Overdose Prevention and Patient Safety Act

S.3548, CARES Act: To provide emergency assistance and health care response for individuals, families, and businesses affected by the 2020 coronavirus pandemic; Practice Support/Grants to Practice S.3201, Temporary Reauthorization and Study of the Emergency Scheduling of Fentanyl Analogues Act: Letter to Congressional Leadership regarding Fentanyl Surprise Medical Bills S.2723, Mitigating Emergency Drug Shortages Act: reducing drug shortages H.R. 3502, Protecting People From Surprise Medical Bills Act H.R. 2500, National Defense Authorization Act for Fiscal Year 2020: Krishnamoorthi amdt on drug shortages H.R. 3107, Improving Seniors' Timely Access to Care Act of 2019: pre-authorization S. 1895, Lower Health Care Costs Act H.R. 3692, Addiction Treatment Access Improvement Act of 2017: Medically assisted treatment; opioids H.R. 5761, Ending Maternal Mortality Act of 2018: Maternal mortality H.R. 5718, Perioperative Reduction of Opioids Act: Opioids H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S. 2516, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S.2680, Opioid Crisis Response Act of 2018: Medically assisted treatment; opioids S.2456, CARA 2.0 Act of 2018: Medically assisted treatment; opioids H.R. 1565, Saving Lives, Saving Costs S.1475, Saving Lives, Saving Costs Comprehensive Addiction and Recovery Act of 2016 (PL 114-198) FY 2021 LHHS Appropriations: Fiscal Year 2021 Appropriations for Subcommittee on Labor, Health and Human Services Outside Witness Testimony Affordable Care Act reform efforts H.R. 1628, American Health Care Act of 2017 S. Amdt. 1030 to H.R. 1628, "Graham-Cassidy" Better Care Reconciliation Act of 2017 H.R. 1492, Medical Controlled Substances Transportation Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 3545, Overdose Prevention and Patient Safety Act H.R. 3446, Restoring Board Immunity Act of 2017: Professional Licensing S.2260, Opioids and STOP Pain Initiative ACT:opioids 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care H.R.3928, Truth in Healthcare Marketing Act of 2017 H.R. 1554, REDI Act: student loan debt repayment for residents 21st Century Cures Initiative Drug Shortages - FDA, DEA, HHS, CMS, GAO, House Energy and Commerce Committee, Senate HELP Committee DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management FTC Letters to States re: Interventional Pain Medicine & Advanced Practice Nurses & Competition in Healthcare Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee FDA SMART TOTS - pediatric anesthesia research USP - US Pharmacopeia National Pain Strategy Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Sequestration Opioids and opioid abuse; Brain health Anesthesiologist Assistants Blood management Immigration: Foreign Physician Immigration Status COVID-19: Increased supply of PPE and ventilators,Funding for physician practices impacted by the cancellation of elective surgeries, unique role of anesthesiologists in responding to COVID-19 pandemic, medical liability, Scope of Practice (Waiver of federal supervision requirement under the Emergency Declaration)

Client expense: $340,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

Surprise Medical Bills S.2723, Mitigating Emergency Drug Shortages Act: reducing drug shortages H.R. 3502, Protecting People From Surprise Medical Bills Act H.R. 2500, National Defense Authorization Act for Fiscal Year 2020: Krishnamoorthi amdt on drug shortages H.R. 3107, Improving Seniors' Timely Access to Care Act of 2019: pre-authorization S. 1895, Lower Health Care Costs Act H.R. 3692, Addiction Treatment Access Improvement Act of 2017: Medically assisted treatment; opioids H.R. 5761, Ending Maternal Mortality Act of 2018: Maternal mortality H.R. 5718, Perioperative Reduction of Opioids Act: Opioids H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S. 2516, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S.2680, Opioid Crisis Response Act of 2018: Medically assisted treatment; opioids S.2456, CARA 2.0 Act of 2018: Medically assisted treatment; opioids H.R. 1565, Saving Lives, Saving Costs S.1475, Saving Lives, Saving Costs Comprehensive Addiction and Recovery Act of 2016 (PL 114-198) Affordable Care Act reform efforts H.R. 1628, American Health Care Act of 2017 S. Amdt. 1030 to H.R. 1628, "Graham-Cassidy" Better Care Reconciliation Act of 2017 H.R. 1492, Medical Controlled Substances Transportation Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 3545, Overdose Prevention and Patient Safety Act H.R. 3446, Restoring Board Immunity Act of 2017: Professional Licensing S.2260, Opioids and STOP Pain Initiative ACT:opioids 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care H.R.3928, Truth in Healthcare Marketing Act of 2017 H.R. 1554, REDI Act: student loan debt repayment for residents 21st Century Cures Initiative Drug Shortages - FDA, DEA, HHS, CMS, GAO, House Energy and Commerce Committee, Senate HELP Committee DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management FTC Letters to States re: Interventional Pain Medicine & Advanced Practice Nurses & Competition in Healthcare Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee FDA SMART TOTS - pediatric anesthesia research USP - US Pharmacopeia National Pain Strategy Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Sequestration Opioids and opioid abuse; Brain health Anesthesiologist Assistants Blood management

Client expense: $300,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

Surprise Medical Bills H.R. 3502, Protecting People From Surprise Medical Bills Act H.R. 2500, National Defense Authorization Act for Fiscal Year 2020: Krishnamoorthi amdt on drug shortages H.R. 3107, Improving Seniors' Timely Access to Care Act of 2019: pre-authorization S. 1895, Lower Health Care Costs Act H.R. 3692, Addiction Treatment Access Improvement Act of 2017: Medically assisted treatment; opioids H.R. 5761, Ending Maternal Mortality Act of 2018: Maternal mortality H.R. 5718, Perioperative Reduction of Opioids Act: Opioids H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S. 2516, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S.2680, Opioid Crisis Response Act of 2018: Medically assisted treatment; opioids S.2456, CARA 2.0 Act of 2018: Medically assisted treatment; opioids H.R. 1565, Saving Lives, Saving Costs S.1475, Saving Lives, Saving Costs Comprehensive Addiction and Recovery Act of 2016 (PL 114-198) Affordable Care Act reform efforts H.R. 1628, American Health Care Act of 2017 S. Amdt. 1030 to H.R. 1628, "Graham-Cassidy" Better Care Reconciliation Act of 2017 H.R. 1492, Medical Controlled Substances Transportation Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 3545, Overdose Prevention and Patient Safety Act H.R. 3446, Restoring Board Immunity Act of 2017: Professional Licensing S.2260, Opioids and STOP Pain Initiative ACT:opioids 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care H.R.3928, Truth in Healthcare Marketing Act of 2017 H.R. 1554, REDI Act: student loan debt repayment for residents 21st Century Cures Initiative Drug Shortages - FDA, DEA, HHS, CMS, GAO, House Energy and Commerce Committee, Senate HELP Committee DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management FTC Letters to States re: Interventional Pain Medicine & Advanced Practice Nurses & Competition in Healthcare Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee FDA SMART TOTS - pediatric anesthesia research USP - US Pharmacopeia National Pain Strategy Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Sequestration Opioids and opioid abuse; Brain health Anesthesiologist Assistants Blood management

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

Surprise Medical Bills H.R. 3502, Protecting People From Surprise Medical Bills Act S. 1895, Lower Health Care Costs Act H.R. 3692, Addiction Treatment Access Improvement Act of 2017: Medically assisted treatment; opioids H.R. 5761, Ending Maternal Mortality Act of 2018: Maternal mortality H.R. 5718, Perioperative Reduction of Opioids Act: Opioids H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S. 2516, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S.2680, Opioid Crisis Response Act of 2018: Medically assisted treatment; opioids S.2456, CARA 2.0 Act of 2018: Medically assisted treatment; opioids H.R. 1565, Saving Lives, Saving Costs S.1475, Saving Lives, Saving Costs Comprehensive Addiction and Recovery Act of 2016 (PL 114-198) Affordable Care Act reform efforts H.R. 1628, American Health Care Act of 2017 S. Amdt. 1030 to H.R. 1628, "Graham-Cassidy" Better Care Reconciliation Act of 2017 H.R. 1492, Medical Controlled Substances Transportation Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 3545, Overdose Prevention and Patient Safety Act H.R. 3446, Restoring Board Immunity Act of 2017: Professional Licensing S.2260, Opioids and STOP Pain Initiative ACT:opioids 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care H.R.3928, Truth in Healthcare Marketing Act of 2017 H.R. 1554, REDI Act: student loan debt repayment for residents 21st Century Cures Initiative Drug Shortages - FDA, DEA, HHS, CMS, GAO, House Energy and Commerce Committee, Senate HELP Committee DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management FTC Letters to States re: Interventional Pain Medicine & Advanced Practice Nurses & Competition in Healthcare Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee FDA SMART TOTS - pediatric anesthesia research USP - US Pharmacopeia National Pain Strategy Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Sequestration Opioids and opioid abuse; Brain health Anesthesiologist Assistants

Client expense: $310,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

H.R. 3692, Addiction Treatment Access Improvement Act of 2017: Medically assisted treatment; opioids H.R. 5761, Ending Maternal Mortality Act of 2018: Maternal mortality H.R. 5718, Perioperative Reduction of Opioids Act: Opioids H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S. 2516, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S.2680, Opioid Crisis Response Act of 2018: Medically assisted treatment; opioids S.2456, CARA 2.0 Act of 2018: Medically assisted treatment; opioids H.R. 1565, Saving Lives, Saving Costs S.1475, Saving Lives, Saving Costs Comprehensive Addiction and Recovery Act of 2016 (PL 114-198) Affordable Care Act reform efforts H.R. 1628, American Health Care Act of 2017 S. Amdt. 1030 to H.R. 1628, "Graham-Cassidy" Better Care Reconciliation Act of 2017 H.R. 1492, Medical Controlled Substances Transportation Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 3545, Overdose Prevention and Patient Safety Act H.R. 3446, Restoring Board Immunity Act of 2017: Professional Licensing S.2260, Opioids and STOP Pain Initiative ACT:opioids 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care H.R.3928, Truth in Healthcare Marketing Act of 2017 H.R. 5734, Resident Education Deferred Interest Act: student loan debt repayment for residents 21st Century Cures Initiative Drug Shortages - FDA, DEA, HHS, CMS, GAO, House Energy and Commerce Committee, Senate HELP Committee DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management FTC Letters to States re: Interventional Pain Medicine & Advanced Practice Nurses & Competition in Healthcare Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee FDA SMART TOTS - pediatric anesthesia research USP - US Pharmacopeia National Pain Strategy Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Sequestration Opioids and Opioid abuse; Brain health

