Opioid Workforce Act of 2018

Adequacy of health care workforce associated with expansion of health care coverage; Reauthorization of the Childrens Health Insurance Program (CHIP); issues related to health care coverage; issues related to health care coverage; H.R. 2257, Guard and Reservists Education Improvement Act; H.R. 3, Spending Cuts to Expired and Unnecessary Programs Act; Graduate Medical Education Issues; H.R. 5358/S. 2597, Childrens Hospital GME Support Reauthorization Act of 2018; S. 3014, Rural Physician Workforce Production act of 2018; H.R. 5818/S. 2843, Opioid Workforce Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; Nicotine regulation issues; S. 2446, Safe Staffing for Nurse and Patient Safety Act; POLST issues; H.R. 6458 NOTA Amendments Bill of 2019; Issues related to allocation of Livers; S. 348 Resident Physician Shortage Reduction Act of 2019; Title VII and VIII; Nursing workforce development programs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for Graduate Medical Education (GME) funding including the Resident Physician Shortage Reduction Act of 2019 (S. 348/H.R. 1763) and the Opioid Workforce Act of 2018 (H.R. 5818/S. 2843) and Advancing Medical Resident Training in Community Hospitals Act (H.R. 1358) Support for delay of impending Medicaid Disproportionate Share Hospital payment cuts Support for full protection of Critical Access Hospital payments including the Critical Access Hospital Relief Act of 2019 (H.R. 1041) Support for implementation of Organ Procurement and Transplantation Network Liver Policy Support for changes to Medicare Volume Decrease Adjustment calculation including the Access for Rural Communities Act (H.R. 3672) Support for correction of erroneous reductions of GME residency positions Support for Protecting Local Access to Care for Everyone Act (H.R. 2552) Opposition to 340B program reductions in Centers for Medicare and Medicaid Services (CMS) 2018 Outpatient Prospective Payment System (OPPS) proposed rule [CMS-1678-P] Opposition to site-neutral payment reductions to hospital outpatient departments proposed in CMS 2019 OPPS proposed rule [CMS-1695-P] Support for policies to preserve Medicare Disproportionate Share Hospital funding as part of CMS 2019 Inpatient Prospective Payment System proposed rule [CMS-1694-P] Opposition to Department of Homeland Security Proposed Rule on Inadmissibility on Public Charge Grounds [DHS Docket No. USCIS-2010-0012] Opposition to Medicare Area Wage Index changes in CMS 2020 inpatient prospective payment system proposed rule [CMS-1716-P] Opposition to setting rates or bundling ER payments to address disputes between insurers and hospitals for surprise bills. Advocacy on various surprise billing bills (S. 1895, H.R.3502, H.R.3630)

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

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

Support for Graduate Medical Education (GME) funding including the Resident Physician Shortage Reduction Act of 2019 (S. 348/H.R. 1763) and the Opioid Workforce Act of 2018 (H.R. 5818/S. 2843) and Advancing Medical Resident Training in Community Hospitals Act (H.R. 1358) Support for delay of impending Medicaid Disproportionate Share Hospital payment cuts Support for full protection of Critical Access Hospital payments including the Critical Access Hospital Relief Act of 2019 (H.R. 1041) Support for implementation of Organ Procurement and Transplantation Network Liver Policy Support for changes to Medicare Volume Decrease Adjustment calculation Support for correction of erroneous reductions of GME residency positions Opposition to 340B program reductions in Centers for Medicare and Medicaid Services (CMS) 2018 Outpatient Prospective Payment System (OPPS) proposed rule [CMS-1678-P] Opposition to site-neutral payment reductions to hospital outpatient departments proposed in CMS 2019 OPPS proposed rule [CMS-1695-P] Support for policies to preserve Medicare Disproportionate Share Hospital funding as part of CMS 2019 Inpatient Prospective Payment System proposed rule [CMS-1694-P] Opposition to Department of Homeland Security Proposed Rule on Inadmissibility on Public Charge Grounds [DHS Docket No. USCIS-2010-0012] Opposition to setting rates or bundling ER payments to address disputes between insurers and hospitals for surprise bills. Advocacy on various surprise billing bills (S. 1895, H.R.3502, H.R.3630)

