act. H.R. 2267, Resident Physician Shortage Reduction Act of 2017. H.R. 2641, Promoting Life-Saving New Therapies for Neonates Act of 2017. H.R. 2999, Patients' Access to Treatments Act of 2017. H.R. 3635, Local Coverage Determination Clarification Act of 2017. H.R. 3728, EMPOWER Act of 2017. H.R. 3767, Ensuring Children's Access to Specialty Care Act of 2017. H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018. H.R. 5150, Protecting Medicare from Excessive Price Increases Act of 2018. H.R.6157, Defense and Labor, Health and Human Services Consolidated Appropriations Act, 2019. (P.L. 115-245) H.R. 6470, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019. S. 251, Protecting Medicare from Executive Action Act of 2017. S. 260, Protecting Seniors' Access to Medicare Act of 2017. S. 637, Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017. S. 794, Local Coverage Determination Clarification Act of 2017. S. 898, Conrad State 30 and Physician Access Reauthorization Act. S. 989, Ensuring Children's Access to Specialty Care Act of 2017. S. 1301, Resident Physician Shortage Reduction Act of 2017. S. 1304, A bill to amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes. S. 2553, Know the Lowest Price Act of 2018 (P.L. 115-262). S. 2554, Patient Right to Know Drug Prices Act (P.L. 115-263). S. 2908, To provide for electronic prior authorization under Medicare part D for covered part D drugs, and for other purposes. S. 3158, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019. S. 3159, Department of Defense Appropriations Act, 2019. S. 3160, To improve access to, and utilization of, bone mass measurement benefits.

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

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

Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor federal and legislative activity related to Medicare Reimbursement. Monitor federal issues and legislation associated with health care policy. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of 21st Century Cures Act (P.L. 114-255). H.R. 6, SUPPORT for Patients and Communities Act. H.R. 849, Protecting Seniors' Access to Medicare Act of 2017. H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act. H.R. 1316, Prescription Drug Price Transparency Act. H.R. 1628, American Health Care Act of 2017. H.R. 1703, Medical Product Communications Act of 2017. H.R. 1898, To improve access to, and utilization of, bone mass measurement benefits. H.R. 1920, To amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes. H.R.2077, Restoring the Patient's Voice Act of 2017. H.R. 2141, Conrad State 30 and Physician Access Reauthorization Act. H.R. 2267, Resident Physician Shortage Reduction Act of 2017. H.R. 2641, Promoting Life-Saving New Therapies for Neonates Act of 2017. H.R. 2999, Patients' Access to Treatments Act of 2017. H.R. 3635, Local Coverage Determination Clarification Act of 2017. H.R. 3728, EMPOWER Act of 2017. H.R. 3767, Ensuring Children's Access to Specialty Care Act of 2017. H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018. H.R. 5150, Protecting Medicare from Excessive Price Increases Act of 2018. H.R.6157, Defense and Labor, Health and Human Services Consolidated Appropriations Act, 2019. H.R. 6470, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019. S. 251, Protecting Medicare from Executive Action Act of 2017. S. 260, Protecting Seniors' Access to Medicare Act of 2017. S. 637, Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017. S. 794, Local Coverage Determination Clarification Act of 2017. S. 898, Conrad State 30 and Physician Access Reauthorization Act. S. 989, Ensuring Children's Access to Specialty Care Act of 2017. S. 1301, Resident Physician Shortage Reduction Act of 2017. S. 1304, A bill to amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes. S. 2553, Know the Lowest Price Act of 2018 (P.L. 115-262). S. 2554, Patient Right to Know Drug Prices Act (P.L. 115-263). S. 2908, To provide for electronic prior authorization under Medicare part D for covered part D drugs, and for other purposes. S. 3158, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019. S. 3160, To improve access to, and utilization of, bone mass measurement benefits.

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

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

Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor federal and legislative activity related to Medicare Reimbursement. Monitor federal issues and legislation associated with health care policy. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of 21st Century Cures Act (P.L. 114-255). H.J. Res. 143, Continuing appropriations for fiscal year 2019. (P.L. 115-298) H.R. 6, SUPPORT for Patients and Communities Act. (P.L. 115-271) H.R. 849, Protecting Seniors' Access to Medicare Act of 2017. H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act. H.R. 1316, Prescription Drug Price Transparency Act. H.R. 1628, American Health Care Act of 2017. H.R. 1703, Medical Product Communications Act of 2017. H.R. 1898, To improve access to, and utilization of, bone mass measurement benefits. H.R. 1920, To amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes. H.R.2077, Restoring the Patient's Voice Act of 2017. H.R. 2141, Conrad State 30 and Physician Access Reauthorization Act. H.R. 2267, Resident Physician Shortage Reduction Act of 2017. H.R. 2641, Promoting Life-Saving New Therapies for Neonates Act of 2017. H.R. 2999, Patients' Access to Treatments Act of 2017. H.R. 3635, Local Coverage Determination Clarification Act of 2017. H.R. 3728, EMPOWER Act of 2017. H.R. 3767, Ensuring Children's Access to Specialty Care Act of 2017. H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018. H.R. 5150, Protecting Medicare from Excessive Price Increases Act of 2018. H.R.6157, Defense and Labor, Health and Human Services Consolidated Appropriations Act, 2019. (P.L. 115-245) H.R. 6470, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019. S. 251, Protecting Medicare from Executive Action Act of 2017. S. 260, Protecting Seniors' Access to Medicare Act of 2017. S. 637, Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017. S. 794, Local Coverage Determination Clarification Act of 2017. S. 898, Conrad State 30 and Physician Access Reauthorization Act. S. 989, Ensuring Children's Access to Specialty Care Act of 2017. S. 1301, Resident Physician Shortage Reduction Act of 2017. S. 1304, A bill to amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes. S. 2553, Know the Lowest Price Act of 2018 (P.L. 115-262). S. 2554, Patient Right to Know Drug Prices Act (P.L. 115-263). S. 2908, To provide for electronic prior authorization under Medicare part D for covered part D drugs, and for other purposes. S. 3158, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019. S. 3159, Department of Defense Appropriations Act, 2019. S. 3160, To improve access to, and utilization of, bone mass measurement benefits.

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

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

Medicare Graduate Medical Education H.R. 2267/S. 1301, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions Health Care Delivery and Payment Reform Proposals H.R. 4392, a bill to prevent cuts to the 340B drug savings program, which would provide relief from deep cuts to payments to hospitals participating in the 340B program Opposed H.R. 4710, a bill to implement reporting requirement for certain 340B participants and to establish a 2-year moratorium on new 340B program participants H.R. 6071, Stretching Entity Resources for Vulnerable Communities Act - provisions related to rescinding Medicare reimbursements cuts, codifying the definition of patient Additional legislative proposals modifying the 340B program

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policy Issues related to the Hospital Compare Star Ratings S. 568/H.R.1421, "Improving Access to Medicare Coverage Act" - provisions related to counting outpatient observation services toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare H.R. 2267/S. 1301, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 4392, a bill to prevent cuts to the 340B drug savings program, which would provide relief from deep cuts to payments to hospitals participating in the 340B program Opposed H.R. 4710, a bill to implement reporting requirement for certain 340B participants and to establish a 2-year moratorium on new 340B program participants H.R. 6071, Stretching Entity Resources for Vulnerable Communities Act - provisions related to rescinding Medicare reimbursements cuts, codify the definition of patient Additional legislative proposals modifying the 340B program

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to protecting Medicaid H.R. 2267, S. 1301, Resident Physician Shortage Reduction Act of 2017, Issues pertaining to Graduate Medical Education.