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

Blueprint on Drug Pricing State Reinsurance Program H.R. 6 - The Support for Patients and Communities Act HR 4666 - Relief Act of 2017. Costello (R-PA) S 1835 - Lower Premiums through Reinsurance Act of 2017. Collins (R-ME) HR 3545 - Overdose Prevention and Patient Safety Act. Murphy (R-PA) S 1850 - Protecting Jessica Grubbs Legacy Act. Manchin (D-WV) HR 4200 & S 2052 - To provide for temporary funding for health insurance cost-sharing reduction payments and provide targeted tax relief, and for other purposes. HR 2212 & S 974 - Creating and Restoring Equal Access To Equivalent Samples Act of 2017: A bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Marino (R-PA) & Leahy (D-VT) HR 3922 - Community Health And Medical Professionals Improve Our Nation Act of 2017: To extend funding for certain public health programs, and for other purposes. Walden (R-OR) S 1354 - Individual Health Insurance Marketplace Improvement Act: A bill to establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Carper (D-DE) S 1859 - Healthcare Tax Relief Act: A bill to extend the moratorium on the annual fee on health insurance providers. Gardner (R-CO) H.R. 1215 - Protecting Access to Care Act of 2017: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. King (R-IA) H.R.1101 - Small Business Health Fairness Act of 2017: To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. Johnson (R-TX). S. 974 and H.R. 2212 - Creates Act of 2017: To promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Leahy (D-VT) & Marino (R-PA). HR 173 and S 40 - Middle Class Health Benefits Tax Repeal Act of 2017: To amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage. Kelly (R-PA) & Heller (R-NV). HR 708 - State Age Rating Flexibility Act of 2017: To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. Buschon (R-IN). HR 710 -Health Coverage State Flexibility Act of 2017: To amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. Flores (R-TX). HR 749 - Lower Drug Costs through Competition Act: To increase competition in the pharmaceutical industry. Schrader (D-OR) H.R.1121 - Pre-existing Conditions Protection Act of 2017: To amend the Public Health Service Act to prohibit application of pre-existing condition exclusions and to guarantee availability of health insurance coverage in the individual and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable Care Act, and for other purposes. Walden (R-OR). HR 1175 and S 403 - Health Savings Act of 2017: To amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes. Paulsen (R-MN) & Hatch (R-UT). HR 1304 - Self-Insurance Protection Act: To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans. Roe (R-TN) HR 1776 & S 771 Improving Access To Affordable Prescription Drugs Act: To improve access to affordable prescription drugs. Schakowsky (D-IL) & Franken (D-MN) HR 2051 - To amend the Federal Food, Drug, and Cosmetic Act to ensure that eligible product developers have competitive access to approved drugs and licensed biological products, so as to enable eligible product developers to develop and test new products, and for other purposes. McKinley (R-WV) S 191 - Patient Freedom Act of 2017: To improve patient choice by allowing States to adopt market based alternatives to the Affordable Care Act that increase access to affordable health insurance and reduce costs while ensuring important consumer protections and improving patient care. Cassidy (R-LA) S 637 - Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017: To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. Wyden (D-OR) HR - 6082 Overdose Prevention and Patient Safety Act S 2554 Patient Right to Know Drug Prices Act

Client expense: $210,000 · Firm income: Not reported

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

Issues relating to P.L. 111-148, the Patient Protection and Affordable Care Act, and P.L. 111-152, the Health Care and Education Reconciliation Act, including exchanges, cost sharing reduction, market reforms, and non-discrimination provisions. The high cost employer health insurance excise tax, including H.R. 173 and S. 58, the Middle Class Health Benefits Tax Repeal Act of 2017, and H.R. 4616, the Employer Relief Act of 2018, regarding a one-year delay of the Cadillac Tax. H.R. 4620, the Protecting Families and Small Businesses Act of 2017, regarding relief from the Health Insurance Tax. Substance use disorders and 42 CFR Part 2 - Confidentiality of Substance Use Disorder Patient Records, specifically H.R. 3545, H.R. 5795, and H.R.6082, the Overdose Prevention and Patient Safety Act (OPPS Act), H.R. 6, the SUPPORT for Patients and Communities Act, and S. 2680, the Opioid Crisis Response Act of 2018. Issues related to proposed changes to the definition of Employer Under Section 3(5) of ERISA for Association Health Plans. 21st Century Cures Act, section 4004, Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs, information blocking and interoperability.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.6-Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act H.R.1057-Synthetics Trafficking and Overdose Prevention Act of 2017 H.R.1492-Medical Controlled Substances Transportation Act of 2017 H.R.2851-Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017 H.R.3545-Overdose Prevention and Patient Safety (OPPS) Act H.R.4922-Stopping Overdoses of Fentanyl Analogues Act H.R.5176-Preventing Overdoses While in Emergency Rooms Act of 2018 H.R.5197-Alternatives to Opioids (ALTO) in the Emergency Department Act H.R.5531-Opioid Emergency Response Act H.R.5558-Alternatives to Opioids Prescribing Act H.R.6082-Overdose Prevention and Patient Safety (OPPS) Act S.372-Synthetics Trafficking and Overdose Prevention Act of 2017 S.1327-Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017 S.1553-Stopping Overdoses of Fentanyl Analogues Act S.2516-Alternatives to Opioids (ALTO) in the Emergency Department Act S.2609-Recovery Coaches Offer Addiction Counseling and Healing (COACH) Act S.2610-Preventing Overdoses While in Emergency Departments Act of 2018 S.2680-Opioid Crisis Response Act of 2018

Client expense: $549,617 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

Essential emergency medication shortages Mental health services for emergency psychiatric patients Price transparency, out-of-network reimbursement of emergency medical services H.Res.906-Congratulating the American College of Emergency Physicians on its 50th anniversary H.R.6-Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act H.R.372-Competetive Health Insurance Reform Act of 2017 H.R.548-Health Care Safety Net Enhancement Act of 2017 H.R.767-Stop, Observe, Ask, and Respond (SOAR) to Health and Wellness Act of 2017 H.R.817-End Surprise Billing Act of 2017 H.R.880-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act H.R.1057-Synthetics Trafficking and Overdose Prevention Act of 2017 H.R.1215-Protecting Access to Care Act of 2017 H.R.1323-Reducing Unnecessary Emergency Room Visits under Medicaid Act H.R.1492-Medical Controlled Substances Transportation Act of 2017 H.R.1565-Saving Lives, Saving Costs Act H.R.1822-Good Samaritan Health Professionals Act of 2017 H.R.1876-Good Samaritan Health Professionals Act of 2017 H.R.2200-Frederick Douglass Trafficking Victims Prevention and Protection Reauthorization Act of 2017 H.R.2410-Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2017 H.R.2851-Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017 H.R.2957-Save Rural Hospitals Act H.R.3181-Medicare Choices Empowerment and Protection Act H.R.3258-Marketplace Certainty Act H.R.3545-Overdose Prevention and Patient Safety (OPPS) Act H.R.4922-Stopping Overdoses of Fentanyl Analogues Act H.R.5176-Preventing Overdoses While in Emergency Rooms Act of 2018 H.R.5197-Alternatives to Opioids (ALTO) in the Emergency Department Act H.R.5531-Opioid Emergency Response Act H.R.5558-Alternatives to Opioids Prescribing Act H.R.5678-Rural Emergency Medical Center Act of 2018 H.R.5734-Resident Education Deferred Interest Act H.R.6082-Overdose Prevention and Patient Safety (OPPS) Act H.R.6143-Patient Right to Know Drug Prices Act H.R.6144-Know the Lowest Price Act of 2018 H.R.6372-To require the Secretary of Health and Human Services issue regulations to ensure due process rights for physicians furnishing emergency medical services H.R.6502-Reducing Unnecessary Senior Hospitalizations Act of 2018 H.R.6615-Traumatic Brain Injury Program Reauthorization Act of 2018 H.R.6733-Know the Cost Act of 2018 H.R.6748-Emergency Medical Services for Children Program Reauthorization Act of 2018 H.R.7223-Right Rebate Act of 2018 Senate resolution congratulating the American College of Emergency Physicians on its 50th anniversary S.191-Patient Freedom Act of 2017 S.256-SOAR to Health and Wellness Act of 2017 S.284-End Surprise Billing Act of 2017 S.372- Synthetics Trafficking and Overdose Prevention Act of 2017 S.527-Health Care Safety Net Enhancement Act of 2017 S.568-Improving Access to Medicare Coverage Act of 2017 S.781-Good Samaritan Health Professionals Act of 2017 S.1016-Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 S.1022-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act S.1130-Rural Emergency Acute Care Hospital (REACH) Act S.1462-Marketplace Certainty Act S.1530- Medicare Choices Empowerment and Protection Act S.1553-Stopping Overdoses of Fentanyl Analogues Act S.1835-Lower Premiums Through Reinsurance Act of 2017 S.2465-Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2018 S.2516-Alternatives to Opioids (ALTO) in the Emergency Department Act S.2544-Patient Right to Know Drug Prices Act S.2553-Know the Lowest Price Act of 2018 S.2609-Recovery Coaches Offer Addiction Counseling and Healing (COACH) Act S.2610-Preventing Overdoses While in Emergency Departments Act of 2018 S.2680-Opioid Crisis Response Act of 2018 S.3482-Emergency Medical Services for Children Program Reauthorization Act of 2018 S.3531-Emergency Care Improvement Act S.3657-Traumatic Brain Injury Program Reauthorization Act of 2018 S.3702-Right Rebate Act of 2018

Client expense: $549,617 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

Bipartisan Health Care Stabilization Act (Alexander-Murray) - funding for cost sharing reduction benefits, stabilization of individual market Bipartisan Health Care Stabilization Act; updated version (Alexander-Walden-Collins-Costello) - funding for cost sharing reduction benefits and reinsurance, stabilization of individual market S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 581, Jessies Law (Manchin-Capito) - patient history of opioid use disorder S. 1201, Health Care Options for All Act (McCaskill) - coverage options in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction benefits S. 1516, Coverage Across State Lines (Heller) S. 1667, Protecting Consumers from Unreasonable Rates Act (Feinstein) - rate review S. 1835, Lower Premiums Through Reinsurance Act (Collins-Nelson) - invisible high risk pool and reinsurance programs S. 1976, Increasing Access to Care Act (Scott) - copper plan S. 1985, Protect Access to Birth Control Act (Murray) - coverage of contraceptive services S. 2052, Healthcare Market Certainty and Mandate Relief Act (Hatch) - funding for cost sharing reduction benefits, HSA improvements, ACA individual mandate S. 2241 (King) - fees on excepted benefits and standalone dental plans S. 2303, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - calculation of medical loss ratios S. 3388, Ensuring Coverage for Patients with Pre-Existing Conditions Act (Tillis) - protections for individuals with pre-existing conditions S. 3541, Reducing Costs for Out-of-Network Services Act (Shaheen) -cost-sharing for out-of-network services S. 3592, No More Surprise Medical Bills Act (Hassan) - surprise medical bills S. 3742, Cancer Drug Parity Act (Smith) - cost sharing for cancer drugs H.R. 2, Agriculture and Nutrition Act (Conaway) - agricultural association health plans H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 421, Allowing Greater Access to Safe and Effective Contraception Act (Love) - non-prescription contraceptives, HSA flexibility H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 1606, DOC Access Act (Carter) - reimbursement for dental and vision providers H.R. 3450, Protecting Consumers from Unreasonable Rates Act (Schakowsky) - rate review H.R. 3545, Overdose Prevention and Patient Safety Act (Murphy- Blumenauer) -- confidentiality of drug and alcohol treatment and prevention records H.R. 3976, Access to Marketplace Insurance Act (Cramer) - third party payments H.R. 4082, Protect Access to Birth Control Act (DeGette) - coverage of contraceptive services H.R. 4200, Healthcare Market Certainty and Mandate Relief Act (Brady) - funding for cost sharing reduction benefits, HSA improvements H.R. 4225 (Hudson) - fees on excepted benefits and standalone dental plans H.R. 4575, Access to Independent Health Insurance Advisors Act (Long-Schrader) - calculation of medical loss ratios H.R. 4666, Premium Relief Act (Costello) - Patient and State Stability Fund H.R. 4695, Bipartisan Market Stabilization and Innovation Act (Schrader) - stabilization of individual market H.R. 6311, Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act (Roskam) - access to catastrophic plans, definition of qualified health plans H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan H.R. 6496, Continuing Coverage for Preexisting Conditions Act (Joyce) - protections for individuals with pre-existing conditions H.R. 7003, Federal Invisible Risk Sharing Program (Schweikert) Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.