Client expense: $230,000 · Firm income: Not reported

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

Adequacy of health care workforce associated with expansion of health care coverage; Reauthorization of the Childrens Health Insurance Program (CHIP); issues related to health care coverage; issues related to health care coverage; H.R. 2257, Guard and Reservists Education Improvement Act; H.R. 3, Spending Cuts to Expired and Unnecessary Programs Act; Graduate Medical Education Issues; H.R. 5358/S. 2597, Childrens Hospital GME Support Reauthorization Act of 2018; S. 3014, Rural Physician Workforce Production act of 2018; H.R. 5818/S. 2843, Opioid Workforce Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; Nicotine regulation issues; S. 2446, Safe Staffing for Nurse and Patient Safety Act; POLST issues; H.R. 6458 NOTA Amendments Bill of 2019; Issues related to allocation of Livers; S. 348 Resident Physician Shortage Reduction Act of 2019; Title VII and VIII; Nursing workforce development programs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare-Graduate Medical Education Advancing Medical Resident Training in Community Hospitals Act, H.R. 284 Advancing Medical Resident Training in Community Hospitals Act of 2017, H.R. 4552/S. 1291 Advancing Medical Resident Training in Community Hospitals Act of 2018, H.R. 6056 Resident Physician Shortage Act of 2017, H.R. 2267/ S. 1301 Restoring Rural Residencies Act, S. 455 Rural Physician Workforce Production Act of 2018, S. 3014 HRSA THCGME Program Creating Access to Residency Education (CARE) Act of 2018, H.R. 7233 Opioid Workforce Act of 2018, H.R. 5818/ S. 2843 Community and Public Health Programs Extension Act (S. 192) Advancing Medical Resident Training in Community Hospitals Act of 2019, H.R. 1358 Resident Physician Shortage Reduction Act of 2019 (H.R. 1763/ S. 348) Rural Physician Workforce Production Act of 2019, S. 289 Training the Next Generation of Primary Care Doctors Act of 2019, S. 304

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for Graduate Medical Education (GME) funding including the Resident Physician Shortage Reduction Act of 2019 (S. 348/H.R. 1763) and reintroduction of the Opioid Workforce Act of 2018 (H.R. 5818/S. 2843) Support for delay of impending Medicaid Disproportionate Share Hospital payment cuts Support for legislation to address opioid epidemic including legislation to align 42 CFR Part 2 with the Health Insurance Portability and Accountability Act Support for full protection of Critical Access Hospital payments including the Critical Access Hospital Relief Act of 2019 (H.R. 1041) Support for reintroduction of REMC Act of 2018 (H.R. 5678) Support for implementation of Organ Procurement and Transplantation Network Liver Policy Support for changes to Medicare Volume Decrease Adjustment calculation Support for correction of erroneous reductions of GME residency positions Opposition to 340B program reductions in Centers for Medicare and Medicaid Services (CMS) 2018 Outpatient Prospective Payment System (OPPS) proposed rule [CMS-1678-P] Opposition to site-neutral payment reductions to hospital outpatient departments proposed in CMS 2019 OPPS proposed rule [CMS-1695-P] Support for policies to preserve Medicare Disproportionate Share Hospital funding as part of CMS 2019 Inpatient Prospective Payment System proposed rule [CMS-1694-P] Opposition to Department of Homeland Security Proposed Rule on Inadmissibility on Public Charge Grounds [DHS Docket No. USCIS-2010-0012] Opposition to setting rates or bundling ER payments to address disputes between insurers and hospitals for surprise bills.

