IMPROVE Act

H.R. 3325, S. 428 - ACE Kids Act, H.R. 7217 - IMPROVE Act: Issues pertaining to Part D rebates; 2020 Notice of Benefit and Payment Parameters, Money Follows the Person, Medicaid Medical Loss Ratio. H.R. 4378 - Continuing Appropriations Act, 2020, and Health Excellence Act of 2019: Issues related to Money Follows the Person. S. 2543 - Prescription Drug Pricing Reduction Act of 2019: Issues related to drug pricing; Medicaid; Medicare.

Client expense: $1,330,000 · 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. 7217 - IMPROVE Act: Issues pertaining to Part D rebates; 2020 Notice of Benefit and Payment Parameters, Money Follows the Person, Medicaid Medical Loss Ratio.

Client expense: $1,350,000 · 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. 7217 - IMPROVE Act: Issues pertaining to Part D rebates; 2020 Notice of Benefit and Payment Parameters, Money Follows the Person, Medicaid Medical Loss Ratio.

Client expense: $1,100,000 · 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. 3325, S. 428 - ACE Kids Act, H.R. 7217 - IMPROVE Act: Issues pertaining to Part D rebates; 2020 Notice of Benefit and Payment Parameters, Money Follows the Person, Medicaid Medical Loss Ratio. H.R. 4378 - Continuing Appropriations Act, 2020, and Health Excellence Act of 2019: Issues related to Money Follows the Person. S. 2543 - Prescription Drug Pricing Reduction Act of 2019: Issues related to drug pricing; Medicaid; Medicare.

Client expense: $1,070,000 · 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. 3325, S. 428 - ACE Kids Act, H.R. 7217 - IMPROVE Act: Issues pertaining to Part D rebates; 2020 Notice of Benefit and Payment Parameters, Money Follows the Person, Medicaid Medical Loss Ratio.

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

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

H.R. 7217 - IMPROVE Act: Issues pertaining to Part D rebates; 2020 Notice of Benefit and Payment Parameters, Money Follows the Person, Medicaid Medical Loss Ratio.

Client expense: $1,100,000 · 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. 3325, S. 428 - ACE Kids Act, H.R. 7217 - IMPROVE Act: Issues pertaining to Part D rebates; 2020 Notice of Benefit and Payment Parameters, Money Follows the Person, Medicaid Medical Loss Ratio. H.R. 4378 - Continuing Appropriations Act, 2020, and Health Excellence Act of 2019: Issues related to Money Follows the Person. S. 2543 - Prescription Drug Pricing Reduction Act of 2019: Issues related to drug pricing; Medicaid; Medicare.

Client expense: $1,040,000 · 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. 3325, S. 428 - ACE Kids Act, H.R. 7217 - IMPROVE Act: Issues pertaining to Part D rebates; 2020 Notice of Benefit and Payment Parameters, Money Follows the Person, Medicaid Medical Loss Ratio.

Client expense: $1,430,000 · Firm income: Not reported

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

H.R. 7217 - IMPROVE Act; H.R. 3325/S. 428; Issues pertaining to Part D rebates; 2020 NBPP. H.R. 3325/S. 428 - "ACE Kids Act" - to amend title XIX of the Social Security Act to provide states with the option of providing coordinated care for children with complex medical conditions through a health home, regarding all provisions. S. 2554 - "Patients' Right to Know Drug Price Act of 2018", issues pertaining to drug pricing.

Client expense: $1,280,000 · Firm income: Not reported

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

H.R. 807/S.253 Medicare Access to Rehabilitation Services Act (Medicare Appeals Procedures) QPP Prevention Initiatives for Fraud and Abuse in The Medicare program Accountable health care organizations/patient centered medical homes Electronic health records/health information technology incentives for Physical Therapists Local coverage determinations/EMG NCCI Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage PCORI National priority for research and research agenda Health information technology Functional Limitation Reporting Therapy Cap: Targeted Medical Review Essential Health Benefits MIPS/PPP Medicaid essential health benefits EHR/LTPAC settings: transitions of care Medicare improvement standards Bundled payment models/CJR Common assessment tool for Medicare post-acute care Medicare appeals process Inclusion of physical therapists in quality programs Self-referral Coverage of telehealth APTA Registry Quality Programs Accelerating Innovation in Medicine Act (AIM) IMPACT Medicare Pilot Programs Chronic Care Management New evaluation and reevaluation CPT codes & misvalued codes Orthotics and Prosthetics Medicare Private Contracting S.870 - Chronic Care Act SNF 3-Day Rule Registry- ACI HR 2042 - Frontline Act Youth Concussion Management DME HR 3446 RBI Act H.R. 5261 Teach Act Opioid related H.R. 5197 Alto Act Opioid related Administrative Burden H.R. 5686, Medicare Clear Health Options in Care for Enrollees Act H.R. 5773, Preventing Addiction for Susceptible Seniors Act H.R. 5774, Combating Opioid Abuse for Care in Hospitals Act H.R. 5718, Perioperative Reduction for Opioids Act H.R. 5719, Reduce Overprescribing Opioids in Treatment Act H.R. 5722, Dr. Todd Graham Pain Management Improvement Act H.R. 6, Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. S. 3120, HEAL Act S. 2680, Opioid Crisis Response Act PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Certified EHR technology HR 7217 Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act (IMPROVE ACT) S. 3458: Improvements to Home Health HR 3635: Local Coverage Determination Clarification Act of 2018