Client expense: $1,550,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office

S 3702/HR 7223 - Tax legislation, provisions regarding generic drugs S 3738/HR 7251 - Patent legislation regarding inter partes review HR 302 - FAA Re-authorization (provisions related to air ambulance services HR 7217 - IMPROVE Act Blueprint on Drug Pricing State Reinsurance Program H.R. 6 - The Support for Patients and Communities Act S 1835 - Lower Premiums through Reinsurance Act of 2017. Collins (R-ME) HR 3545 - Overdose Prevention and Patient Safety Act. Murphy (R-PA) S 1850 - Protecting Jessica Grubbs Legacy Act. Manchin (D-WV) HR 4200 & S 2052 - To provide for temporary funding for health insurance cost-sharing reduction payments and provide targeted tax relief, and for other purposes. HR 2212 & S 974 - Creating and Restoring Equal Access To Equivalent Samples Act of 2017: A bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Marino (R-PA) & Leahy (D-VT) S 1354 - Individual Health Insurance Marketplace Improvement Act: A bill to establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Carper (D-DE) S 1859 - Healthcare Tax Relief Act: A bill to extend the moratorium on the annual fee on health insurance providers. Gardner (R-CO) H.R. 1215 - Protecting Access to Care Act of 2017: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. King (R-IA) H.R.1101 - Small Business Health Fairness Act of 2017: To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. Johnson (R-TX). S. 974 and H.R. 2212 - Creates Act of 2017: To promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Leahy (D-VT) & Marino (R-PA). HR 173 and S 40 - Middle Class Health Benefits Tax Repeal Act of 2017: To amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage. Kelly (R-PA) & Heller (R-NV). HR 708 - State Age Rating Flexibility Act of 2017: To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. Buschon (R-IN). HR 710 -Health Coverage State Flexibility Act of 2017: To amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. Flores (R-TX). HR 749 - Lower Drug Costs through Competition Act: To increase competition in the pharmaceutical industry. Schrader (D-OR) H.R.1121 - Pre-existing Conditions Protection Act of 2017: To amend the Public Health Service Act to prohibit application of pre-existing condition exclusions and to guarantee availability of health insurance coverage in the individual and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable Care Act, and for other purposes. Walden (R-OR). HR 1175 and S 403 - Health Savings Act of 2017: To amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes. Paulsen (R-MN) & Hatch (R-UT). HR 1304 - Self-Insurance Protection Act: To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans. Roe (R-TN) HR 1776 & S 771 Improving Access To Affordable Prescription Drugs Act: To improve access to affordable prescription drugs. Schakowsky (D-IL) & Franken (D-MN) HR 2051 - To amend the Federal Food, Drug, and Cosmetic Act to ensure that eligible product developers have competitive access to approved drugs and licensed biological products, so as to enable eligible product developers to develop and test new products, and for other purposes. McKinley (R-WV) S 191 - Patient Freedom Act of 2017: To improve patient choice by allowing States to adopt market based alternatives to the Affordable Care Act that increase access to affordable health insurance and reduce costs while ensuring important consumer protections and improving patient care. Cassidy (R-LA) S 637 - Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017: To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. Wyden (D-OR) HR - 6082 Overdose Prevention and Patient Safety Act S 2554 Patient Right to Know Drug Prices Act

Client expense: $1,190,000 · Firm income: Not reported

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

Issues relating to P.L. 111-148, the Patient Protection and Affordable Care Act and P.L. 111-152, the Health Care and Education Reconciliation Act, including exchanges, cost sharing reduction, market reforms, and non-discrimination provisions. The high cost employer health insurance excise tax, including H.R. 173 and S. 58, the Middle Class Health Benefits Tax Repeal Act of 2017, and H.R. 4616, the Employer Relief Act of 2018, regarding a one-year delay of the Cadillac Tax. H.R. 4620, the the Protecting Families and Small Businesses Act of 2017, regarding relief from the Health Insurance Tax. Substance use disorders and 42 CFR Part 2 - Confidentiality of Substance Use Disorder Patient Records, specifically H.R. 3545, H.R. 5795, and H.R.6082, the Overdose Prevention and Patient Safety Act (OPPS Act), H.R. 6, the SUPPORT for Patients and Communities Act and S. 2680, the Opioid Crisis Response Act of 2018. Issues related to proposed changes to the definition of Employer Under Section 3(5) of ERISA for Association Health Plans.

Client expense: $1,460,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, U.S. Trade Representative (USTR), White House Office

Essential emergency medication shortages Mental health services for emergency psychiatric patients Price transparency, out-of-network reimbursement of emergency medical services H.Res.906-Congratulating the American College of Emergency Physicians on its 50th anniversary H.R.6-Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act H.R.372-Competetive Health Insurance Reform Act of 2017 H.R.548-Health Care Safety Net Enhancement Act of 2017 H.R.767-Stop, Observe, Ask, and Respond (SOAR) to Health and Wellness Act of 2017 H.R.817-End Surprise Billing Act of 2017 H.R.880-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act H.R.1057-Synthetics Trafficking and Overdose Prevention Act of 2017 H.R.1215-Protecting Access to Care Act of 2017 H.R.1323-Reducing Unnecessary Emergency Room Visits under Medicaid Act H.R.1492-Medical Controlled Substances Transportation Act of 2017 H.R.1565-Saving Lives, Saving Costs Act H.R.1822-Good Samaritan Health Professionals Act of 2017 H.R.1876-Good Samaritan Health Professionals Act of 2017 H.R.2200-Frederick Douglass Trafficking Victims Prevention and Protection Reauthorization Act of 2017 H.R.2410-Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2017 H.R.2851-Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017 H.R.2957-Save Rural Hospitals Act H.R.3181-Medicare Choices Empowerment and Protection Act H.R.3258-Marketplace Certainty Act H.R.3545-Overdose Prevention and Patient Safety (OPPS) Act H.R.4922-Stopping Overdoses of Fentanyl Analogues Act H.R.5176-Preventing Overdoses While in Emergency Rooms Act of 2018 H.R.5197-Alternatives to Opioids (ALTO) in the Emergency Department Act H.R.5531-Opioid Emergency Response Act H.R.5558-Alternatives to Opioids Prescribing Act H.R.5678-Rural Emergency Medical Center Act of 2018 H.R.5734-Resident Education Deferred Interest Act H.R.6082-Overdose Prevention and Patient Safety (OPPS) Act H.R.6143-Patient Right to Know Drug Prices Act H.R.6144-Know the Lowest Price Act of 2018 H.R.6372-To require the Secretary of Health and Human Services issue regulations to ensure due process rights for physicians furnishing emergency medical services H.R.6502-Reducing Unnecessary Senior Hospitalizations Act of 2018 H.R.6733-Know the Cost Act of 2018 Senate resolution congratulating the American College of Emergency Physicians on its 50th anniversary S.191-Patient Freedom Act of 2017 S.256-SOAR to Health and Wellness Act of 2017 S.284-End Surprise Billing Act of 2017 S.372- Synthetics Trafficking and Overdose Prevention Act of 2017 S.527-Health Care Safety Net Enhancement Act of 2017 S.568-Improving Access to Medicare Coverage Act of 2017 S.781-Good Samaritan Health Professionals Act of 2017 S.1016-Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 S.1022-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act S.1130-Rural Emergency Acute Care Hospital (REACH) Act S.1462-Marketplace Certainty Act S.1530- Medicare Choices Empowerment and Protection Act S.1553-Stopping Overdoses of Fentanyl Analogues Act S.1835-Lower Premiums Through Reinsurance Act of 2017 S.2465-Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2018 S.2516-Alternatives to Opioids (ALTO) in the Emergency Department Act S.2544-Patient Right to Know Drug Prices Act S.2553-Know the Lowest Price Act of 2018 S.2609-Recovery Coaches Offer Addiction Counseling and Healing (COACH) Act S.2610-Preventing Overdoses While in Emergency Departments Act of 2018 S.2680-Opioid Crisis Response Act of 2018 S.3531-Emergency Care Improvement Act

Client expense: $402,721 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.6-Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act H.R.1057-Synthetics Trafficking and Overdose Prevention Act of 2017 H.R.1492-Medical Controlled Substances Transportation Act of 2017 H.R.2851-Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017 H.R.3545-Overdose Prevention and Patient Safety (OPPS) Act H.R.4922-Stopping Overdoses of Fentanyl Analogues Act H.R.5176-Preventing Overdoses While in Emergency Rooms Act of 2018 H.R.5197-Alternatives to Opioids (ALTO) in the Emergency Department Act H.R.5531-Opioid Emergency Response Act H.R.5558-Alternatives to Opioids Prescribing Act H.R.6082-Overdose Prevention and Patient Safety (OPPS) Act S.372-Synthetics Trafficking and Overdose Prevention Act of 2017 S.1327-Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017 S.1553-Stopping Overdoses of Fentanyl Analogues Act S.2516-Alternatives to Opioids (ALTO) in the Emergency Department Act S.2609-Recovery Coaches Offer Addiction Counseling and Healing (COACH) Act S.2610-Preventing Overdoses While in Emergency Departments Act of 2018 S.2680-Opioid Crisis Response Act of 2018

Client expense: $402,721 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health Information Technology, Interoperability, Clinical Quality Measures, Patient Identification/Patient Data Matching, Healthcare Cybersecurity, Telehealth, Electronic Health Records and the EHR Incentive Program, H.R. 3120 - bill to reduce Meaningful Use hardship exemptions, S. 2059 - EHR Regulatory Relief Act, opioids, H.R. 3545 - Overdose Prevention and Patient Safety (OPPS) Act, H.R. 6082 -Overdose Prevention and Patient Safety Act, H.R. 6378 - Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018, HIPAA, H.R. 6 - SUPPORT for Patients and Communities Act, H.R. 3528 - Every Prescription Conveyed Securely Act

Client expense: $15,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Institute of Standards & Technology (NIST), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

Healthcare access, safety and quality. alignment of 42 CFR Part 2 with HIPAA by co-sponsoring, S.1850, the Protecting Jessica Grubb's Legacy Act and H.R.3545, the Opioid Prevention and Patient Safety Act, federal response to the opioid crisis; Medicare bad debt reporting

Client expense: $352,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

Drug pricing; 340B Drug Discount Program; Program for All Inclusive Care of the Elderly (PACE);HR 4392, to provide that the provisions of the Hospital OPPS final rule provisions related to changes in payment for certain 340B drugs have no force or effect; alignment of 42 CFR Part 2 with HIPAA by co-sponsoring, S.1850, the Protecting Jessica Grubb's Legacy Act and H.R.3545, the Opioid Prevention and Patient Safety Act, federal response to the opioid crisis; Medicare bad debt reporting; Medicare Outpatient PPS proposed rule