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

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

Adequacy of health care workforce associated with expansion of health care coverage; Reauthorization of the Childrens Health Insurance Program (CHIP); issues related to health care coverage; issues related to health care coverage; H.R. 2257, Guard and Reservists Education Improvement Act; H.R. 3, Spending Cuts to Expired and Unnecessary Programs Act; Graduate Medical Education Issues; H.R. 5358/S. 2597, Childrens Hospital GME Support Reauthorization Act of 2018; S. 3014, Rural Physician Workforce Production act of 2018; H.R. 5818/S. 2843, Opioid Workforce Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; Nicotine regulation issues; S. 2446, Safe Staffing for Nurse and Patient Safety Act; POLST issues; H.R. 6458 NOTA Amendments Bill of 2019; Issues related to allocation of Livers; S. 348 Resident Physician Shortage Reduction Act of 2019; Title VII and VIII; Nursing workforce development programs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid Long term care/home and community based services, including workforce issues Medicare Electronic visit verification S. 2065, HR 4143 (dialysis) HR 6042 (Medicaid personal care services payments) S. 2843, HR 5818 (Opioid crisis) HR 6

Client expense: $122,013 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid Long term care/home and community based services, including workforce issues Medicare Money follow the person Electronic visit verification S. 2065, HR 4143 (dialysis) HR 6042 (Medicaid personal care services payments) S. 2843, HR 5818 (Opioid crisis)

Client expense: $128,962 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Opioid issues (S. 2680, the Opioid Crisis Response Act of 2018; H.R. 5176, Preventing Overdoses While in Emergency Rooms (POWER) Act; H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act; H.R. 5009, Jessies Law; H.R. 5818 / S. 2843, the Opioid Workforce Act; H.R. 5797, the IMD CARE Act; H.R. 6082/H.R. 5795, the Overdose Prevention and Patient Safety Act; S. 2905, Strengthening Partnerships to Prevent Opioid Abuse Act; S. 2460, Every Prescription Conveyed Securely Act; S. 2920, Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act; H.R. 5582, the Abuse Deterrent Access Act; H.R. 5685, the Medicare Opioid Safety Education Act; Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018; H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act; S. 2899, Caring Recovery for Infants and Babies Act; S. 2898, Medication-Assisted Treatment Improvement Act; S.2911, Enhancing Patient Access to Non-Opioid Treatment Options) Draft Protecting Patients from Surprise Medical Bills Act HIPAA policy in mental and behavioral health information sharing 21st Century Cures Act implementation Pandemic and All Hazards Preparedness Reauthorization, including Hospital Preparedness Program (S. 2852, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) of 2018) S.781/ HR 1876. Good Samaritan Health Professional Act of 2017 Health workforce reauthorizations (H.R. 959, the Title VIII Nursing Workforce Reauthorization Act; H.R. 3728, the Educating Medical Professionals and Optimizing Workforce Efficiency Readiness (EMPOWER) Act; H.R. 1676, the Palliative Care and Hospice Education and Training Act Liver allocation policy (H.R. 6458 National Organ Transplant Act Amendments of 2018; H.R. 6517 Fairness in Liver Allocation Act of 2018) H.R. 5678, Rural Emergency Medical Center (REMC) Act of 2018) Disproportionate share hospital payments (H.R. 1892, Bipartisan Budget Act of 2018; implementation of the S-10 worksheet) H.R. 2267 / S. 1301, Resident Physician Shortage Reduction Act H.R. 5818 / S. 2843, Opioid Workforce Act Telehealth payment (H.R. 1892, Bipartisan Budget Act of 2018; H.R. 6, SUPPORT for Patients and Communities Act) Stark law reform Hospital outpatient payment policy Site neutral payment policy included in outpatient prospective payment system proposed rule Physician fee schedule rule Evaluation and management coding and payment policy in physician fee schedule rule S. 2597 / H.R. 5385, Children's Hospital GME Support Reauthorization Act of 2018 Opioid funding (CARA implementation; S. 2004, Combating the Opioid Epidemic Act; H.R. 1892, Bipartisan Budget Act of 2018; Consolidated Appropriations Act, 2018) Behavioral health funding (H.R. 1892, Bipartisan Budget Act of 2018; Consolidated Appropriations Act, 2018; H.R. 6157) HR 6470 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019 H.R. 5645, the Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act Public Charge proposed rule Q4 Submitted Letters SUBJECT: DHS Docket No. USCIS-2010-0012, Inadmissibility on Public Charge Grounds; Proposed Rule SUBJECT: Docket No. FDA-2018-N-3272, Identifying the Root Causes of Drug Shortages and Finding Enduring Solutions SUBJECT: CMS-1701-P, Medicare Program: Medicare Shared Savings Program; Accountable Care Organizations Pathways to Success Proposed Rule SUBJECT: OIG-0803-N, Request for Information Regarding Anti-Kickback Statute and Beneficiary Inducements CMP SUBJECT: CMS-3346-P, Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction SUBJECT: Notice of Proposed Rulemaking, 340B Drug Pricing Program Ceiling Price and Manufacturer Civil Monetary Penalties Effective Date Change