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

Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), HOUSE OF REPRESENTATIVES, SENATE

H.R. 2267/ S. 1301, Resident Shortage Physician Reduction Act of 2017 Issue: Support additional funding of graduate medical education H.R. 5818/S.2843, Opioid Workforce Act of 2018 Issue: Support additional funding for graduate medical education for addiction medicine, addiction psychiatry, and pain management residency programs S. 3014 Rural Physician Workforce Production Act of 2018 Issue: Oppose legislation redesigning Medicare GME payment formulas Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts Issue: Support Medicare Graduate Medical Education (GME) per resident amount technical corrections and administrative relief. Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose overly burdensome discussion draft Medicaid GME transparency legislation. Issue: Educate Congress on role of academic medicine as it relates to price transparency initiatives S. 455, Restoring Rural Residencies Act of 2017 Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Development and implementation of new Medicaid Disproportionate Share Hospital (DSH) formula required under the ACA. Issue: Support extension of Medicaid Disproportionate Share Hospital (DSH) cuts delay Issue: Support allowing providers in new delivery models (e.g., ACOs, bundled payments, etc.) to access medical records with information on substance use disorders Issue: Support aligning 42 CFR Part 2 regulations with the Health Insurance Portability and Accountability Act (HIPAA) for the purposes of treatment, payment, and healthcare operations. Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs Issue: ACA Section 1115 and 1332 Medicaid Waivers Issue: ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. Issue: Support a third agreement period for certain Accountable Care Organizations in Medicare Shared Savings Program Issue: Support a delay in CMS issuing a final national coverage decision until the agency has an opportunity to receive and consider alternatives to limiting coverage to FDA-approved diagnostic tests developed using Next Generation Sequencing technology. H.R. 7217, Improving Medicaid Programs and Opportunities for Eligible Beneficiaries (IMPROVE) Act, Title I H.R. 3325/S. 428, ACE Kids Act Issue: Support legislation to improve health care for children with complex medical conditions on Medicaid Issue: Oppose Physician Fee Schedule rule proposal to collapse Medicare E/M coding

Client expense: $892,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Natl Science Foundation (NSF), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA), Vice President of the U.S., White House Office

Administration proposals relating to health care reform and Medicaid funding. H.R. 2267 and S. 1301: Resident Physician Shortage Reduction Act A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes (ALL).

Client expense: $60,000 · 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, 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) 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 rule Evaluation and management coding and payment policy in physician fee schedule rule S. 2597 / H.R. 5385, Children's Hospital GME Support Reauthorization Act of 2018 Requirement for public posting of chargemaster in electronically readable form

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for Graduate Medical Education (GME) funding including the Resident Physician Shortage Reduction Act (S. 1301/H.R. 2267) and the Opioid Workforce Act of 2018 (H.R. 5818/S. 2843) Support for legislation to address opioid epidemic (SUPPORT for Patients and Communities Act (H.R. 6)) including bills to modify to institute of mental disease exclusion (H.R. 5797) and to align 42 CFR Part 2 with the Health Insurance Portability and Accountability Act (H.R. 6082) and policies to expand ability to prescribe buprenorphine treatment Support for full protection of Critical Access Hospital payments Support for REMC Act of 2018 (H.R. 5678) Support for Fairness in Liver Allocation Act (H.R. 6517) 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 (OPPS) proposed rule [CMS-1678-P] and support for legislation (H.R. 4392, H.R. 6071) to halt these payment cut Opposition to changes to 340B program (H.R. 4710, H.R. 6240) Opposition to site-neutral payment reductions to hospital outpatient departments proposed in CMS 2019 OPPS proposed rule [CMS-1695-P] Support for policies to preserve Medicare Disproportionate Share Hospital funding as part of CMS 2019 Inpatient Prospective Payment System proposed rule [CMS-1694-P] Opposition to Department of Homeland Security Proposed Rule on Inadmissibility on Public Charge Grounds [DHS Docket No. USCIS-2010-0012]

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

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

American Health Care Act of 2017 (H.R. 1628) Access to Precision Medicine Advancement Act Resident Physician Shortage Reduction Act of 2017 (H.R.2267) Better Care Reconciliation Act Paul Coverdell Forensic Science Grant Program The Diagnostic Accuracy & Innovation Act Independent Advisory Payment Board

Client expense: $325,721 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5818, Opioid Workforce Act of 2018, provisions related to Graduate Medical Education. HR 2267, Resident Physician Shortage Reduction Act of 2017, provisions related to Graduate Medical Education. Site neutral changes in the Outpatient Prospective Payment System proposed rule

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor federal and legislative activity related to Medicare Reimbursement. Monitor federal issues and legislation associated with health care policy. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of 21st Century Cures Act (P.L. 114-255). H.J. Res. 143, Continuing appropriations for fiscal year 2019. (P.L. 115-298) H.R. 6, SUPPORT for Patients and Communities Act. (P.L. 115-271) H.R. 849, Protecting Seniors' Access to Medicare Act of 2017. H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act. H.R. 1316, Prescription Drug Price Transparency Act. H.R. 1628, American Health Care Act of 2017. H.R. 1703, Medical Product Communications Act of 2017. H.R. 1898, To improve access to, and utilization of, bone mass measurement benefits. H.R. 1920, To amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes. H.R.2077, Restoring the Patient's Voice Act of 2017. H.R. 2141, Conrad State 30 and Physician Access Reauthorization Act. H.R. 2267, Resident Physician Shortage Reduction Act of 2017. H.R. 2641, Promoting Life-Saving New Therapies for Neonates Act of 2017. H.R. 2999, Patients' Access to Treatments Act of 2017. H.R. 3635, Local Coverage Determination Clarification Act of 2017. H.R. 3728, EMPOWER Act of 2017. H.R. 3767, Ensuring Children's Access to Specialty Care Act of 2017. H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018. H.R. 5150, Protecting Medicare from Excessive Price Increases Act of 2018. H.R.6157, Defense and Labor, Health and Human Services Consolidated Appropriations Act, 2019. (P.L. 115-245) H.R. 6470, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019. S. 251, Protecting Medicare from Executive Action Act of 2017. S. 260, Protecting Seniors' Access to Medicare Act of 2017. S. 637, Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017. S. 794, Local Coverage Determination Clarification Act of 2017. S. 898, Conrad State 30 and Physician Access Reauthorization Act. S. 989, Ensuring Children's Access to Specialty Care Act of 2017. S. 1301, Resident Physician Shortage Reduction Act of 2017. S. 1304, A bill to amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes. S. 2553, Know the Lowest Price Act of 2018 (P.L. 115-262). S. 2554, Patient Right to Know Drug Prices Act (P.L. 115-263). S. 2908, To provide for electronic prior authorization under Medicare part D for covered part D drugs, and for other purposes. S. 3158, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019. S. 3159, Department of Defense Appropriations Act, 2019. S. 3160, To improve access to, and utilization of, bone mass measurement benefits.

Client expense: Not reported · Firm income: $60,000

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

Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor federal and legislative activity related to Medicare Reimbursement. Monitor federal issues and legislation associated with health care policy. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of 21st Century Cures Act (P.L. 114-255). H.J. Res. 143, Continuing appropriations for fiscal year 2019. (P.L. 115-298) H.R. 6, SUPPORT for Patients and Communities Act. (P.L. 115-271) H.R. 849, Protecting Seniors' Access to Medicare Act of 2017. H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act. H.R. 1316, Prescription Drug Price Transparency Act. H.R. 1628, American Health Care Act of 2017. H.R. 1703, Medical Product Communications Act of 2017. H.R. 1898, To improve access to, and utilization of, bone mass measurement benefits. H.R. 1920, To amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes. H.R.2077, Restoring the Patient's Voice Act of 2017. H.R. 2141, Conrad State 30 and Physician Access Reauthorization Act. H.R. 2267, Resident Physician Shortage Reduction Act of 2017. H.R. 2641, Promoting Life-Saving New Therapies for Neonates Act of 2017. H.R. 2999, Patients' Access to Treatments Act of 2017. H.R. 3635, Local Coverage Determination Clarification Act of 2017. H.R. 3728, EMPOWER Act of 2017. H.R. 3767, Ensuring Children's Access to Specialty Care Act of 2017. H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018. H.R. 5150, Protecting Medicare from Excessive Price Increases Act of 2018. H.R.6157, Defense and Labor, Health and Human Services Consolidated Appropriations Act, 2019. (P.L. 115-245) H.R. 6470, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019. S. 251, Protecting Medicare from Executive Action Act of 2017. S. 260, Protecting Seniors' Access to Medicare Act of 2017. S. 637, Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017. S. 794, Local Coverage Determination Clarification Act of 2017. S. 898, Conrad State 30 and Physician Access Reauthorization Act. S. 989, Ensuring Children's Access to Specialty Care Act of 2017. S. 1301, Resident Physician Shortage Reduction Act of 2017. S. 1304, A bill to amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes. S. 2553, Know the Lowest Price Act of 2018 (P.L. 115-262). S. 2554, Patient Right to Know Drug Prices Act (P.L. 115-263). S. 2908, To provide for electronic prior authorization under Medicare part D for covered part D drugs, and for other purposes. S. 3158, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019. S. 3159, Department of Defense Appropriations Act, 2019. S. 3160, To improve access to, and utilization of, bone mass measurement benefits.