Client expense: $352,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

Support H.R. 304/S. 916, The Protecting Patient Access to Emergency Medications Act of 2017, a bill to amend the Controlled Substances Act with regard to the provision of emergency medical services and discussed companion legislation with the Senate; Support H.R. 372, The Competitive Health Insurance Reform Act of 2017, a bill to repeal McCarran-Ferguson with respect to the business of health insurance; Discussed with members of congress working on legislation that maintains coverage and improves Americas health care system through patient-centered care; Oppose HR 1156/ S 1133 , Patient Access to Higher Quality Health Care Act of 2017, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; Support HR 1215, Protecting Access to Care Act, a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; Urged CMS to release guidance pertaining to hospital co-location arrangements and to provide flexibility in the agencys co-location policies; Support HR 2141/ S 898, the Conrad State 30 and Physician Access Act of 2017, a bill that would reauthorize the Conrad State 30 Program and make other changes to improve patient access to care; Support S.781/ HR 1876. Good Samaritan Health Professional Act of 2017, a bill to amend the Public Health Service Act to limit the liability of health care professionals who volunteer to provide health care services in response to a disaster; Support HR 2212/ S 974Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2017, a bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products; Meet with HRSA Administrator and senior staff on 340B drug pricing program; Discussed marketplace stabilization solutions with Hill staff; Support and Recommend changes to HR 1253, Mental Health and Substance Abuse Treatment Accessibility Act of 2017 a bill to authorize the Secretary of Health and Human Services to make loans and loan guarantees for constructing or renovating, or planning construction or renovation of, qualified psychiatric and substance abuse treatment facilities, and for other purposes: advocated for changes to clarify/expand the entities that can be loan applicants/recipients; Urged the Administration to suspend the faulty star ratings from the Hospital Compare website; Eliminate barriers to care with the creation of an Anti-Kickback safe harbor for clinical integration arrangements that establishes the basic accountabilities for the use of incentive payment or shared savings programs among hospitals, physicians and other providers, along with a safe-harbor for assistance to patients that would protect providers from financial penalties under the Civil Monetary Penalties (CMPs) for providing an inducement to a patient; Advocated for changes including: eliminating geographic and setting locations requirements so patients outside of rural areas can benefit from telehealth; expanding the types of technology that can be used, including remote monitoring; and covering all services that are safe to provide, rather than a small list of approved services; Submit Statement Stabilizing Premiums and Helping Individuals in the Individual Insurance Market for 2018: Health Care Stakeholders about the importance of stabilizing the Health Insurance Marketplaces for 2018 and beyond; We urged Congress to pass legislation to fund the ACA cost-sharing reductions; Urged Senators to oppose the Graham-Cassidy proposal being considered in the Senate because this proposal would make significant changes to health care coverage and health care financing; Review of H.R. 3528, Every Prescription Conveyed Securely Act, a bill to amend title XVIII of the Social Security Act to require e-prescribing for coverage under part D of the Medicare program of prescription drugs that are controlled substances; Discussions with Congress on prescription drug monitoring programs, the dispensing of controlled substances, and clinical workflow; Discussions with Congress on draft legislation related to prescription drug monitoring programs; Urged Congress to consider advancing solutions aimed at making our health care system stronger, protecting access and coverage, and exploring new delivery system reforms that have the potential to make care both more affordable and safer; Review of The Combating the Opioid Epidemic Act, a bill to provide funding to combat the opioid epidemic; Discussions with the White House/Office of National Drug Control Policy about the opioid epidemic, including concerns about regulations that prohibit the sharing of substance use disorder records among health care providers; Support 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; Letter to congress outlining AHA opposition to a potential policy that would cut payments to hospitals treating hospice patients; Oppose H.R. 4710, 340B Protecting Access for the Underserved and Safety-Net Entities (PAUSE) Act, a bill to amend the Public Health Service Act to establish a moratorium on the registration of certain new 340B hospitals and associated site; Sent comments to the Energy and Commerce Subcommittee on Oversight and Investigations for its hearing on Examining the Impact of Health Care Consolidation.; Letter sent to the Energy & Commerce Subcommittee for its hearing on, "Combating the Opioid Crisis: Helping Communities Balance Enforcement and Patient Safety"; Letter submitted to the Ways and Means Committee on policy recommendations to address the opioid epidemic; Sent letter to discuss the current state of health care costs, and efforts to increase transparency in the pricing of health care services and the quality of care; Addressed our concerns with the MedPAC Commissions draft recommendation to substantially reduce payments for off-campus stand-alone emergency departments (EDs) that are within 6 miles of an on-campus hospital ED; Support HR 4776, Hospital Preparedness Reauthorization Act of 2018, a bill to amend the Public Health Service Act to reauthorize a program of partnerships for State and regional hospital preparedness to improve surge capacity and would increase the level of authorized funding for the Hospital Preparedness Program to $515 million; Submitted statement to the Senate HELP Committee on the Hearing on How to Reduce Health Care Costs: Understanding the Cost of Health Care in America; Submitted a Statement for the HELP hearing on Effective Administration of the 340B Drug Pricing Program; Support certain provisions in Helping to End Addiction and Lesson (HEAL) Substance Use Disorders Act of 2018; Support HR 6071, Stretching Entity Resources for Vulnerable Communities Act or the SERV Communities Act, A bill to amend the Public Health Service Act to clarify the intent of the 340B program and provide for enhanced 340B program integrity; Support S 2597Childrens Hospital GME Support Reauthorization Act of 2018, A bill to amend the Public Health Service Act to reauthorize the program of payments to children's hospitals that operate graduate medical education programs; Support HR 3545, Overdose Prevention and Patient Safety ActA bill to amend the Public Health Service Act to protect the confidentiality of substance use disorder patient records; Support S 2516, Alternatives to Opioids (ALTO) in the Emergency Department ActA bill to direct the Secretary of Health and Human Services to conduct a demonstration program to test alternative pain management protocols to limit the use of opioids in emergency departments; Support HR 5176/ S 2610, Preventing Overdoses While in Emergency Rooms Act of 2018 A bill to require the Secretary of Health and Human Services to provide coordinated care to patients who have experienced a non-fatal overdose after emergency room discharge; Submit statement to the Ways and Means Subcommittee on Health on the hearing Identifying Innovative Practices and Technology in Health Care; Support S 1845 Lead-Safe Housing for Kids Act" To amend the Lead-Based Paint Poisoning Prevention Act to provide for additional procedures for families with children under the age of 6; Submitted statement to the Energy & Commerce Health Subcommittee for the hearing "Improving the Coordination and Quality of Substance Use Disorder Treatment." The statement focuses on 42 CFR Part 2; Comments to HELP Committee's discussion draft of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018; The current Pandemic and All-Hazards Preparedness Act (PAHPA) will sunset on October 1, 2018 so this is "must-do" legislation; Support S 2852, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 (PAHPAI), A bill to reauthorize certain programs under the Pandemic and All-Hazards Preparedness Reauthorization Act; Supports S. 2372, VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION Act of 2018).A bill to establish a permanent community care program for veterans, to establish a commission for the purpose of making recommendations regarding the modernization or realignment of facilities of the Veterans Health Administration, to improve construction of the Department of Veterans Affairs, to make certain improvements in the laws administered by the Secretary of Veterans Affairs relating to the home loan program of the Department of Veterans Affairs,Submitted a statement to the Ways and Means Committee hearing on "Lowering Costs and Expanding Access to Health Care through Consumer-Directed Health Plans;" Submitted a statement to the Senate HELP Subcommittee on "Primary Health and Retirement Security on Health Care in Rural America: Examining Experiences and Costs"; Submitted a statement to the Senate HELP Committee on "Reducing Health Care Costs: Eliminating Excess Health Care Spending and Improving Quality and Value for Patients"; Submitted comments on the consumer-directed health plan legislation to the Committee on Ways & Means; Submitted a statement to the Energy and Commerce Subcommittee on Health on "Opportunities to Improve the 340B Drug Pricing Program"; Discussions about maternal health issues sent by the majority oversight and health subcommittee chairs; Discussions about the Megan Rondini Act; Surprise billing letter to congressional and committee leadership and discussions with members on the same issue; Letter on short-term limited duration plan rule; Meeting with Committee to discuss clarification of Anti-Kickback Statute provisions in the SUPPORT Act.

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

Repeal of the Affordable Care Act H.R. 1628 The American Health Care Act Development of legislation to protect essential hospitals Issues related to telehealth Mental Health Essential Health Benefits created by the Affordable Care Act Access to hospital emergency services Issues related to the 340B Drug Pricing Program HR1628 Better Care Reconciliation Act ACA Cost Sharing Reduction Subsidies Graham-Cassidy Amendment to HR 1628 340B drug pricing program HR3545-Overdose, Prevention and Patient Advocacy Act HR4392 CMS OPPS 340b rule moratorium HR4710 340b PAUSE Act Bipartisan Healthcare Stabilization Act of 2017 Opioid Crisis Response Act of 2018 42 CFR Part 2 IMD Exclusion Prescription drug monitoring programs H.R. 5197, S. 2516, Alternatives to opioids in the emergency dept Act H.R. 5102, Substance Use Disorder Workforce Loan Repayment Act H.R. 5261, Treatment, Education, and Community Help to Combat Opioid Addiction Act Poison Center Network Enhancement Act A Bill to support the peer support specialist workforce HR6 Support for Patients and Communities Act H.R. 4710 PAUSE Act HELP Act S. 2312 HR6378 Pandemic and All Hazards Preparedness and Advancing Innovation Act S.974 CREATES Act S.2843 Opioid Workforce Act HEAL Act S.3120 SERV Communities Act H. R. 6071 S.428, H.R. 3325 The Advancing Care for Exceptional (ACE) Kids Act Cassidy Surprise Billing Draft H.R.6 Support for Patients and Communities Act Protecting Patients from Surprise Medical Bills Hassan Surprise Billing-S. 3592, No more Surprise Medical Bills Act H.R. 7328, Pandemic and All-Hazards Preparedness and Advancing Innovation Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

ACA implementation (exchange operations and functionality, risk mitigation programs, risk adjustment) ACA reform (reconciliation, individual mandate, cost sharing reduction subsidies, reinsurance transitional policies) The Bipartisan Budget Act of 2018 (H.R. 1892) Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act of 2017 (S. 974 and H.R. 2212) Overdose Prevention and Patient Safety Act (H.R. 3545 and H.R. 6082) Jessies Law (H.R. 5009) Mental health and substance use (42 CFR Part 2) Individual market and exchange stabilization Association health plans Short Term Limited Duration Plans Out of network billing (FAA Reauthorization Act of 2018, H.R. 302) ACA third party payments Telehealth Price of prescription drugs Opioid addiction issues and response (prescription drug monitoring programs) Prior authorization SUPPORT for Patients and Communities Act (H.R. 6) Veterans health care Task Force on the Impact of Affordable Housing Crisis Act of 2018 (S. 3231) Readiness for Elders and Americans with Disabilities Inclusion (READI) for Disaster Act (S. 3679)

Client expense: $1,840,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, White House Office