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

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Rural hospital policies (H.R. 741/S. 243, H.R. 1955/S. 872, S. 1130, straight policy extension of Medicare dependent hospital and low volume adjustment payments, H.R. 1892, Bipartisan Budget Act of 2018); H.R. 5678, Rural Emergency Medical Center (REMC) Act of 2018) Disproportionate share hospital payments (H.R. 1892, Bipartisan Budget Act of 2018; implementation of the S-10 worksheet) H.R. 2267 / S. 1301, Resident Physician Shortage Reduction Act H.R. 5818 / S. 2843, Opioid Workforce Act Telehealth payment (H.R. 1892, Bipartisan Budget Act of 2018; H.R. 6, SUPPORT for Patients and Communities Act) Stark law reform Hospital outpatient payment policy Site neutral payment policy included in outpatient prospective payment system proposed rule Physician fee schedule rule Evaluation and management coding and payment policy in physician fee schedule rule S. 2597 / H.R. 5385, Children's Hospital GME Support Reauthorization Act of 2018 Requirement for public posting of chargemaster in electronically readable form

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B Drug Pricing Program Opioid issues (S. 2680, the Opioid Crisis Response Act of 2018; H.R. 5176, Preventing Overdoses While in Emergency Rooms (POWER) Act; H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act; H.R. 5009, Jessies Law; H.R. 5818 / S. 2843, the Opioid Workforce Act; H.R. 5797, the IMD CARE Act; H.R. 6082/H.R. 5795, the Overdose Prevention and Patient Safety Act; S. 2905, Strengthening Partnerships to Prevent Opioid Abuse Act; S. 2460, Every Prescription Conveyed Securely Act; S. 2920, Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act; H.R. 5582, the Abuse Deterrent Access Act; H.R. 5685, the Medicare Opioid Safety Education Act; Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018; H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act; S. 2899, Caring Recovery for Infants and Babies Act; S. 2898, Medication-Assisted Treatment Improvement Act; S.2911, Enhancing Patient Access to Non-Opioid Treatment Options) Draft Protecting Patients from Surprise Medical Bills Act HIPAA policy in mental and behavioral health information sharing 21st Century Cures Act implementation Pandemic and All Hazards Preparedness Reauthorization, including Hospital Preparedness Program (S. 2852 / H.R. 6378, H.R. 7328, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) of 2018) S.781/ HR 1876. Good Samaritan Health Professional Act of 2017 Health workforce reauthorizations (H.R. 959, the Title VIII Nursing Workforce Reauthorization Act; H.R. 3728, the Educating Medical Professionals and Optimizing Workforce Efficiency Readiness (EMPOWER) Act; H.R. 1676, the Palliative Care and Hospice Education and Training Act Liver allocation policy S.2554, Patient Right to Know Drug Prices Act Consumer-directed health care proposals (Associations Health Plans, Short-term Limited Duration Insurance plans, Section 1332 waivers) Maternal health legislation (H.R. 315, Improving Access to Maternity Care Act and H.R. 1318, Preventing Maternal Deaths Act)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to Graduate Medical Education.Issues related to price transparency and Issues related to S. 2843 / H.R. 5818.