Client expense: Not reported · Firm income: $60,000

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

Health care reform, Hospital related issues and initiatives. Medicaid 1115 Waiver S.2051/H.R.4206, Medicare Care Coordinator Improvement Act H.R.4392, To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes. S.1301/H.R.2267, Resident Physician Shortage Reduction Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

American Health Care Act of 2017 (HR 1628) Health Care Safety Net Enhancement Act (HR 548) Congenital Heart Futures Reauthorization Act (S 477/HR 1222) USPSTF Transparency and Accountability Act (HR 539) Protecting Access to Care Act of 2017 (HR 1215) Resident Physician Shortage Reduction Act of 2017 (HR2267/S.1301) Prohibit Smoking in VA Facilities Act (H.R.1662) The Veterans Affairs Medical Scribe Pilot Act of 2017 (H.R. 1848) Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Medicare Access and CHIP Reauthorization Act of 2015 Implementation, Medicare Physician Payment Reform, MEDPAC, surgical global payments, Affordable Care Act Implementation, Affordable Care Act Repeal & Replace, health care reform, health care quality improvement, physician workforce, comparative effectiveness research, health information technology, EHR meaningful use, EHR data blocking, Patient-Centered Outcomes Research Institute, MEDCAC, Centers for Medicare & Medicaid Innovation, registry access to Medicare claims data, Social Security Death Master File, lung cancer screenings, AHRQ funding, USPSTF, Graduate Medical Education, electronic cigarette and cigar regulation, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Proposed Medical Device Surveillance System, Meaningful Use, Congenital Heart Disease Funding, Unique Device Identifiers, Medical Liability Reform, essential health benefits, tobacco riders in appropriations bills, tobacco regulation in the FDA, Evaluation and Management coding collapse, price transparency, ECMO coding

Client expense: $84,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), SENATE, Social Security Administration (SSA)

H.R. 2267 Internet Gambling Regulation, Consumer Protection and Enforcement Act H.R. 2266 Reasonable Prudence in Regulations Act

Client expense: $354,488 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Policies impacting Medicare coverage and reimbursement for clinical laboratory services. Implementation of the Affordable Care Act (P.L.111-148). Medicare and Medicaid funding for graduate medical education. FDA regulation of Laboratory-Developed Tests (LDTs). Medicaid safety-net issues. S.3120, HEAL Act of 2018. H.R.6, SUPPORT for Patients and Communities Act. S.3014, Rural Physician Workforce Production Act of 2018. H.R.2267/S.1301, Resident Physician Shortage Reduction Act of 2017.

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

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

Issues related to hospital and related provider reimbursement, outpatient hospital payment restrictions, disproportionate share hospitals, graduate medical education, delivery system reforms, and site neutrality payment policies; H.R.2267/S.1301, Resident Physician Shortage Reduction Act of 2017.

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

Government targets: HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

Issues related to hospital and other provider-related reimbursement, including: graduate medical education, value-based purchasing programs, post acute care, and inclusion of unique device identifiers on claims; H.R.2267/S.1301, Resident Physician Shortage Reduction Act of 2017.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Hospital and Medicaid issues related to repeal and replace of the Affordable Care Act (ACA), including opposition to the American Health Care Act (House), the Better Care Reconciliation Act (Senate), the Graham-Cassidy-Heller-Johnson bill, and President Trumps FY 2019 Budget Proposal. Graduate Medical Education (GME) issues, including the Resident Physician Shortage Reduction Act of 2017 (support) (H.R. 2267/S. 1301), the Opioid Workforce Act of 2018 (support) (H.R. 5818/S. 2843), and the cuts and changes to Medicare and Medicaid GME programs in President Trumps FY 2019 budget proposal (oppose). Medicaid Disproportionate Share Hospital (DSH) cuts issues, including supporting the inclusion of a DSH cut delay in the Bipartisan Budget Act of 2018 (support) (H.R. 1892) and the continuation of DSH cuts in President Trumps FY 2019 Budget Proposal (oppose). Provide comments to CMS and OMB to advocate for a delay in further use of S-10 data for allocation of the Medicare DSH uncompensated care pool. Oppose legislation and regulations that would harm the 340B Drug Discount Program, including the cuts outlined in President Trumps FY 2019 Budget Proposal. Provide comments to CMS addressing payments to off-campus hospital outpatient departments. Support legislation to reverse the cuts to the 340B Drug Discount Program in CMS Final 2017 OPPS Rule, the SERV Communities Act (support) (H.R. 6071) and H.R. 4392 (support) Support Federal funding for Puerto Ricos Medicaid program and for Medicaid for individuals and families displaced by hurricanes. Oppose legislation that would harm Medicaid GME programs including the Medicaid Graduate Medical Education Transparency Act (oppose). Support legislation to repeal the Medicaid IMD exclusion, the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act (support) (H.R. 5797), and support the inclusion of the legislation in the SUPPORT for Patients and Communities Act (support) (H.R. 6) and the Opioid Crisis Response Act of 2018 (support) (S. 2680). Support the inclusion of legislation to increase GME funding, the Opioid Workforce Act of 2018 (support) (H.R. 5818/S. 2843), in the SUPPORT for Patients and Communities Act (support) (H.R. 6) and the Opioid Crisis Response Act of 2018 (support) (S. 2680). Oppose the FY 2020-2025 Medicaid DSH cuts, and support proposals that would delay or repeal the scheduled cuts. Support legislative proposals to reverse the site-neutral provisions in the CMS OPPS final rule for 2019. Oppose 340b and site-neutral provisions in the CMS OPPS proposed and final rules for 2019. Sent comment letter to HHS regarding its OPPS proposed rule for CY 2019. The letter addressed issues related to site-neutral policies, 340B, WAC-based payments, packaging for non-opioid pain treatments, and changes to the IPO list, among other topics.

Client expense: $580,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Office of Management & Budget (OMB), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

Hospital and Medicaid issues related to repeal and replace of the Affordable Care Act (ACA), including opposition to The American Health Care Act (House), the Better Care Reconciliation Act (Senate) (H.R. 1628), the Graham-Cassidy-Heller-Johnson bill, and the Trump Administration's FY 2019 budget proposal. Organ donation issues, including the liver transplant allocation system and in support of new proposed UNOS system. Discussions with HHS and DHS regarding cybersecurity issues. Advocated for individual marketplace stabilization measures, including the funding of ACA cost sharing reduction payments in standalone legislation and in FY 2018 funding legislation. Graduate Medical Education (GME) issues, including the Resident Physician Shortage Reduction Act of 2017 (support) (H.R. 2267/S. 1301), the Opioid Workforce Act of 2018 (support) (H.R. 5818/S. 2843), the Medicaid Graduate Medical Education Transparency Act (oppose), and the cuts and changes to Medicare and Medicaid GME programs in President Trumps FY 2019 budget proposal (oppose). Support the inclusion of legislation to increase GME funding, the Opioid Workforce Act of 2018 (support) (H.R. 5818/S. 2843), in the SUPPORT for Patients and Communities Act (support) (H.R. 6) and the Opioid Crisis Response Act of 2018 (support) (S. 2680). Support legislation to repeal the Medicaid IMD exclusion, the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act (support) (H.R. 5797), and support the inclusion of the legislation in the SUPPORT for Patients and Communities Act (support) (H.R. 6) and the Opioid Crisis Response Act of 2018 (support) (S. 2680). Support legislation to align 42 CFR Part 2 regulations with the Health Insurance Portability and Accountability Act (HIPAA), The Overdose Prevention and Patient Safety Act (support) (H.R. 6082), and support the inclusion of the legislation in the SUPPORT for Patients and Communities Act (support) (H.R. 6) and the Opioid Crisis Response Act of 2018 (support) (S. 2680). Support the SUPPORT for Patients and Communities Act (support) (H.R. 6). Support the Opioid Crisis Response Act of 2018 (support) (S. 2680). Lobby HHS, HRSA, OPTN and UNOS on liver allocation reforms. Support liver allocation reforms, including the Fairness in Liver Allocation Act (support) (H.R. 6517). Oppose legislation to amend the National Organ Transplant Act, the National Organ Transplant Act Amendments of 2018 (oppose) (H.R. 6458), and the inclusion of language that would amend the National Organ Transplant Act in the Labor-HHS appropriations bill (H.R. 6157). Oppose the FY 2020-2025 Medicaid DSH cuts, and support proposals that would delay or repeal the scheduled cuts. Support proposals that would increase funding levels for programs related to hospital infrastructure, access to capital, workforce issues, health information technology, and telehealth. Support legislative proposals to reverse the site-neutral provisions in the CMS OPPS final rule for 2019. Oppose 340b and site-neutral provisions in the CMS OPPS proposed and final rules for 2019. Raise awareness about surprise billing laws on both the federal and state levels.