ACA implementation (exchange operations and functionality, risk mitigation programs, risk adjustment) ACA reform (reconciliation, individual mandate, cost sharing reduction subsidies, reinsurance transitional policies) The Bipartisan Budget Act of 2018 (H.R. 1892) Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act of 2017 (S. 974 and H.R. 2212) Overdose Prevention and Patient Safety Act (H.R. 3545 and H.R. 6082) Jessies Law (H.R. 5009) Mental health and substance use (42 CFR Part 2) Individual market and exchange stabilization Association health plans Short Term Limited Duration Plans Out of network billing (FAA Reauthorization Act of 2018, H.R. 302) ACA third party payments Telehealth Price of prescription drugs Opioid addiction issues and response (prescription drug monitoring programs) Prior authorization SUPPORT for Patients and Communities Act (H.R. 6) Veterans health care Task Force on the Impact of Affordable Housing Crisis Act of 2018 (S. 3231) Readiness for Elders and Americans with Disabilities Inclusion (READI) for Disaster Act (S. 3679)

Client expense: $1,840,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, White House Office

Issues relating to P.L. 111-148, the Patient Protection and Affordable Care Act, and P.L. 111-152, the Health Care and Education Reconciliation Act, including exchanges, cost sharing reduction, market reforms, and non-discrimination provisions. The high cost employer health insurance excise tax, including H.R. 173 and S. 58, the Middle Class Health Benefits Tax Repeal Act of 2017, and H.R. 4616, the Employer Relief Act of 2018, regarding a one-year delay of the Cadillac Tax. H.R. 4620, the Protecting Families and Small Businesses Act of 2017, regarding relief from the Health Insurance Tax. Substance use disorders and 42 CFR Part 2 - Confidentiality of Substance Use Disorder Patient Records, specifically H.R. 3545, H.R. 5795, and H.R.6082, the Overdose Prevention and Patient Safety Act (OPPS Act), H.R. 6, the SUPPORT for Patients and Communities Act, and S. 2680, the Opioid Crisis Response Act of 2018. Issues related to proposed changes to the definition of Employer Under Section 3(5) of ERISA for Association Health Plans. 21st Century Cures Act, section 4004, Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs, information blocking and interoperability.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues relating to P.L. 111-148, the Patient Protection and Affordable Care Act and P.L. 111-152, the Health Care and Education Reconciliation Act, including exchanges, cost sharing reduction, market reforms, and non-discrimination provisions. The high cost employer health insurance excise tax, including H.R. 173 and S. 58, the Middle Class Health Benefits Tax Repeal Act of 2017, and H.R. 4616, the Employer Relief Act of 2018, regarding a one-year delay of the Cadillac Tax. H.R. 4620, the the Protecting Families and Small Businesses Act of 2017, regarding relief from the Health Insurance Tax. Substance use disorders and 42 CFR Part 2 - Confidentiality of Substance Use Disorder Patient Records, specifically H.R. 3545, H.R. 5795, and H.R.6082, the Overdose Prevention and Patient Safety Act (OPPS Act), H.R. 6, the SUPPORT for Patients and Communities Act and S. 2680, the Opioid Crisis Response Act of 2018. Issues related to proposed changes to the definition of Employer Under Section 3(5) of ERISA for Association Health Plans. 21st Century Cures Act, section 4004, Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs, information blocking and interoperability.

Client expense: $2,360,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, U.S. Trade Representative (USTR), White House Office

Bipartisan Health Care Stabilization Act (Alexander-Murray) - funding for cost sharing reduction benefits, stabilization of individual market Bipartisan Health Care Stabilization Act; updated version (Alexander-Walden-Collins-Costello) - funding for cost sharing reduction benefits and reinsurance, stabilization of individual market S. 147, Obamacare Taxpayer Bailout Prevention Act (Rubio) - ACA risk corridors program S. 581, Jessies Law (Manchin-Capito) - patient history of opioid use disorder S. 1201, Health Care Options for All Act (McCaskill) - coverage options in bare counties S. 1354, Individual Health Insurance Marketplace Improvement Act (Carper-Kaine) - individual market reinsurance fund, outreach and enrollment activities S. 1462, Marketplace Certainty Act (Shaheen) - funding for cost-sharing reduction benefits S. 1516, Coverage Across State Lines (Heller) S. 1667, Protecting Consumers from Unreasonable Rates Act (Feinstein) - rate review S. 1835, Lower Premiums Through Reinsurance Act (Collins-Nelson) - invisible high risk pool and reinsurance programs S. 1976, Increasing Access to Care Act (Scott) - copper plan S. 1985, Protect Access to Birth Control Act (Murray) - coverage of contraceptive services S. 2052, Healthcare Market Certainty and Mandate Relief Act (Hatch) - funding for cost sharing reduction benefits, HSA improvements, ACA individual mandate S. 2241 (King) - fees on excepted benefits and standalone dental plans S. 2303, Access to Independent Health Insurance Advisors Act (Isakson-Coons) - calculation of medical loss ratios S. 3388, Ensuring Coverage for Patients with Pre-Existing Conditions Act (Tillis) - protections for individuals with pre-existing conditions S. 3541, Reducing Costs for Out-of-Network Services Act (Shaheen) -cost-sharing for out-of-network services S. 3592, No More Surprise Medical Bills Act (Hassan) - surprise medical bills S. 3742, Cancer Drug Parity Act (Smith) - cost sharing for cancer drugs H.R. 2, Agriculture and Nutrition Act (Conaway) - agricultural association health plans H.R. 314, Health Care Choice Act (Blackburn) - selling insurance across state lines H.R. 372, Competitive Health Insurance Reform Act (Gosar) - McCarran-Ferguson Act H.R. 421, Allowing Greater Access to Safe and Effective Contraception Act (Love) - non-prescription contraceptives, HSA flexibility H.R. 706, Plan Verification and Fairness Act (Blackburn) - verifying eligibility for special enrollment periods H.R. 708, State Age Rating Flexibility Act (Buchson) - age rating bands H.R. 710, Health Coverage State Flexibility Act (Flores) - grace period for premium payments H.R. 1101, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1121, Pre-existing Conditions Protection Act (Walden) - protections for patients with pre-existing conditions H.R. 1304, Self-Insurance Protection Act (Roe) - medical stop-loss insurance H.R. 1409, Cancer Drug Parity Act (Lance) - coverage of oral anti-cancer drugs H.R. 1606, DOC Access Act (Carter) - reimbursement for dental and vision providers H.R. 3450, Protecting Consumers from Unreasonable Rates Act (Schakowsky) - rate review H.R. 3545, Overdose Prevention and Patient Safety Act (Murphy- Blumenauer) -- confidentiality of drug and alcohol treatment and prevention records H.R. 3976, Access to Marketplace Insurance Act (Cramer) - third party payments H.R. 4082, Protect Access to Birth Control Act (DeGette) - coverage of contraceptive services H.R. 4200, Healthcare Market Certainty and Mandate Relief Act (Brady) - funding for cost sharing reduction benefits, HSA improvements H.R. 4225 (Hudson) - fees on excepted benefits and standalone dental plans H.R. 4575, Access to Independent Health Insurance Advisors Act (Long-Schrader) - calculation of medical loss ratios H.R. 4666, Premium Relief Act (Costello) - Patient and State Stability Fund H.R. 4695, Bipartisan Market Stabilization and Innovation Act (Schrader) - stabilization of individual market H.R. 6311, Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act (Roskam) - access to catastrophic plans, definition of qualified health plans H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan H.R. 6496, Continuing Coverage for Preexisting Conditions Act (Joyce) - protections for individuals with pre-existing conditions H.R. 7003, Federal Invisible Risk Sharing Program (Schweikert) Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to all payor claims databases; issues related to association health plans; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues relating to the individual market; and other issues relating to health care reform implementation.

Client expense: $1,540,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office

Implementation of Public Law 114-198 pharmacy provisions; Implementation of Public Law 114-255 pharmacy provisions; H.R. 1854/S. 778, Prescription Drug Monitoring Act of 2017; S 892 / H.R. 4408, Opioid Addiction Prevention Act of 2017; HR 3528 / S.2460, Every Prescription Conveyed Securely Act; H.R. 3545, Overdose Prevention and Patient Safety Act; S. 1850, Protecting Jessica Grubbs Legacy Act; H.R. 1271, DXM Abuse Prevention Act of 2017; H.R. 1375, Prescriber Support Act of 2017; S. 523, Budgeting for Opioid Addiction Treatment Act; S. 581 / H.R. 5009, Jessies Law; S 1079, Protecting Americans from Dangerous Opioids Act; H.R. 4236, MONITOR Act of 2017; H.R. 3991, Expanded Access to Opioid Abuse Treatment Act of 2017; H.R. 4275, Empowering Pharmacists in the Fight Against Opioid Abuse Act; H.R. 5219, Opioid Prescription Verification Act of 2018; H.R. 5676, SENIOR Communities Protection Act of 2018; H.R. 5773, PASS Act of 2018; Draft legislation, Medicare Care Coordination Improvement Act of 2017; Draft legislation, Pain Care Coordination Act of 2018; S. 2456/H.R. 5311, CARA 2.0 Act of 2018; H.R. 5687, SOUND Disposal and Packaging Act; H.R. 5202, Ensuring Patient Access to Substance Use Disorder Treatments Act of 2018; H.R. 5812, CONNECTIONS Act; H.R. 5801, Medicaid PARTNERSHIP Act; H.R. 6, SUPPORT for Patients and Communities Act; H.R. 5808, Medicaid Pharmaceutical Home Act of 2018; H.R. 5675, To amend title XVIII of the Social Security Act to require prescription drug plan sponsors under the Medicare program to establish drug management programs for at-risk beneficiaries; S. 2680, Opioid Crisis Response Act of 2018; S. 2645 / H.R. 5628, Access to Increased Drug Disposal Act of 2018; H.R. 6600 / S. 3282, the DEA Order Clearinghouse Act of 2018; H.R. 6688, ALERT Act of 2018

Client expense: $240,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Personnel Management (OPM), SENATE, Small Business Administration (SBA), Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

General monitoring on Not-for-profit hospitals charity care and community benefits; Medicare payment issues; Health care reform, Hospital related issues and initiatives. Public Law 110-343, Patient Protection and Affordable Care Act, Hospital related issues and initiatives. Public Law 111-148, The Patient Protection and Affordable Care Act, Hospital related issues and initiatives. Public Law 111-152, Health Care and Education Reconciliation Act of 2010, Hospital related issues and initiatives. H.R.3726, Stark Administrative Simplification Act H.R.3545, Support the Opioid Prevention and Patient Safety Act Public Law 115-271, SUPPORT for Patients and Communities Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions related to health care and medicaid H.R.2938, Road to Recovery Act H.R.3545, The Overdose Prevention and Patient Safety Act H.R. 6, The Substance Use Dis-Order Prevention that Promotes Opioid Recovery and Treatment Act S.2680, Opioid Crisis Response Act of 2018

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.6, The SUPPORT for Patients and Communities Act, H.R. 6082 / H.R. 3545 / H.R. 5795, The Overdose Prevention and Patient Safety Act, S. 2680, the Opioid Crisis Response Act of 2018 and issues related to 42 CFR Part 2 and Confidentiality of Substance Use Disorder Patient Records. Monitored issues related to drug pricing; monitored issues related to pharmacy benefit managers, including the safe harbor protection; monitored issues related to association health plans.