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

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

Issues related to health care coverage, graduate medical education, and 340B. H.R.5385/S.2597, Children's Hospital GME Support Reauthorization Act of 2018. S.3014, Rural Physician Workforce Production Act of 2018. H.R.5818/S.2843, Opioid Workforce Act of 2018.

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

Government targets: Agriculture, Dept of (USDA), HOUSE OF REPRESENTATIVES, SENATE

H.R. 5818 Opioid Workforce Act of 2018 H.R. 6071 The SERV Communities Act (2018)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

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

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

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

Adequacy of health care workforce associated with expansion of health care coverage; Reauthorization of the Childrens Health Insurance Program (CHIP); issues related to health care coverage; H.R. 2257, Guard and Reservists Education Improvement Act; H.R.3, Spending Cuts to Expired and Unnecessary Programs Act; Graduate Medical Education Issues; H.R. 5385/S. 2597, Children's Hospital GME Support Reauthorization Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; H.R. 5818/S. 2843, Opioid Workforce Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; Nicotine regulation issues; S. 2446, Safe Staffing for Nurse and Patient Safety Act; POLST issues; H.R. 6458 NOTA Amendments Bill of 2019; Issues related to allocation of Livers.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

H.R. 5818/S. 2843 - "Opioid Workforce Act of 2018" H.R. 6 - "SUPPORT for Patients and Communities Act of 2018" - Supported Legislation. H.R. 6378/S. 2852 - "The Pandemic and All Hazards Preparedness Act (PAHPA)" - Monitored and reviewed legislation. Monitored Congressional Proposals concerning health price transparency. H.R. 676/S.1804 - "Expanded & Improved Medicare For All Act" - Oppose legislation to impose single payer health care delivery H.R. 959 - "Title VIII Nursing Workforce Re-authorization Act of 2018" - Urge support for legislation to provide loan repayment for nurses to practice in any care setting. Surprise Billing - Support protecting patients from surprise bills.

Client expense: $720,000 · Firm income: Not reported

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

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)

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

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

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare and Medicaid policy related to hospital and physician care, including bills related to graduate medical education policy and other issues. Specific bills included: "The Opioid Workforce Act of 2018 (H.R. 5818 and S.2843)" and "The Diagnostic Accuracy and Innovation Act (no bill number)".

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

In support of extension for 340B program and opposition to proposal to reduce Medicare Part B payments for drugs acquired through 340B program. In support of at least two years delay of cuts to hospitals serving a disproportionate share of Medicaid and uninsured patients. In support of H.R.4392 that provides a one-year moratorium on 340B regulations. In support of H.R.5641, the State Offices of Rural Health Reauthorization Act. In support of H.R.5818/S.2843, the Opioid Workforce Act. In opposition to proposals to expand certain site-neutral payment policies to grandfathered off-campus hospital provider-based departments.