Client expense: $580,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Office of Management & Budget (OMB), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

H.R. 2267, S. 1301, Resident Physician Shortage Reduction Act of 2017, Issues pertaining to Graduate Medical Education. Issues pertaining to protecting Medicaid.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to funding for medical research; Health care delivery system reforms. Funding for graduate medical education. H.R. 2267/S. 1301, Resident Physician Shortage Reduction Act of 2017, FY19 appropriations for NIH funding; general opioid issues, H.R. 6 SUPPORT Patients and Communities Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Indirect and Direct Medical Education adjustment for teaching hospitals (GME) Resident Physician Shortage Reduction Act of 2017 (H.R. 2267/S.1301) Opioid Workforce Act of 2018 (H.R. 5818/S. 2843)

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

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

Issues related to implementation of PPACA (PL: 111-148) and its impact on hospitals; Funding for graduate medical education. H.R. 2267/S. 1301, Resident Physician Shortage Reduction Act of 2017. Liver Allocation Fairness Act, H.R. 6517

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

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

H.R. 1173/S. 448, the Medicare Mental Health Access Act H.R. 849, the Protecting Seniors Access to Medicare Act S. 1301/H.R. 2267, the Resident Physician Shortage Reduction Act H.R. 2276/S. 2575, the Audiology Patient Choice Act H.R. 5594, the Improving Access to Remote Behavioral Health Treatment Act of 2018 S. 2680, the Opioid Crisis Response Act of 2018 H.R. 6, the SUPPORT for Patients and Communities Act H.R. 1925, the At-Risk Youth Medicaid Protection Act H.R. 2509, the Medicare Mental Health Inpatient Equity Act S. 1169, the Medicaid Coverage for Addiction Recovery Expansion Act H.R. 2687, the Medicaid Coverage for Addiction Recovery Expansion Act H.R. 4005, the Medicaid Reentry Act H.R. 4097, the Medicare Beneficiary Opioid Addiction Treatment Act S. 2843/H.R. 5818, the Opioid Workforce Act of 2018 Comments re: the Centers for Medicare & Medicaid Services (CMS) decision to suspend the risk adjustment payments to insurers participating in the individual and small-group marketplaces, as mandated by the Affordable Care Act Support for S.J.Res.63, a joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to "Short-Term, Limited Duration Insurance. Comments re: CMSs proposed rule, Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2019. CMS-1693-P Comments re: CMSs proposed rule, Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations-Pathways to Success. Comments re: CMSs proposed rule, Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations-Pathways to Success Comment on the CY 2019 Proposed Rule for the Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction. Issue relating to suicide prevention; in general Issues relating to the enforcement of mental health parity; in general

Client expense: $250,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Immigration & Customs Enforcement (ICE), Veterans Affairs, Dept of (VA)

Disproportionate share hospital payments Telehealth Payment Hospital outpatient payment policy Stark law reform H.R. 2267/S. 1301 - Resident Physician Shortage Reduction Act H.R. 5818/S. 2843 - Opioid Workforce Act Hospital outpatient payment policy Site neutral payment policy included in outpatient prospective payment system proposed rule Physician fee schedule proposed rule

Client expense: $290,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 114-10 - Medicare and CHIP Reauthorization Act of 2017 Implementation H.R. 6 - SUPPORT for Patients and Communities Act H.R. 5507 - Critical Access Hospital Relief Act of 2018 H. R. 5809 - Postoperative Opioid Prevention Act of 2018 H.R 4143/S. 2065 - Dialysis PATIENTS Demonstration Act of 2017 S. 2852/H.R. 6378 - Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 (PAHPAI) H.R. 5385 - Children's Hospital GME Support Reauthorization Act of 2018 S. 2809 - A bill to amend title XVIII of the Social Security Act to provide for electronic prior authorization under Medicare part D for covered part D drugs, and for other purposes. H.R. 5106 - Investor Choice Against Gun Proliferation Act H.R.1057 - STOP Act of 2017 H.R. 1822, 1876/S. 781 - Good Samaritan Health Professionals Act of 2017 H.R. 880/S. 1022 - Mission Zero Act H.R. 1017/S. 479 - Removing Barriers to Colorectal Cancer Screening Act of 2017 H.R. 820/S. 292 - Childhood Cancer STAR Act H.R. 5160 - Cancer Care Planning and Communications Act of 2018 H.R. 1704 - ACCESS Act of 2017 H.R. 2267 - Resident Physician Shortage Reduction Act of 2017 H.R. 1676/S. 693 - Palliative Care and Hospice Education and Training Act H.R. 4909/S. 2495 - STOP School Violence Act of 2018 H.R. 4841 - Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018 H.R. 4206/S. 2051 - Medicare Care Coordination Improvement Act H.R. 1892 - Bipartisan Budget Act of 2018 H.R. 1625 - Omnibus H.R. 2906/S. 1351 - Ensuring Access to General Surgery Act of 2017 H.R. 4434/S.2135 - Fix NICS Act of 2017 H.R. 548/S. 527 - Health Care Safety Net Enhancement Act of 2017 H.R. 849/S. 260, S. 251 - Protecting Seniors' Access to Medicare Act of 2017 H.R. 2843/S.1317 - Medicaid and CHIP Quality Improvement Act of 2017 H.R. 3120 - Electronic Health Record Meaningful Use H.R. 2276/S.2575 - Audiology Patient Choice Act of 2018 H.R. 6157 - Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 H.R. 6545 - Violence Against Women Reauthorization Act of 2018 H.R. 6808 - Patient Navigation Assistance Act of 2018 H.R.4897 - Women and Lung Cancer Research and Preventive Services Act of 2018 H.R. 930/S. 497 - Lymphedema Treatment Act H.R. 7083 - Access to Genetic Counselor Services Act of 2018 H.R. 1318 - Preventing Maternal Deaths Act of 2018 Medicaid GME Transparency Act Bleeding Control for the Injured (Stop The Bleed campaign) Injury Prevention Initiatives Childrens Health Insurance Program Reauthorization Cancer Research and Funding Opioids EHR Clinician Burden/Administrative Burden Mis-valued Codes Medicare Sequestration Congenital Anomalies Global Codes Qualified clinical data registry (QCDR) Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) VA Health Issues DOD Health Issues The Emergency Medical Services for Children Program MIPS cost measure development E-Prior Authorization Digital health systems Sports Medicine Firearms Research Hospital-based violence intervention programs National Trauma System (Military-Civilian Trauma Care) Visa Denial Medicare Fraud Surprise Billing Draft Legislation Stark Law Reform and Medicare Administrative Burden relief Alternative Payment Models (APMs) Physician Fee Schedule Quality Payment Program (QPP) Out-of-Network billing Narrow networks/Network Adequacy Hospital-based Violence Intervention Programs Out of the Crucible: U.S. Military Combat Casualty Care principles