Client expense: Not reported · Firm income: $60,750

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

H.R. 6, the SUPPORT for Patients and Communities Act; S. 2680, the Opioid Crisis Response Act of 2018; H.R. 6082 / H.R. 3545 / H.R. 5795, the Overdose Prevention and Patient Safety Act, and issues related to 42 CFR Part 2; issues related to hospital rape kits; issues related to out-of-network providers; H.R. 7217, The IMPROVE Act.

Client expense: Not reported · Firm income: $93,000

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

Medicaid expansion and reform Medicaid and Medicare disproportionate share hospitals (DSH) funding wage index; national budget neutrality Children's hospitals graduate medical education (CHGME) Indirect and direct graduate medical education (GME) Trauma Patient Protection and Affordable Care Act (PPACA) Behavioral health Off-campus hospital outpatient departments (HOPD) Stark law; anti-kickback updates 340B; H.R. 4392 rescinding authority of CMS to implement 340B cuts Opioids funding Stark Law and Anti-kickback statute revisions Pandemic and All Hazards Preparedness Act reauthorization (S.2852) H.R. 3545/H.R. 6082: Overdose Prevention and Patient Safety Act amending 42 CFR Part II to allow providers to share medical information. MISSION Zero (S. 1022/H.R. 880)

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

1.S. 2317/H.R. 3692 - Addiction Treatment Access Improvement Act - amend the Controlled Substances Act to provide for additional flexibility with respect to medication-assisted treatment for opioid use disorders, and for other purposes. 2.H.R. 6 - SUPPORT for Patients and Communities Act - provide for opioid use disorder prevention, recovery, and treatment, and for other purposes. 3.S. 2608 - Opioid Crisis Response Act - address the opioid crisis 4.H.R. 5605 - Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act - provide for an opioid use disorder treatment demonstration program, and for other purposes 5.H.R. 5797 - Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act - provide under Medicaid services for certain individuals with opioid use disorders in institutions for mental diseases. 6.H.R. 5800 - the Medicaid IMD ADDITIONAL INFO Act - require the Medicaid and CHIP Payment and Access Commission to conduct an exploratory study and report on requirements applicable to and practices of institutions for mental diseases under the Medicaid program. 7.H.R. 5483 - Special Registration for Telemedicine Clarification Act - impose a deadline for the promulgation of interim final regulations in accordance with section 311(h) of the Controlled Substances Act (21 U.S.C. 831(h)) specifying the circumstances in which a special registration may be issued to a practitioner to engage in the practice of telemedicine, and for other purposes. 8.H.R. 5272 - a bill to ensure that programs and activities that are funded by a grant, cooperative agreement, loan, or loan guarantee from the Department of Health and Human Services, and whose purpose is to prevent or treat a mental health or substance use disorder, are evidence-based 9.S. 2524/H.R. 5102, Substance Use Disorder Workforce Loan Repayment Act - amend the Public Health Service Act to authorize a loan repayment program for substance use disorder treatment employees, and for other purposes 10.H.R. 4005 - the Medicaid Reentry Act - promote State innovations to ease transitions to the community for individuals who are inmates of a public institution and eligible for medical assistance under the Medicaid program. 11.S. 2253/H.R. 3192 - the CHIP Mental Health Parity Act - amend title XXI of the Social Security Act to ensure access to mental health services for children under the Childrens Health Insurance Program, and for other purposes 12.N/A 13.N/A 14.S. 2711, the Enhancing Access to Addiction Treatment Act - amend section 303 of the Controlled Substances Act to facilitate waivers of the separate registration requirement for physicians dispensing narcotic drugs to individuals for maintenance treatment or detoxification treatment 15.H.R. 5776 - Medicare and Opioid Safe Treatment Act - provide access to Medication-Assisted Treatment (MAT) in Medicare through bundled payments made to Opioid Treatment Programs for holistic service 16.S. 2875 - Comprehensive Opioid Management and Bundled Addiction Treatment Act of 2018 - amend title XVIII of the Social Security Act to provide for Medicare coverage of certain services furnished by opioid treatment programs, and for other purposes 17.S. 2843/H.R. 5818 - Opioid Workforce Act - amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis 18. S.3462 - Improving Coverage for Substance Use Disorder Recovery Expansion Act-amend title XIX of the Social Security Act to provide States with the option to provide medical assistance for substance use disorder treatment services to individuals between the ages of 21 and 64 with substance use disorders, and for other purposes 19. H.R. 3545/6082 - the Overdose Prevention and Patient Safety Act amends the Public Health Service Act to align federal privacy standards for substance use disorder (SUD) patient records more closely with standards under the Health Insurance Portability and Accountability Act (HIPAA). 20. Provided technical assistance on draft bills regarding grants for medication-assisted treatment/recovery programs for incarcerated individuals 21. Advocated for techinical changes to allow DATA waivered practitioners to treat hospitalized patients with OUD as a primary diagnosis with medications via hospital orders/controlled substance stock 22. Advocated for eligibility clarification to include addiction medicine physicians under current loan repayment/scholarship programs 23. Advocated for rapid healthcare response teams after clinics are shut down; DEA agent education around buprenorphine prescribing

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

1.S. 2317/H.R. 3692 - Addiction Treatment Access Improvement Act - amend the Controlled Substances Act to provide for additional flexibility with respect to medication-assisted treatment for opioid use disorders, and for other purposes. 2.H.R. 6 - SUPPORT for Patients and Communities Act - provide for opioid use disorder prevention, recovery, and treatment, and for other purposes. 3.S. 2608 - Opioid Crisis Response Act - address the opioid crisis 4.H.R. 5605 - Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act - provide for an opioid use disorder treatment demonstration program, and for other purposes 5.H.R. 5797 - Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act - provide under Medicaid services for certain individuals with opioid use disorders in institutions for mental diseases. 6.H.R. 5800 - the Medicaid IMD ADDITIONAL INFO Act - require the Medicaid and CHIP Payment and Access Commission to conduct an exploratory study and report on requirements applicable to and practices of institutions for mental diseases under the Medicaid program. 7.H.R. 5483 - Special Registration for Telemedicine Clarification Act - impose a deadline for the promulgation of interim final regulations in accordance with section 311(h) of the Controlled Substances Act (21 U.S.C. 831(h)) specifying the circumstances in which a special registration may be issued to a practitioner to engage in the practice of telemedicine, and for other purposes. 8.H.R. 5272 - a bill to ensure that programs and activities that are funded by a grant, cooperative agreement, loan, or loan guarantee from the Department of Health and Human Services, and whose purpose is to prevent or treat a mental health or substance use disorder, are evidence-based 9.S. 2524/H.R. 5102, Substance Use Disorder Workforce Loan Repayment Act - amend the Public Health Service Act to authorize a loan repayment program for substance use disorder treatment employees, and for other purposes 10.H.R. 4005 - the Medicaid Reentry Act - promote State innovations to ease transitions to the community for individuals who are inmates of a public institution and eligible for medical assistance under the Medicaid program. 11.S. 2253/H.R. 3192 - the CHIP Mental Health Parity Act - amend title XXI of the Social Security Act to ensure access to mental health services for children under the Childrens Health Insurance Program, and for other purposes 12.N/A 13.N/A 14.S. 2711, the Enhancing Access to Addiction Treatment Act - amend section 303 of the Controlled Substances Act to facilitate waivers of the separate registration requirement for physicians dispensing narcotic drugs to individuals for maintenance treatment or detoxification treatment 15.H.R. 5776 - Medicare and Opioid Safe Treatment Act - provide access to Medication-Assisted Treatment (MAT) in Medicare through bundled payments made to Opioid Treatment Programs for holistic service 16.S. 2875 - Comprehensive Opioid Management and Bundled Addiction Treatment Act of 2018 - amend title XVIII of the Social Security Act to provide for Medicare coverage of certain services furnished by opioid treatment programs, and for other purposes 17.S. 2843/H.R. 5818 - Opioid Workforce Act - amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis 18. S.3462 - Improving Coverage for Substance Use Disorder Recovery Expansion Act-amend title XIX of the Social Security Act to provide States with the option to provide medical assistance for substance use disorder treatment services to individuals between the ages of 21 and 64 with substance use disorders, and for other purposes 19. H.R. 3545/6082 - the Overdose Prevention and Patient Safety Act amends the Public Health Service Act to align federal privacy standards for substance use disorder (SUD) patient records more closely with standards under the Health Insurance Portability and Accountability Act (HIPAA). 20. Provided technical assistance on draft bills regarding grants for medication-assisted treatment/recovery programs for incarcerated individuals 21. Advocated for techinical changes to allow DATA waivered practitioners to treat hospitalized patients with OUD as a primary diagnosis with medications via hospital orders/controlled substance stock 22. Advocated for eligibility clarification to include addiction medicine physicians under current loan repayment/scholarship programs 23. Advocated for rapid healthcare response teams after clinics are shut down; DEA agent education around buprenorphine prescribing

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

1.S. 2317/H.R. 3692 - Addiction Treatment Access Improvement Act - amend the Controlled Substances Act to provide for additional flexibility with respect to medication-assisted treatment for opioid use disorders, and for other purposes. 2.H.R. 6 - SUPPORT for Patients and Communities Act - provide for opioid use disorder prevention, recovery, and treatment, and for other purposes. 3.S. 2608 - Opioid Crisis Response Act - address the opioid crisis 4.H.R. 5605 - Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act - provide for an opioid use disorder treatment demonstration program, and for other purposes 5.H.R. 5797 - Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act - provide under Medicaid services for certain individuals with opioid use disorders in institutions for mental diseases. 6.H.R. 5800 - the Medicaid IMD ADDITIONAL INFO Act - require the Medicaid and CHIP Payment and Access Commission to conduct an exploratory study and report on requirements applicable to and practices of institutions for mental diseases under the Medicaid program. 7.H.R. 5483 - Special Registration for Telemedicine Clarification Act - impose a deadline for the promulgation of interim final regulations in accordance with section 311(h) of the Controlled Substances Act (21 U.S.C. 831(h)) specifying the circumstances in which a special registration may be issued to a practitioner to engage in the practice of telemedicine, and for other purposes. 8.H.R. 5272 - a bill to ensure that programs and activities that are funded by a grant, cooperative agreement, loan, or loan guarantee from the Department of Health and Human Services, and whose purpose is to prevent or treat a mental health or substance use disorder, are evidence-based 9.S. 2524/H.R. 5102, Substance Use Disorder Workforce Loan Repayment Act - amend the Public Health Service Act to authorize a loan repayment program for substance use disorder treatment employees, and for other purposes 10.H.R. 4005 - the Medicaid Reentry Act - promote State innovations to ease transitions to the community for individuals who are inmates of a public institution and eligible for medical assistance under the Medicaid program. 11.S. 2253/H.R. 3192 - the CHIP Mental Health Parity Act - amend title XXI of the Social Security Act to ensure access to mental health services for children under the Childrens Health Insurance Program, and for other purposes 12.N/A 13.N/A 14.S. 2711, the Enhancing Access to Addiction Treatment Act - amend section 303 of the Controlled Substances Act to facilitate waivers of the separate registration requirement for physicians dispensing narcotic drugs to individuals for maintenance treatment or detoxification treatment 15.H.R. 5776 - Medicare and Opioid Safe Treatment Act - provide access to Medication-Assisted Treatment (MAT) in Medicare through bundled payments made to Opioid Treatment Programs for holistic service 16.S. 2875 - Comprehensive Opioid Management and Bundled Addiction Treatment Act of 2018 - amend title XVIII of the Social Security Act to provide for Medicare coverage of certain services furnished by opioid treatment programs, and for other purposes 17.S. 2843/H.R. 5818 - Opioid Workforce Act - amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis 18. S.3462 - Improving Coverage for Substance Use Disorder Recovery Expansion Act-amend title XIX of the Social Security Act to provide States with the option to provide medical assistance for substance use disorder treatment services to individuals between the ages of 21 and 64 with substance use disorders, and for other purposes 19. H.R. 3545/6082 - the Overdose Prevention and Patient Safety Act amends the Public Health Service Act to align federal privacy standards for substance use disorder (SUD) patient records more closely with standards under the Health Insurance Portability and Accountability Act (HIPAA). 20. Provided technical assistance on draft bills regarding grants for medication-assisted treatment/recovery programs for incarcerated individuals 21. Advocated for techinical changes to allow DATA waivered practitioners to treat hospitalized patients with OUD as a primary diagnosis with medications via hospital orders/controlled substance stock 22. Advocated for eligibility clarification to include addiction medicine physicians under current loan repayment/scholarship programs 23. Advocated for rapid healthcare response teams after clinics are shut down; DEA agent education around buprenorphine prescribing