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

Government targets: Agriculture, Dept of (USDA), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Office of Management & Budget (OMB), SENATE

P.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. P.L. 115-120 Making Further Appropriations for Fiscal Year Ending September 30, 2018 and for other purposes. All provisions related to the Children's Health Insurance Program and Medicare Rural Hospital payments. H.R. 1892 Bipartisan Budget Act of 2018. All provisions related to the Children's Health Insurance Program, Medicare, Medicaid disproportionate share hospital payments, biomedical research and medical education. H.R. 1625 Consolidated Appropriations Act of 2018. All provisions related to the Children's Health Insurance Program, Medicare, Medicaid disproportionate share hospital payments, biomedical research and medical education. H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes. All Provisions. S 2312 Helping Ensure Low-Income Patients Have Access to Care and Treatment Act. All provisions related to the 340B drug discount program. H.R. 4710 Pause Act. All provisions related to the 340B drug discount program. H.R. 6 Support for Patients and Communities Act. All provisions related to Opioids. H.R. 5818 The Opioid Workforce Act of 2018. All provisions. S. 2843 The Opioid Workforce Act of 2018. All provisions. S. 1291 Advancing Medical Resident Training in Community Hospitals Act of 2017. All provisions. H.R. 4552 Advancing Medical Resident Training in Community Hospitals Act of 2017. All provisions. Ochsner Nominee for the Physician-Focused Payment Technical Advisory Committee. Centers for Medicare and Medicaid Hospital Outpatient Prospective Payment System proposed rule related to Section 603 of the Bipartisan Budget Act of 2015 applying site neutral payment policy to exempted off-campus hospital out-patient departments. All Provisions. Development of Value Based Payment Programs Digital Medicine/Health Programs

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

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

P.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. P.L. 115-120 Making Further Appropriations for Fiscal Year Ending September 30, 2018 and for other purposes. All provisions related to the Children's Health Insurance Program and Medicare Rural Hospital payments. H.R. 1892 Bipartisan Budget Act of 2018. All provisions related to the Children's Health Insurance Program, Medicare, Medicaid disproportionate share hospital payments, biomedical research and medical education. H.R. 1625 Consolidated Appropriations Act of 2018. All provisions related to the Children's Health Insurance Program, Medicare, Medicaid disproportionate share hospital payments, biomedical research and medical education. H.R. 6 Support for Patients and Communities Act. All provisions related to Opioids. H.R. 5818 The Opioid Workforce Act of 2018. All provisions. S. 2843 The Opioid Workforce Act of 2018. All provisions. H.R. 6458 National Organ Transplant Amendments of 2018. All provisions. Digital Medicine/Health Programs Deputy Secretary's (HHS) Innovation and Investment Summit Nomination Health Resources and Services Administration Remote Pregnancy Monitoring Program Liver Allocation and Transplantation Policy

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

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

H.R. 5818/S. 2843 - "Opioid Workforce Act of 2018" H.R. 6 - "SUPPORT for Patients and Communities Act of 2018" - Supported Legislation. H.R. 6378/S. 2852 - "The Pandemic and All Hazards Preparedness Act (PAHPA)" - Monitored and reviewed legislation. Monitored Congressional Proposals concerning health price transparency. H.R. 676/S.1804 - "Expanded & Improved Medicare For All Act" - Oppose legislation to impose single payer health care delivery H.R. 959 - "Title VIII Nursing Workforce Re-authorization Act of 2018" - Urge support for legislation to provide loan repayment for nurses to practice in any care setting.

Client expense: $650,000 · Firm income: Not reported

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

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

Client expense: $857,000 · Firm income: Not reported

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

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

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

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

Children's hospital Graduate medical education (CHGME) Indirect and Direct Medical Education adjustment for teaching hospitals (GME) Resident Physician Shortage Reduction Act of 2017 (H.R. 2267/S.1301) Opioid Workforce Act of 2018 (H.R. 5818/S. 2843)