Client expense: $16,092 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Veterans Affairs, Dept of (VA)

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 114-10 - Medicare and CHIP Reauthorization Act of 2017 Implementation H.R. 6 - SUPPORT for Patients and Communities Act H.R. 5507 - Critical Access Hospital Relief Act of 2018 H. R. 5809 - Postoperative Opioid Prevention Act of 2018 H.R 4143/S. 2065 - Dialysis PATIENTS Demonstration Act of 2017 S. 2852/H.R. 6378 - Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 (PAHPAI) H.R. 5385 - Children's Hospital GME Support Reauthorization Act of 2018 S. 2809 - A bill to amend title XVIII of the Social Security Act to provide for electronic prior authorization under Medicare part D for covered part D drugs, and for other purposes. H.R. 5106 - Investor Choice Against Gun Proliferation Act H.R.1057 - STOP Act of 2017 H.R. 1822, 1876/S. 781 - Good Samaritan Health Professionals Act of 2017 H.R. 880/S. 1022 - Mission Zero Act H.R. 1017/S. 479 - Removing Barriers to Colorectal Cancer Screening Act of 2017 H.R. 820/S. 292 - Childhood Cancer STAR Act H.R. 5160 - Cancer Care Planning and Communications Act of 2018 H.R. 1704 - ACCESS Act of 2017 H.R. 2267 - Resident Physician Shortage Reduction Act of 2017 H.R. 1676/S. 693 - Palliative Care and Hospice Education and Training Act H.R. 4909/S. 2495 - STOP School Violence Act of 2018 H.R. 4841 - Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018 H.R. 4206/S. 2051 - Medicare Care Coordination Improvement Act H.R. 1892 - Bipartisan Budget Act of 2018 H.R. 1625 - Omnibus H.R. 2906/S. 1351 - Ensuring Access to General Surgery Act of 2017 H.R. 4434/S.2135 - Fix NICS Act of 2017 H.R. 548/S. 527 - Health Care Safety Net Enhancement Act of 2017 H.R. 849/S. 260, S. 251 - Protecting Seniors' Access to Medicare Act of 2017 H.R. 2843/S.1317 - Medicaid and CHIP Quality Improvement Act of 2017 H.R. 3120 - Electronic Health Record Meaningful Use H.R. 2276/S.2575 - Audiology Patient Choice Act of 2018 H.R. 6157 - Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 H.R. 6545 - Violence Against Women Reauthorization Act of 2018 H.R. 6808 - Patient Navigation Assistance Act of 2018 H.R.4897 - Women and Lung Cancer Research and Preventive Services Act of 2018 H.R. 930/S. 497 - Lymphedema Treatment Act H.R. 7083 - Access to Genetic Counselor Services Act of 2018 H.R. 1318 - Preventing Maternal Deaths Act of 2018 Medicaid GME Transparency Act Bleeding Control for the Injured (Stop The Bleed campaign) Injury Prevention Initiatives Childrens Health Insurance Program Reauthorization Cancer Research and Funding Opioids EHR Clinician Burden/Administrative Burden Mis-valued Codes Medicare Sequestration Congenital Anomalies Global Codes Qualified clinical data registry (QCDR) Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) VA Health Issues DOD Health Issues The Emergency Medical Services for Children Program MIPS cost measure development E-Prior Authorization Digital health systems Sports Medicine Firearms Research Hospital-based violence intervention programs National Trauma System (Military-Civilian Trauma Care) Visa Denial Medicare Fraud Surprise Billing Draft Legislation Stark Law Reform and Medicare Administrative Burden relief Alternative Payment Models (APMs) Physician Fee Schedule Quality Payment Program (QPP) Out-of-Network billing Narrow networks/Network Adequacy Hospital-based Violence Intervention Programs Out of the Crucible: U.S. Military Combat Casualty Care principles

Client expense: $16,092 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Veterans Affairs, Dept of (VA)

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 114-10 - Medicare and CHIP Reauthorization Act of 2017 Implementation H.R. 6 - SUPPORT for Patients and Communities Act H.R. 5507 - Critical Access Hospital Relief Act of 2018 H. R. 5809 - Postoperative Opioid Prevention Act of 2018 H.R 4143/S. 2065 - Dialysis PATIENTS Demonstration Act of 2017 S. 2852/H.R. 6378 - Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 (PAHPAI) H.R. 5385 - Children's Hospital GME Support Reauthorization Act of 2018 S. 2809 - A bill to amend title XVIII of the Social Security Act to provide for electronic prior authorization under Medicare part D for covered part D drugs, and for other purposes. H.R. 5106 - Investor Choice Against Gun Proliferation Act H.R.1057 - STOP Act of 2017 H.R. 1822, 1876/S. 781 - Good Samaritan Health Professionals Act of 2017 H.R. 880/S. 1022 - Mission Zero Act H.R. 1017/S. 479 - Removing Barriers to Colorectal Cancer Screening Act of 2017 H.R. 820/S. 292 - Childhood Cancer STAR Act H.R. 5160 - Cancer Care Planning and Communications Act of 2018 H.R. 1704 - ACCESS Act of 2017 H.R. 2267 - Resident Physician Shortage Reduction Act of 2017 H.R. 1676/S. 693 - Palliative Care and Hospice Education and Training Act H.R. 4909/S. 2495 - STOP School Violence Act of 2018 H.R. 4841 - Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018 H.R. 4206/S. 2051 - Medicare Care Coordination Improvement Act H.R. 1892 - Bipartisan Budget Act of 2018 H.R. 1625 - Omnibus H.R. 2906/S. 1351 - Ensuring Access to General Surgery Act of 2017 H.R. 4434/S.2135 - Fix NICS Act of 2017 H.R. 548/S. 527 - Health Care Safety Net Enhancement Act of 2017 H.R. 849/S. 260, S. 251 - Protecting Seniors' Access to Medicare Act of 2017 H.R. 2843/S.1317 - Medicaid and CHIP Quality Improvement Act of 2017 H.R. 3120 - Electronic Health Record Meaningful Use H.R. 2276/S.2575 - Audiology Patient Choice Act of 2018 H.R. 6157 - Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 H.R. 6545 - Violence Against Women Reauthorization Act of 2018 H.R. 6808 - Patient Navigation Assistance Act of 2018 H.R.4897 - Women and Lung Cancer Research and Preventive Services Act of 2018 H.R. 930/S. 497 - Lymphedema Treatment Act H.R. 7083 - Access to Genetic Counselor Services Act of 2018 H.R. 1318 - Preventing Maternal Deaths Act of 2018 Medicaid GME Transparency Act Bleeding Control for the Injured (Stop The Bleed campaign) Injury Prevention Initiatives Childrens Health Insurance Program Reauthorization Cancer Research and Funding Opioids EHR Clinician Burden/Administrative Burden Mis-valued Codes Medicare Sequestration Congenital Anomalies Global Codes Qualified clinical data registry (QCDR) Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) VA Health Issues DOD Health Issues The Emergency Medical Services for Children Program MIPS cost measure development E-Prior Authorization Digital health systems Sports Medicine Firearms Research Hospital-based violence intervention programs National Trauma System (Military-Civilian Trauma Care) Visa Denial Medicare Fraud Surprise Billing Draft Legislation Stark Law Reform and Medicare Administrative Burden relief Alternative Payment Models (APMs) Physician Fee Schedule Quality Payment Program (QPP) Out-of-Network billing Narrow networks/Network Adequacy Hospital-based Violence Intervention Programs Out of the Crucible: U.S. Military Combat Casualty Care principles

Client expense: $169,817 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Veterans Affairs, Dept of (VA)