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

1.S. 2317/H.R. 3692 - Addiction Treatment Access Improvement Act - amend the Controlled Substances Act to provide for additional flexibility with respect to medication-assisted treatment for opioid use disorders, and for other purposes. 2.H.R. 6 - SUPPORT for Patients and Communities Act - provide for opioid use disorder prevention, recovery, and treatment, and for other purposes. 3.S. 2608 - Opioid Crisis Response Act - address the opioid crisis 4.H.R. 5605 - Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act - provide for an opioid use disorder treatment demonstration program, and for other purposes 5.H.R. 5797 - Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act - provide under Medicaid services for certain individuals with opioid use disorders in institutions for mental diseases. 6.H.R. 5800 - the Medicaid IMD ADDITIONAL INFO Act - require the Medicaid and CHIP Payment and Access Commission to conduct an exploratory study and report on requirements applicable to and practices of institutions for mental diseases under the Medicaid program. 7.H.R. 5483 - Special Registration for Telemedicine Clarification Act - impose a deadline for the promulgation of interim final regulations in accordance with section 311(h) of the Controlled Substances Act (21 U.S.C. 831(h)) specifying the circumstances in which a special registration may be issued to a practitioner to engage in the practice of telemedicine, and for other purposes. 8.H.R. 5272 - a bill to ensure that programs and activities that are funded by a grant, cooperative agreement, loan, or loan guarantee from the Department of Health and Human Services, and whose purpose is to prevent or treat a mental health or substance use disorder, are evidence-based 9.S. 2524/H.R. 5102, Substance Use Disorder Workforce Loan Repayment Act - amend the Public Health Service Act to authorize a loan repayment program for substance use disorder treatment employees, and for other purposes 10.H.R. 4005 - the Medicaid Reentry Act - promote State innovations to ease transitions to the community for individuals who are inmates of a public institution and eligible for medical assistance under the Medicaid program. 11.S. 2253/H.R. 3192 - the CHIP Mental Health Parity Act - amend title XXI of the Social Security Act to ensure access to mental health services for children under the Childrens Health Insurance Program, and for other purposes 12.N/A 13.N/A 14.S. 2711, the Enhancing Access to Addiction Treatment Act - amend section 303 of the Controlled Substances Act to facilitate waivers of the separate registration requirement for physicians dispensing narcotic drugs to individuals for maintenance treatment or detoxification treatment 15.H.R. 5776 - Medicare and Opioid Safe Treatment Act - provide access to Medication-Assisted Treatment (MAT) in Medicare through bundled payments made to Opioid Treatment Programs for holistic service 16.S. 2875 - Comprehensive Opioid Management and Bundled Addiction Treatment Act of 2018 - amend title XVIII of the Social Security Act to provide for Medicare coverage of certain services furnished by opioid treatment programs, and for other purposes 17.S. 2843/H.R. 5818 - Opioid Workforce Act - amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis 18. S.3462 - Improving Coverage for Substance Use Disorder Recovery Expansion Act-amend title XIX of the Social Security Act to provide States with the option to provide medical assistance for substance use disorder treatment services to individuals between the ages of 21 and 64 with substance use disorders, and for other purposes 19. H.R. 3545/6082 - the Overdose Prevention and Patient Safety Act amends the Public Health Service Act to align federal privacy standards for substance use disorder (SUD) patient records more closely with standards under the Health Insurance Portability and Accountability Act (HIPAA). 20. Provided technical assistance on draft bills regarding grants for medication-assisted treatment/recovery programs for incarcerated individuals 21. Advocated for techinical changes to allow DATA waivered practitioners to treat hospitalized patients with OUD as a primary diagnosis with medications via hospital orders/controlled substance stock 22. Advocated for eligibility clarification to include addiction medicine physicians under current loan repayment/scholarship programs 23. Advocated for rapid healthcare response teams after clinics are shut down; DEA agent education around buprenorphine prescribing

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

1.S. 2317/H.R. 3692 - Addiction Treatment Access Improvement Act - amend the Controlled Substances Act to provide for additional flexibility with respect to medication-assisted treatment for opioid use disorders, and for other purposes. 2.H.R. 6 - SUPPORT for Patients and Communities Act - provide for opioid use disorder prevention, recovery, and treatment, and for other purposes. 3.S. 2608 - Opioid Crisis Response Act - address the opioid crisis 4.H.R. 5605 - Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act - provide for an opioid use disorder treatment demonstration program, and for other purposes 5.H.R. 5797 - Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act - provide under Medicaid services for certain individuals with opioid use disorders in institutions for mental diseases. 6.H.R. 5800 - the Medicaid IMD ADDITIONAL INFO Act - require the Medicaid and CHIP Payment and Access Commission to conduct an exploratory study and report on requirements applicable to and practices of institutions for mental diseases under the Medicaid program. 7.H.R. 5483 - Special Registration for Telemedicine Clarification Act - impose a deadline for the promulgation of interim final regulations in accordance with section 311(h) of the Controlled Substances Act (21 U.S.C. 831(h)) specifying the circumstances in which a special registration may be issued to a practitioner to engage in the practice of telemedicine, and for other purposes. 8.H.R. 5272 - a bill to ensure that programs and activities that are funded by a grant, cooperative agreement, loan, or loan guarantee from the Department of Health and Human Services, and whose purpose is to prevent or treat a mental health or substance use disorder, are evidence-based 9.S. 2524/H.R. 5102, Substance Use Disorder Workforce Loan Repayment Act - amend the Public Health Service Act to authorize a loan repayment program for substance use disorder treatment employees, and for other purposes 10.H.R. 4005 - the Medicaid Reentry Act - promote State innovations to ease transitions to the community for individuals who are inmates of a public institution and eligible for medical assistance under the Medicaid program. 11.S. 2253/H.R. 3192 - the CHIP Mental Health Parity Act - amend title XXI of the Social Security Act to ensure access to mental health services for children under the Childrens Health Insurance Program, and for other purposes 12.N/A 13.N/A 14.S. 2711, the Enhancing Access to Addiction Treatment Act - amend section 303 of the Controlled Substances Act to facilitate waivers of the separate registration requirement for physicians dispensing narcotic drugs to individuals for maintenance treatment or detoxification treatment 15.H.R. 5776 - Medicare and Opioid Safe Treatment Act - provide access to Medication-Assisted Treatment (MAT) in Medicare through bundled payments made to Opioid Treatment Programs for holistic service 16.S. 2875 - Comprehensive Opioid Management and Bundled Addiction Treatment Act of 2018 - amend title XVIII of the Social Security Act to provide for Medicare coverage of certain services furnished by opioid treatment programs, and for other purposes 17.S. 2843/H.R. 5818 - Opioid Workforce Act - amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis 18. S.3462 - Improving Coverage for Substance Use Disorder Recovery Expansion Act-amend title XIX of the Social Security Act to provide States with the option to provide medical assistance for substance use disorder treatment services to individuals between the ages of 21 and 64 with substance use disorders, and for other purposes 19. H.R. 3545/6082 - the Overdose Prevention and Patient Safety Act amends the Public Health Service Act to align federal privacy standards for substance use disorder (SUD) patient records more closely with standards under the Health Insurance Portability and Accountability Act (HIPAA). 20. Provided technical assistance on draft bills regarding grants for medication-assisted treatment/recovery programs for incarcerated individuals 21. Advocated for techinical changes to allow DATA waivered practitioners to treat hospitalized patients with OUD as a primary diagnosis with medications via hospital orders/controlled substance stock 22. Advocated for eligibility clarification to include addiction medicine physicians under current loan repayment/scholarship programs 23. Advocated for rapid healthcare response teams after clinics are shut down; DEA agent education around buprenorphine prescribing

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

FAST Genetics Act of 2017 (H.R. 2051) CREATES Act of 2017 (H.R. 2212/S. 974) Preserve Access to Affordable Generics Act (S. 124) 340B PAUSE ACT (H.R. 4710) Legislation to place a moratorium on the 340B drug payment cuts in the CY 2018 Outpatient Prospective Payment System Rule (H.R. 4392) Protecting Jessica Grubbs Legacy Act (S. 1850) Overdose Prevention and Patient Safety Act (H.R. 3545, 5795, 6082) ACA Medicaid disproportionate share hospital (DSH) cuts Childrens Health Insurance Program (CHIP) funding ACO Improvement Act of 2017 (H.R. 4580) Medicare Home Infusion Therapy Access Act of 2017 (S. 1738)/ Section 101 of Medicare Part B Improvement Act of 2017 (H.R. 3178) Prescription Drug Price Transparency Act (MAC bill) (H.R.1316) Improving Transparency and Accuracy in Medicare Part D Spending Act (H.R.1038/S.413) Ensuring Seniors Access to Local Pharmacies Act of 2017 (H.R.1939/S.1044) Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.109) CARA 2.0 Act of 2018 (H.R.5311/S.2456) Biosimilars Competition Act of 2018 (H.R. 6478) Know the Lowest Price Act of 2018 (S.2553) Patient Right to Know Drug Prices Act (S.2554) SUPPORT for Patients and Communities Act (H.R. 6)