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

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

Insurance market policies (Bipartisan Health Care Stabilization Act; Short-term, Limited Duration Health Insurance rule; Association Health Plans rule) Risk adjustment payments Cost sharing reduction payments Insurance navigator funding 340B Drug Pricing Program (H.R. 4392; H.R. 4710, 340B PAUSE Act; S. 2453, Ensuring the Value of the 340B Program Act; H.R. 6071, Stretching Entity Resources for Vulnerable Communities Act; H.R. 2889, Closing Loopholes for Orphan Drugs Act; H.R. 5598, 340B Optimization Act; H.R. 6240, Drug Discount Accountability Act; H.R. 6273, Creating Access to Rape Kit Exams (CARE) for Survivors Act) Opioid issues (S. 2680, the Opioid Crisis Response Act of 2018; H.R. 5176, Preventing Overdoses While in Emergency Rooms (POWER) Act; H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act; H.R. 5009, Jessies Law; H.R. 5818 / S. 2843, the Opioid Workforce Act; H.R. 5797, the IMD CARE Act; H.R. 6082/H.R. 5795, the Overdose Prevention and Patient Safety Act; S. 2905, Strengthening Partnerships to Prevent Opioid Abuse Act; S. 2460, Every Prescription Conveyed Securely Act; S. 2920, Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act; H.R. 5582, the Abuse Deterrent Access Act; H.R. 5685, the Medicare Opioid Safety Education Act; Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018; H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act; S. 2899, Caring Recovery for Infants and Babies Act; S. 2898, Medication-Assisted Treatment Improvement Act; S.2911, Enhancing Patient Access to Non-Opioid Treatment Options) IV and medication shortages Drug prices (American Patients First, Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs; S. 2554 / H.R. 6143, Patient Right to Know Drug Prices Act; S. 2553, Know the Lowest Price Act; H.R. 6733, Know the Cost Act) Draft Protecting Patients from Surprise Medical Bills Act HIPAA policy in mental and behavioral health information sharing 21st Century Cures Act implementation Pandemic and All Hazards Preparedness Reauthorization, including Hospital Preparedness Program (S. 2852, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) of 2018) S.781/ HR 1876. Good Samaritan Health Professional Act of 2017 Health workforce reauthorizations (H.R. 959, the Title VIII Nursing Workforce Reauthorization Act; H.R. 3728, the Educating Medical Professionals and Optimizing Workforce Efficiency Readiness (EMPOWER) Act; H.R. 1676, the Palliative Care and Hospice Education and Training Act Consumer Directed Health Plans Legislation (H.R. 6311 would modify the definition of a qualified health plan and allow individuals purchasing health insurance in the individual market to purchase a "copper" plan or use the premium tax credit to buy off-marketplace coverage; H.R. 6301 to allow CDHPs to provide coverage for services like telehealth, chronic disease management, or primary care visits below the minimum deductible; H.R. 6317 to allow coverage of direct primary care service arrangements; H.R. 6305 to permit use of CDHPs to receive certain employment-related health services like onsite clinics; H.R. 6309 to allow individuals only enrolled in Medicare Part A to contribute to health savings accounts; H.R. 6199 to include certain over-the-counter medical products as qualified medical expenses; H.R. 6306 to increase the current contribution limits for HSAs; H.R. 6312, Personal Health Investment Today (PHIT) Act to count sports equipment and exercise costs toward medical expenses; H.R. 6313 to allow carry-forward of flexible spending account balances each year; H.R. 6314 to allow bronze and catastrophic plans in connection with health savings accounts, allowing plans categorized as catastrophic and bronze in the individual and small group markets to qualify for HSA contributions) H.R. 4616 to delay the implementation of the excise tax on high cost employer-sponsored health coverage; and place a moratorium on the employer mandate Liver allocation policy

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to implementation of PPACA (PL: 111-148) and its impact on hospitals; Funding for graduate medical education. S. 2843/H.R. 5818, The Opioid Workforce Act and H.R. 2267/S. 1301, Resident Physician Shortage Reduction Act of 2017. Liver Allocation Fairness Act, H.R. 6517

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5818/S. 2843; Opioid Workforce Act of 2018; All provisions. Issues related to HOPD rate cuts. Issues related to the 340B program. Issues related to organ transplantation equity. Issues related to the FDA regulation of laboratory developed tests.

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

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