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 114-10 - Medicare and CHIP Reauthorization Act of 2017 Implementation H.R. 6 - SUPPORT for Patients and Communities Act H.R. 5507 - Critical Access Hospital Relief Act of 2018 H. R. 5809 - Postoperative Opioid Prevention Act of 2018 H.R 4143/S. 2065 - Dialysis PATIENTS Demonstration Act of 2017 S. 2852/H.R. 6378 - Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 (PAHPAI) H.R. 5385 - Children's Hospital GME Support Reauthorization Act of 2018 S. 2809 - A bill to amend title XVIII of the Social Security Act to provide for electronic prior authorization under Medicare part D for covered part D drugs, and for other purposes. H.R. 5106 - Investor Choice Against Gun Proliferation Act H.R.1057 - STOP Act of 2017 H.R. 1822, 1876/S. 781 - Good Samaritan Health Professionals Act of 2017 H.R. 880/S. 1022 - Mission Zero Act H.R. 1017/S. 479 - Removing Barriers to Colorectal Cancer Screening Act of 2017 H.R. 820/S. 292 - Childhood Cancer STAR Act H.R. 5160 - Cancer Care Planning and Communications Act of 2018 H.R. 1704 - ACCESS Act of 2017 H.R. 2267 - Resident Physician Shortage Reduction Act of 2017 H.R. 1676/S. 693 - Palliative Care and Hospice Education and Training Act H.R. 4909/S. 2495 - STOP School Violence Act of 2018 H.R. 4841 - Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018 H.R. 4206/S. 2051 - Medicare Care Coordination Improvement Act H.R. 1892 - Bipartisan Budget Act of 2018 H.R. 1625 - Omnibus H.R. 2906/S. 1351 - Ensuring Access to General Surgery Act of 2017 H.R. 4434/S.2135 - Fix NICS Act of 2017 H.R. 548/S. 527 - Health Care Safety Net Enhancement Act of 2017 H.R. 849/S. 260, S. 251 - Protecting Seniors' Access to Medicare Act of 2017 H.R. 2843/S.1317 - Medicaid and CHIP Quality Improvement Act of 2017 H.R. 3120 - Electronic Health Record Meaningful Use H.R. 2276/S.2575 - Audiology Patient Choice Act of 2018 H.R. 6157 - Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 H.R. 6545 - Violence Against Women Reauthorization Act of 2018 H.R. 6808 - Patient Navigation Assistance Act of 2018 H.R.4897 - Women and Lung Cancer Research and Preventive Services Act of 2018 H.R. 930/S. 497 - Lymphedema Treatment Act H.R. 7083 - Access to Genetic Counselor Services Act of 2018 H.R. 1318 - Preventing Maternal Deaths Act of 2018 Medicaid GME Transparency Act Bleeding Control for the Injured (Stop The Bleed campaign) Injury Prevention Initiatives Childrens Health Insurance Program Reauthorization Cancer Research and Funding Opioids EHR Clinician Burden/Administrative Burden Mis-valued Codes Medicare Sequestration Congenital Anomalies Global Codes Qualified clinical data registry (QCDR) Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) VA Health Issues DOD Health Issues The Emergency Medical Services for Children Program MIPS cost measure development E-Prior Authorization Digital health systems Sports Medicine Firearms Research Hospital-based violence intervention programs National Trauma System (Military-Civilian Trauma Care) Visa Denial Medicare Fraud Surprise Billing Draft Legislation Stark Law Reform and Medicare Administrative Burden relief Alternative Payment Models (APMs) Physician Fee Schedule Quality Payment Program (QPP) Out-of-Network billing Narrow networks/Network Adequacy Hospital-based Violence Intervention Programs Out of the Crucible: U.S. Military Combat Casualty Care principles

Client expense: $169,817 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Veterans Affairs, Dept of (VA)