Client expense: $400,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to implementation of the 21st Century Cures Act (Public Law No: 114-255); in general H.R. 5311/S. 2456, the CARA 2.0 Act of 2018 H.R. 2556/S. 1016, the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act S. 1850, the Protecting Jessica Grubbs Legacy Act H.R. 3545, the Overdose Prevention and Patient Safety Act Docket ID: SAMHSA-4162-20, Confidentiality of Substance Use Disorder Patient Records Issues relating to the reauthorization of the Childrens Health Insurance Program H.R. 3192/S. 2253, the CHIP Mental Health Parity Act S. 774, the Trauma-Informed Care for Children and Families Act H.R. 4778/S. 2301, the Behavioral Health Coverage Transparency Act S. 2406/H.R. 5002, the Advancing Cutting-Edge (ACE) Research Act H.R. 5102/S. 2524, the Substance use Disorder Workforce Loan Repayment Act Issues relating to market stabilization for the Affordable Care Act Issues related to opioids. Issues related to gun violence and mental health, in general H.R. 2276/S. 2575, the Audiology Patient Choice Act H.R. 6, SUPPORT for Patients and Communities Act S. 2680, the Opioid Crisis Response Act H.R. 994, the Examining Opioid Treatment Infrastructure Act H.R. 1375, a bill to amend the Public Health Service Act to authorize the Secretary of Health of Human Services to award grants to States (or collaborations of States) to establish, expand, or maintain a comprehensive regional, State, or municipal system to provide training, education, consultation, and other resources to prescribers relating to patient pain, substance misuse, and substance abuse disorders, and for other purposes. S. 581/H.R. 5009, Jessie's Law H.R. 2077, theRestoring the Patient's Voice Act H.R. 2345, the National Suicide Hotline Improvement Act S. 1354, a bill to establish an Individual Market Reinsurance fund to provide funding for State individual market stabilization reinsurance programs. H.R. 3692, the Addiction Treatment Access Improvement Act H.R. 3931/S.1905, the Excellence in Mental Health and Addiction Treatment Expansion Act H.R. 4733/S. 2260, the Opioids and STOP Pain Initiative Act S. 2317, a bill to amend the Controlled Substances Act to provide for additional flexibility with respect to medication-assisted treatment for opioid use disorders, and for other purposes. H.R. 4903, Combating Opioid Misuse By Advancing Treatment (COMBAT) Act H.R. 5083, the Expanding Access to Evidence-Based Opioid Treatment for Seniors Act H.R. 5327, the Comprehensive Opioid Recovery Centers Act H.R. 5385/S. 2597, the Children's Hospital GME Support Reauthorization Act S. 2606, the Opioid ECHO Act H.R. 5795, the Overdose Prevention and Patient Safety Act H.R. 5483, the Special Registration for Telemedicine Clarification Act H.R. 6082, the Overdose Prevention and Patient Safety Act S.3337, the Mental Health Services for Students Act H.R.6597, the Mental Health Professionals Workforce Shortage Loan Repayment Act S. 2554, the Patient Right to Know Drug Prices Act H.R. 6143, the Patient Right to Know Drug Prices Act Issues 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)

S 3702/HR 7223 - Tax legislation, provisions regarding generic drugs S 3738/HR 7251 - Patent legislation regarding inter partes review HR 302 - FAA Re-authorization (provisions related to air ambulance services HR 7217 - IMPROVE Act Blueprint on Drug Pricing State Reinsurance Program H.R. 6 - The Support for Patients and Communities Act S 1835 - Lower Premiums through Reinsurance Act of 2017. Collins (R-ME) HR 3545 - Overdose Prevention and Patient Safety Act. Murphy (R-PA) S 1850 - Protecting Jessica Grubbs Legacy Act. Manchin (D-WV) HR 4200 & S 2052 - To provide for temporary funding for health insurance cost-sharing reduction payments and provide targeted tax relief, and for other purposes. HR 2212 & S 974 - Creating and Restoring Equal Access To Equivalent Samples Act of 2017: A bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Marino (R-PA) & Leahy (D-VT) S 1354 - Individual Health Insurance Marketplace Improvement Act: A bill to establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Carper (D-DE) S 1859 - Healthcare Tax Relief Act: A bill to extend the moratorium on the annual fee on health insurance providers. Gardner (R-CO) H.R. 1215 - Protecting Access to Care Act of 2017: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. King (R-IA) H.R.1101 - Small Business Health Fairness Act of 2017: To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. Johnson (R-TX). S. 974 and H.R. 2212 - Creates Act of 2017: To promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Leahy (D-VT) & Marino (R-PA). HR 173 and S 40 - Middle Class Health Benefits Tax Repeal Act of 2017: To amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage. Kelly (R-PA) & Heller (R-NV). HR 708 - State Age Rating Flexibility Act of 2017: To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. Buschon (R-IN). HR 710 -Health Coverage State Flexibility Act of 2017: To amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. Flores (R-TX). HR 749 - Lower Drug Costs through Competition Act: To increase competition in the pharmaceutical industry. Schrader (D-OR) H.R.1121 - Pre-existing Conditions Protection Act of 2017: To amend the Public Health Service Act to prohibit application of pre-existing condition exclusions and to guarantee availability of health insurance coverage in the individual and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable Care Act, and for other purposes. Walden (R-OR). HR 1175 and S 403 - Health Savings Act of 2017: To amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes. Paulsen (R-MN) & Hatch (R-UT). HR 1304 - Self-Insurance Protection Act: To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans. Roe (R-TN) HR 1776 & S 771 Improving Access To Affordable Prescription Drugs Act: To improve access to affordable prescription drugs. Schakowsky (D-IL) & Franken (D-MN) HR 2051 - To amend the Federal Food, Drug, and Cosmetic Act to ensure that eligible product developers have competitive access to approved drugs and licensed biological products, so as to enable eligible product developers to develop and test new products, and for other purposes. McKinley (R-WV) S 191 - Patient Freedom Act of 2017: To improve patient choice by allowing States to adopt market based alternatives to the Affordable Care Act that increase access to affordable health insurance and reduce costs while ensuring important consumer protections and improving patient care. Cassidy (R-LA) S 637 - Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017: To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. Wyden (D-OR) HR - 6082 Overdose Prevention and Patient Safety Act S 2554 Patient Right to Know Drug Prices Act

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

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

H.R. 3692, Addiction Treatment Access Improvement Act of 2017: Medically assisted treatment; opioids H.R. 5761, Ending Maternal Mortality Act of 2018: Maternal mortality H.R. 5718, Perioperative Reduction of Opioids Act: Opioids H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S. 2516, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S.2680, Opioid Crisis Response Act of 2018: Medically assisted treatment; opioids S.2456, CARA 2.0 Act of 2018: Medically assisted treatment; opioids H.R. 1565, Saving Lives, Saving Costs S.1475, Saving Lives, Saving Costs Comprehensive Addiction and Recovery Act of 2016 (PL 114-198) Affordable Care Act reform efforts H.R. 1628, American Health Care Act of 2017 S. Amdt. 1030 to H.R. 1628, "Graham-Cassidy" Better Care Reconciliation Act of 2017 H.R. 1492, Medical Controlled Substances Transportation Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 3545, Overdose Prevention and Patient Safety Act H.R. 3446, Restoring Board Immunity Act of 2017: Professional Licensing S.2260, Opioids and STOP Pain Initiative ACT:opioids 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care H.R.3928, Truth in Healthcare Marketing Act of 2017 H.R. 5734, Resident Education Deferred Interest Act: student loan debt repayment for residents 21st Century Cures Initiative Drug Shortages - FDA, DEA, HHS, CMS, GAO, House Energy and Commerce Committee, Senate HELP Committee DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management FTC Letters to States re: Interventional Pain Medicine & Advanced Practice Nurses & Competition in Healthcare Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee FDA SMART TOTS - pediatric anesthesia research USP - US Pharmacopeia National Pain Strategy Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Sequestration Opioids and Opioid abuse; Brain health

Client expense: $200,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

Meaningful Use; 21st Century Cures implementation and oversight; Innovation for Healthier Americans - identifying opportunities for meaningful reform to our nation's Medicare product discovery and development; patient access to data; The "Access to Telehealth Services for Opioid Use Disorders" Act; the "Every Prescription Conveyed Securely" Act, H.R. 3528; "Overdose Prevention and Patient Safety (OPPS)" Act, H.R. 3545 and H.R. 6082; the "Standardizing Electronic Prior Authorization for Safe Prescribing" Act of 2018, H.R. 4841; the "Protecting Jessica Grub's Legacy" Act S. 1850; The "Ensuring Patient Access to Healthcare Records" Act of 2017, H.R. 4613; the "Support for Patient and Communities Act," H.R. 6; the "Preventing Addiction for Susceptible Seniors Issues(PASS) Act," H.R. 5773; Issues related to Prescription Drug Monitoring Programs; The "Reducing Unnecessary Senior Hospitalization Act" H.R. 6502; The "Streamline Small Cell Deployment Act" S.3157; The "Analyzing and Leveraging Existing Rx Transactions Act" HR 6688. )

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

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

HR 1628 - Better Care Reconciliation Act (BCRA). A bill to repeal and replace the Affordable Care Act and make systematic reforms to Medicaid funding. HR 6 - Includes Medicaid, Medicare, and public health reforms to combat the opioid crisis by advancing treatment and recovery initiatives, improving prevention, protecting communities, and bolstering efforts to combat illicit synthetic drugs like fentanyl. HR 3545 - Act to protect the confidentiality of substance use disorder patient records.

Client expense: $180,000 · Firm income: Not reported

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

HR 3331/S 1732 "Improving Access to Behavioral Health Information Technology Act," all provisions. HR 1628 "American Health Care Act of 2017," all provisions. HR 3545/S. 1850, "Protecting Jessica Grubb's Legacy Act". HR 6082, Overdose Prevention and Patient Safety Act. HR 6 - SUPPORT for Patients and Communities Act

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

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

ACA implementation (exchange operations and functionality, risk mitigation programs, risk adjustment, transitional policies) ACA reform (reconciliation, individual mandate, cost sharing reduction subsidies, reinsurance) ACA enrollment The Bipartisan Budget Act of 2018 (H.R. 1892) Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act of 2017 (S. 974 and H.R. 2212) Overdose Prevention and Patient Safety Act (H.R. 3545 and H.R. 6082) Jessies Law (H.R. 5009) Mental health and substance use (42 CFR Part 2) Individual market and exchange stabilization Association health plans Short Term Limited Duration Plans Out of network billing (FAA Reauthorization Act of 2018, H.R. 302) ACA third party payments Telehealth Price of prescription drugs Opioid addiction issues and response (prescription drug monitoring programs) H.R. 6, SUPPORT for Patients and Communities Act

Client expense: $730,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, White House Office

ACA implementation (exchange operations and functionality, risk mitigation programs, risk adjustment, transitional policies) ACA reform (reconciliation, individual mandate, cost sharing reduction subsidies, reinsurance) ACA enrollment The Bipartisan Budget Act of 2018 (H.R. 1892) Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act of 2017 (S. 974 and H.R. 2212) Overdose Prevention and Patient Safety Act (H.R. 3545 and H.R. 6082) Jessies Law (H.R. 5009) Mental health and substance use (42 CFR Part 2) Individual market and exchange stabilization Association health plans Short Term Limited Duration Plans Out of network billing (FAA Reauthorization Act of 2018, H.R. 302) ACA third party payments Telehealth Price of prescription drugs Opioid addiction issues and response (prescription drug monitoring programs) H.R. 6, SUPPORT for Patients and Communities Act

Client expense: $730,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, White House Office

H.R. 6, the SUPPORT for Patients and Communities Act; S. 2680, the Opioid Crisis Response Act of 2018; H.R. 6082 / H.R. 3545 / H.R. 5795, the Overdose Prevention and Patient Safety Act, and issues related to 42 CFR Part 2. Monitored issues related to health care consolidation. H.R. 5797, Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act; H.R. 5385, the Children's Hospital GME Support Reauthorization Act of 2018; H.R. 5804, the Post-Surgical Injections as an Opioid Alternative Act; issues related to hospital rape kits.

Client expense: Not reported · Firm income: $93,000

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE, White House Office