Preserve Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes. Improve Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Veterans Care: Regarding the VA Mission Act of 2018 (H.R. 5674), the College urged Congress to ensure that veterans have access to timely, contiguous care across the spectrum of health care services, with coordination and management of that care in the hands of a primary clinician or clinical care team; that the expansion of care to non-VHA facilities does not come at the cost of maintaining or improving existing VHA services or infrastructure; and that recruitment and retention of clinicians to the VHA is valued appropriately, including reimbursement for services provided; Advocated with Congress on the need for adequate funding for the VHA for FY2019 and the long-term. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically by develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expanding cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introducing legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care; Supporting $690 million in discretionary funding for federal exchanges within CMS Program Operations as part of the FY2019 Labor, Health and Human Services, and Education Appropriations bill. Reduce Unnecessary Administrative Tasks on Physicians and Patients: Congress should accelerate its efforts to reduce administrative burdens on clinicians and patients, including: Passing the Standardizing Electronic Prior Authorization for Safe Prescribing Act (H.R. 4841), which standardizes electronic prior authorization for prescription drugs under Medicare Part D. Adopt even greater harmonization of such standards across the health care industry; Passing the CONNECTIONS Act (H.R. 5812) by Reps. Griffith (R-VA) and Pallone (D-NJ) that would authorize CDC grants to state-run PDMPs to improve data collection and integration into physician clinical workflow specifically, of controlled substances overdose prevention and surveillance activities; Urging health care committees in Congress with jurisdiction over Medicare to exercise their oversight authority of CMS effort to overhaul clinical documentation guidelines with input from practicing clinicians; Passing the Improving Access to Medicare Coverage Act of 2017 (S. 568/H.R. 1421), which deems patients under observation as inpatients for the purposes of satisfying the Medicare 3-day inpatient stay requirement. Health Information Technology (HIT): The College provided feedback on the Centers for Disease Control and Prevention (CDC) Request for Information (RFI) Regarding a National Test Collaborative (NTC), which sought approaches for developing a NTC that would allow for the field testing of health information technology (HIT) in a live clinical setting; expressed concern that building an entirely new testing network will be prohibitively difficult and execution could go wrong unless it is carefully designed, piloted, and tested. Emailing and conference calling with every level of every organization is labor intensive and getting participants engaged in this process will be an enormous effort; urged the need to address the patient privacy issues associated with production settings. These privacy issues may cause concern amongst hospitals and may prevent them from wanting to participate unless addressed; recommended that CDC consider building a CDC-Vendor-End User communication methodology that may be a more manageable undertaking utilizing existing infrastructures. Such a system could allow for CDC to notify EHR vendors who would notify product users when they receive an alert or guidance from CDC, using a process similar to how software updates are released. This approach does not require the sharing of protected health information nor does it require direct access into the production system. Reduce Prescription Drug Costs: Congress should increase transparency and accountability in prescription drug pricing and improve access to lower-cost generic medications by passing the Drug Price Transparency in Communications Act (S. 2157), which would require drug companies to disclose the Wholesale Acquisition Cost of an Rx in Direct-to-Consumer Advertising. Representatives should introduce the companion bill; Passing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2017 (S. 974/H.R. 2212), which would improve patient access to alternative low-cost prescription drugs and biological products by preventing prescription drug manufacturers from misusing the FDAs Risk Evaluation and Mitigation Strategies (REMS) process to make it difficult for competing generics to be brought to the market; Passing the Medicare Prescription Drug Price Negotiation Act of 2017 (S. 41/H.R. 242), which would grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for high�cost drugs and biologics covered under Part D; Passing the Fair Accountability and Innovative Research (FAIR) Pricing Act (S. 1131/H.R. 2439), which would require drug manufacturers to disclose and provide more information about planned drug price increases, including R&D costs. Fund Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2019 for federal programs/initiatives designed to support primary care and reject funding rescissions that would harm childrens health coverage or CMS Innovation Center. This includes funding the Primary Care and Training Enhancement (PCTE) at $71 million in order to maintain and expand the pipeline for individuals training in primary care; Funding the National Health Service Corps (NHSC) at least at $415 million in total program funding to fund scholarships and loan repayment to health care professionals to help expand the countrys primary care workforce and meet the health care needs of underserved communities; Funding the Centers for Disease Control and Prevention (CDC) and Prevention and Public Health Fund (PPHF) at $8.45 billion; including PPHF funding at $805 million; Funding the Agency for Healthcare Research and Quality (AHRQ) at $454 million, restoring the agency to its FY2010 enacted level adjusting for inflation after cuts in FY2016 and FY2017 and a small increase in FY2018 so it can help clinicians help patients by making evidence-informed decisions, fund research that serves as the evidence engine for much of the private sectors work to keep patients safe; Funding the National Institutes of Health (NIH) at $39 billion so that this nations biomedical research can continue to fund cures for disease and maintain the U.S. standing as the world leader in medical and biomedical research. Promote Continued Action to Address the Epidemic of Opioid Use: Congress should pass a comprehensive legislative package to improve prevention, education, treatment and recovery for those suffering from opioid-related addictions, including: Providing for sufficient and increased funding to address the opioid epidemic, building and expanding upon the $4.65 billion in the omnibus bill approved by Congress, with at least $1 billion for programs as authorized by CARA 2.0; Expanding access and coverage for medication assisted treatment (methadone, buprenorphine, and naltrexone to prevent opioid and substance use disorders; Rejecting any proposal to impose a three day prescribing limit for initial opioid prescriptions to ensure that doctors have appropriate flexibility to determine the proper duration of each opioid prescription; Passing the Comprehensive Addiction and Recovery Act 2.0 of 2018 (S. 2456/H.R. 5311) as a step toward a more comprehensive opioids-related package. Reduce Firearms-Related Injury and Death: Congress should pass the Assault Weapons Ban of 2018 (S. 2095/H.R. 5077), which would ban the sale of high velocity, rapid file assault rifles and large capacity ammunition magazines and bump stocks; Pass the Brady Background Expansion Act (S. 2009), to expand background checks to virtually all firearm sales in the United States; Pass the Stop Illegal Trafficking in Firearms Act of 2017 (S. 1185), and the Stop Straw Purchases Act (H.R. 5134). Both would increase penalties for individuals who unlawfully purchase firearms for other persons who are prohibited from possessing firearms (known as straw purchasers); Support $50 million in funding for the CDC to conduct such research; Pass S. 834/H.R. 1832 that authorizes funding for the CDC to conduct such research. Make Graduate Medical Education (GME) Funding More Effective: Congress should develop and pass legislation to reform GME to prioritize funding toward physician specialties where millions of patients lack access, including internal medicine specialists trained in comprehensive primary care, to: Increase the number of GME slots by at least 3,000 per year over five years for specialties facing shortages, including internal medicine, as contained in the Resident Physician Shortage Reduction Act of 2017 (S. 1301/H.R. 2267); Combine DGME/IME into a single, more functional program; broaden the GME financing structure to include all payers; Allocate GME funds transparently and to activities that further the educational mission of teaching and training residents/fellows with input from practicing clinicians and in collaboration with their professional organizations; Support continued adequate funding for the VHA and its substantial contributions to the ongoing training of the next generation of physicians. 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP): Commented on CMS final rule on the 2019 PFS and QPP including - Urged additional refinements are needed to the final E/M documentation and payment policies to provide for immediate documentation relief, ensure the needs of complex patients are appropriately addressed, and avert negative downstream consequences; supports separate payment for technology-based communication services but urges the Agency to reconsider patient cost sharing and burdensome consent polices which may prevent uptake of these critical services; appreciates the burden relief that will result from allowing physicians to delegate Appropriate Use Criteria (AUC) consultations to appropriate clinical staff, but reiterates need to reimburse clinicians for the additional time required to conduct these consultations and pilot testing AUC in limited clinical priority areas before deploying on a larger scale to prevent widespread payment disruptions. With regard to QPP, urged greater simplifying of MIPS scoring by basing point values for individual measures on their relative value to the total MIPS score, taking every opportunity to award cross category credit, and instituting a consistent minimum 90-day reporting period across all categories; develop more Advanced APMs, particularly for small and specialty practices; opposes the use of cost measures that are deemed unreliable or inaccurate and urges CMS not to increase the weight of the Cost Category until every measure meets rigorous reliability and accuracy standards; reduce overall number of quality measures and use only those deemed valid, relevant, and reliable, such as those recommended by ACPs Performance Measurement Committee. Public Charge: The College provided comments on the Department of Homeland Securitys Notice of Proposed Rulemaking: Inadmissibility on Public Charge Grounds (DHS Docket No. USCIS-2010-0012). ACP oppose the DHS proposed rule on public charge because if finalized it would put the health of millions of children and families at risk. The proposed changes would expand the number of programs that the federal government would consider in public charge determinations to include Medicaid, the Medicare Part D Low-Income Subsidy Program, the Supplemental Nutrition Assistance Program, and potentially the Childrens Health Insurance Program (CHIP), among others. By widening public charge determinations in this way, the proposed rule would make it much more likely that lawfully present immigrants and those seeking to lawfully immigrate to the U.S. could be denied lawful permanent resident status, be denied visas, or even be deported, merely on the basis of seeking essential health, nutrition, and housing services for themselves or their families. The proposed rule would undermine the physician-patient relationship and disrupt care continuity, and it is antithetical to the Colleges mission to ensure meaningful access to health care for our patients. Immigrant Children and Pregnant Women in U.S. Custody: The College commented to the U.S. Department of Homeland Security that conditions in the U.S. Customs and Border Protection (CBP) custody are inconsistent with evidence-based recommendations for appropriate care and treatment of children and pregnant women. As such, they are not appropriate for children or pregnant women. ACP calls for a full, transparent, and public investigation of Jakelin Caal Maquins (from Guatemala) death and the circumstances surrounding it, as well as any other deaths that may have occurred in CBP or Immigration and Customs Enforcement custody. The College strongly urges the Department of Homeland Security (DHS) to implement specific meaningful steps to ensure that all children and pregnant women in CBP custody receive appropriate medical and mental health screening and necessary follow-up care by trained providers.

Client expense: $249,755 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE

Preserve Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes. Improve Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Veterans Care: Regarding the VA Mission Act of 2018 (H.R. 5674), the College urged Congress to ensure that veterans have access to timely, contiguous care across the spectrum of health care services, with coordination and management of that care in the hands of a primary clinician or clinical care team; that the expansion of care to non-VHA facilities does not come at the cost of maintaining or improving existing VHA services or infrastructure; and that recruitment and retention of clinicians to the VHA is valued appropriately, including reimbursement for services provided; Advocated with Congress on the need for adequate funding for the VHA for FY2019 and the long-term. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically by develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expanding cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introducing legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care; Supporting $690 million in discretionary funding for federal exchanges within CMS Program Operations as part of the FY2019 Labor, Health and Human Services, and Education Appropriations bill. Reduce Unnecessary Administrative Tasks on Physicians and Patients: Congress should accelerate its efforts to reduce administrative burdens on clinicians and patients, including: Passing the Standardizing Electronic Prior Authorization for Safe Prescribing Act (H.R. 4841), which standardizes electronic prior authorization for prescription drugs under Medicare Part D. Adopt even greater harmonization of such standards across the health care industry; Passing the CONNECTIONS Act (H.R. 5812) by Reps. Griffith (R-VA) and Pallone (D-NJ) that would authorize CDC grants to state-run PDMPs to improve data collection and integration into physician clinical workflow specifically, of controlled substances overdose prevention and surveillance activities; Urging health care committees in Congress with jurisdiction over Medicare to exercise their oversight authority of CMS effort to overhaul clinical documentation guidelines with input from practicing clinicians; Passing the Improving Access to Medicare Coverage Act of 2017 (S. 568/H.R. 1421), which deems patients under observation as inpatients for the purposes of satisfying the Medicare 3-day inpatient stay requirement. Health Information Technology (HIT): The College provided feedback on the Centers for Disease Control and Prevention (CDC) Request for Information (RFI) Regarding a National Test Collaborative (NTC), which sought approaches for developing a NTC that would allow for the field testing of health information technology (HIT) in a live clinical setting; expressed concern that building an entirely new testing network will be prohibitively difficult and execution could go wrong unless it is carefully designed, piloted, and tested. Emailing and conference calling with every level of every organization is labor intensive and getting participants engaged in this process will be an enormous effort; urged the need to address the patient privacy issues associated with production settings. These privacy issues may cause concern amongst hospitals and may prevent them from wanting to participate unless addressed; recommended that CDC consider building a CDC-Vendor-End User communication methodology that may be a more manageable undertaking utilizing existing infrastructures. Such a system could allow for CDC to notify EHR vendors who would notify product users when they receive an alert or guidance from CDC, using a process similar to how software updates are released. This approach does not require the sharing of protected health information nor does it require direct access into the production system. Reduce Prescription Drug Costs: Congress should increase transparency and accountability in prescription drug pricing and improve access to lower-cost generic medications by passing the Drug Price Transparency in Communications Act (S. 2157), which would require drug companies to disclose the Wholesale Acquisition Cost of an Rx in Direct-to-Consumer Advertising. Representatives should introduce the companion bill; Passing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2017 (S. 974/H.R. 2212), which would improve patient access to alternative low-cost prescription drugs and biological products by preventing prescription drug manufacturers from misusing the FDAs Risk Evaluation and Mitigation Strategies (REMS) process to make it difficult for competing generics to be brought to the market; Passing the Medicare Prescription Drug Price Negotiation Act of 2017 (S. 41/H.R. 242), which would grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for high�cost drugs and biologics covered under Part D; Passing the Fair Accountability and Innovative Research (FAIR) Pricing Act (S. 1131/H.R. 2439), which would require drug manufacturers to disclose and provide more information about planned drug price increases, including R&D costs. Fund Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2019 for federal programs/initiatives designed to support primary care and reject funding rescissions that would harm childrens health coverage or CMS Innovation Center. This includes funding the Primary Care and Training Enhancement (PCTE) at $71 million in order to maintain and expand the pipeline for individuals training in primary care; Funding the National Health Service Corps (NHSC) at least at $415 million in total program funding to fund scholarships and loan repayment to health care professionals to help expand the countrys primary care workforce and meet the health care needs of underserved communities; Funding the Centers for Disease Control and Prevention (CDC) and Prevention and Public Health Fund (PPHF) at $8.45 billion; including PPHF funding at $805 million; Funding the Agency for Healthcare Research and Quality (AHRQ) at $454 million, restoring the agency to its FY2010 enacted level adjusting for inflation after cuts in FY2016 and FY2017 and a small increase in FY2018 so it can help clinicians help patients by making evidence-informed decisions, fund research that serves as the evidence engine for much of the private sectors work to keep patients safe; Funding the National Institutes of Health (NIH) at $39 billion so that this nations biomedical research can continue to fund cures for disease and maintain the U.S. standing as the world leader in medical and biomedical research. Promote Continued Action to Address the Epidemic of Opioid Use: Congress should pass a comprehensive legislative package to improve prevention, education, treatment and recovery for those suffering from opioid-related addictions, including: Providing for sufficient and increased funding to address the opioid epidemic, building and expanding upon the $4.65 billion in the omnibus bill approved by Congress, with at least $1 billion for programs as authorized by CARA 2.0; Expanding access and coverage for medication assisted treatment (methadone, buprenorphine, and naltrexone to prevent opioid and substance use disorders; Rejecting any proposal to impose a three day prescribing limit for initial opioid prescriptions to ensure that doctors have appropriate flexibility to determine the proper duration of each opioid prescription; Passing the Comprehensive Addiction and Recovery Act 2.0 of 2018 (S. 2456/H.R. 5311) as a step toward a more comprehensive opioids-related package. Reduce Firearms-Related Injury and Death: Congress should pass the Assault Weapons Ban of 2018 (S. 2095/H.R. 5077), which would ban the sale of high velocity, rapid file assault rifles and large capacity ammunition magazines and bump stocks; Pass the Brady Background Expansion Act (S. 2009), to expand background checks to virtually all firearm sales in the United States; Pass the Stop Illegal Trafficking in Firearms Act of 2017 (S. 1185), and the Stop Straw Purchases Act (H.R. 5134). Both would increase penalties for individuals who unlawfully purchase firearms for other persons who are prohibited from possessing firearms (known as straw purchasers); Support $50 million in funding for the CDC to conduct such research; Pass S. 834/H.R. 1832 that authorizes funding for the CDC to conduct such research. Make Graduate Medical Education (GME) Funding More Effective: Congress should develop and pass legislation to reform GME to prioritize funding toward physician specialties where millions of patients lack access, including internal medicine specialists trained in comprehensive primary care, to: Increase the number of GME slots by at least 3,000 per year over five years for specialties facing shortages, including internal medicine, as contained in the Resident Physician Shortage Reduction Act of 2017 (S. 1301/H.R. 2267); Combine DGME/IME into a single, more functional program; broaden the GME financing structure to include all payers; Allocate GME funds transparently and to activities that further the educational mission of teaching and training residents/fellows with input from practicing clinicians and in collaboration with their professional organizations; Support continued adequate funding for the VHA and its substantial contributions to the ongoing training of the next generation of physicians. 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP): Commented on CMS final rule on the 2019 PFS and QPP including - Urged additional refinements are needed to the final E/M documentation and payment policies to provide for immediate documentation relief, ensure the needs of complex patients are appropriately addressed, and avert negative downstream consequences; supports separate payment for technology-based communication services but urges the Agency to reconsider patient cost sharing and burdensome consent polices which may prevent uptake of these critical services; appreciates the burden relief that will result from allowing physicians to delegate Appropriate Use Criteria (AUC) consultations to appropriate clinical staff, but reiterates need to reimburse clinicians for the additional time required to conduct these consultations and pilot testing AUC in limited clinical priority areas before deploying on a larger scale to prevent widespread payment disruptions. With regard to QPP, urged greater simplifying of MIPS scoring by basing point values for individual measures on their relative value to the total MIPS score, taking every opportunity to award cross category credit, and instituting a consistent minimum 90-day reporting period across all categories; develop more Advanced APMs, particularly for small and specialty practices; opposes the use of cost measures that are deemed unreliable or inaccurate and urges CMS not to increase the weight of the Cost Category until every measure meets rigorous reliability and accuracy standards; reduce overall number of quality measures and use only those deemed valid, relevant, and reliable, such as those recommended by ACPs Performance Measurement Committee. Public Charge: The College provided comments on the Department of Homeland Securitys Notice of Proposed Rulemaking: Inadmissibility on Public Charge Grounds (DHS Docket No. USCIS-2010-0012). ACP oppose the DHS proposed rule on public charge because if finalized it would put the health of millions of children and families at risk. The proposed changes would expand the number of programs that the federal government would consider in public charge determinations to include Medicaid, the Medicare Part D Low-Income Subsidy Program, the Supplemental Nutrition Assistance Program, and potentially the Childrens Health Insurance Program (CHIP), among others. By widening public charge determinations in this way, the proposed rule would make it much more likely that lawfully present immigrants and those seeking to lawfully immigrate to the U.S. could be denied lawful permanent resident status, be denied visas, or even be deported, merely on the basis of seeking essential health, nutrition, and housing services for themselves or their families. The proposed rule would undermine the physician-patient relationship and disrupt care continuity, and it is antithetical to the Colleges mission to ensure meaningful access to health care for our patients. Immigrant Children and Pregnant Women in U.S. Custody: The College commented to the U.S. Department of Homeland Security that conditions in the U.S. Customs and Border Protection (CBP) custody are inconsistent with evidence-based recommendations for appropriate care and treatment of children and pregnant women. As such, they are not appropriate for children or pregnant women. ACP calls for a full, transparent, and public investigation of Jakelin Caal Maquins (from Guatemala) death and the circumstances surrounding it, as well as any other deaths that may have occurred in CBP or Immigration and Customs Enforcement custody. The College strongly urges the Department of Homeland Security (DHS) to implement specific meaningful steps to ensure that all children and pregnant women in CBP custody receive appropriate medical and mental health screening and necessary follow-up care by trained providers.

Client expense: $92,631 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE

H.R. 2267 Resident Physician Shortage Reduction Act Organ (liver) Transplant Allocation Site-Neutral Provider Reimbursement 340B Drug Discount Program Graduate Medical Education (GME)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HRSA Geriatric Workforce Enhancement Program funding Continuation of 340B, HRSA Program CMS Hospital Compare- hospital rating methodology CMS rule on site neutral Oppose Hospital Outpatient Department Cuts and Evaluation & Management (E&M) Code Collapse Suport Resident Physician Shortage Reduction Act of 2017 (H.R. 2267, S. 1301), legislation that would provide 15,000 additional Medicare-supported direct graduate medical education (DGME) and indirect medical education (IME) slots over a five year period.

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

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