Client expense: $252,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

Implementation/Expansion of CDC Falls Program Implementation of Affordable Care Act - provisions pertaining to Essential Health Benefits & Health Insurance Exchanges AHRQ provisions pertaining to PT Physician self-referra/Stark Law American Cures Act H.R. 930/S.497 Lymphadema Treatment Act Health Information Technology Nominations to PCORI Methodology Committees Medicaid Expansion HR. 1639/S.619 Physical Therapist Workforce & Patient Access Act Physician owned distributerships H.R. 302/S.808 Sports Medicine Licensure Clarity Act MACRA/MIPS APMS IMPACT/PAC reform Network adequacy Insurance Benefit parameters H.R. 1361/S.486 Ensuring Access to Quality CRT Medicare Telehealth Parity Act HR2550 American Healthcare Act of 2017/CONNECT - H.R. 2556/S1016 H.R. 1628 - American Health Care Action of 2017 Opioid Epidemic/Pain Management Better Care Reconciliation Act of 2017 H.R.2066 Promoting Integrity in Medicare H.R. 2063 Opioid Pace Act of 2017 H.R. 5261 Teach Act H.R. 5197 Alto Act H.R. 5686, Medicare Clear Health Options in Care for Enrollees Act H.R. 5773, Preventing Addiction for Susceptible Seniors Act H.R. 5774, Combating Opioid Abuse for Care in Hospitals Act H.R. 5718, Perioperative Reduction for Opioids Act H.R. 5719, Reduce Overprescribing Opioids in Treatment Act H.R. 5722, Dr. Todd Graham Pain Management Improvement Act H.R. 6, Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act S. 3120, the HEAL Act S. 2680, Opioid Crisis Response Act Association Retirement Plans State Relief and Empowerment Waivers D.O.L Information Collection Request Extensions Health Reimbursement Accounts HR 7217: Improve Act

Client expense: $252,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

S. 448/H.R. 1173 Medicare Mental Health Access Act S. 874 At-Risk Youth Medicaid Protection Act S. 1905/H.R. 3931 Excellence in Mental Health and Addiction Treatment Expansion Act S. 1169/H.R. 2687 Medicaid Coverage for Addiction Recovery Expansion Act S. 1732/H.R. 3331 To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 6 Support for Patients and Communities Act H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes H.R. 2509 Medicare Mental Health Inpatient Inequity Act H.R. 7217 IMPROVE Act

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

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

S. 448/H.R. 1173 Medicare Mental Health Access Act S. 874 At-Risk Youth Medicaid Protection Act S. 1905/H.R. 3931 Excellence in Mental Health and Addiction Treatment Expansion Act S. 1169/H.R. 2687 Medicaid Coverage for Addiction Recovery Expansion Act S. 1732/H.R. 3331 To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 6 Support for Patients and Communities Act H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes H.R. 2509 Medicare Mental Health Inpatient Inequity Act H.R. 7217 IMPROVE Act

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

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

S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 1016, CONNECT For Health Act (Schatz) - telehealth S. 1169, Medicaid CARE Act (Durbin-Portman) - changes to Medicaid IMD exclusion S. 1688, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 1804, Medicare for All Act (Sanders) - single payer health system S. 1890, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Cardin) - Medigap coverage for beneficiaries with end-stage renal disease S. 1909, BENES Act (Casey) - notifications of Medicare eligibility S. 2027, Medicaid Third Party Liability Act (Portman) - Medicaid third party liability S. 2051, Medicare Care Coordination Improvement Act of 2017 (Portman) - barriers to payment reform models S. 2227, EMPOWER Care Act (Portman-Cantwell) - Medicaid Money Follows the Person Demonstration S. 2707, Informing Seniors About Opioids Act (Nelson) - opioid issues S. 2901, Expanding Telehealth Response to Ensure Addiction Treatment Act (Thune) - opioid issues S. 2904, Medicaid Substance Use Disorder Treatment Via Telehealth Act (Carper) - opioid issues S. 2908, Electronic Prior Authorization in Medicare Part D Act (Roberts) - opioid issues S. 3327, SENIOR Communities Protection Act (Cortez Masto) - preventing fraudulent opioid prescriptions S. 3496, Improving Seniors Access to Quality Benefits Act (Daines-King) - study on MA benchmark cap S. 3497, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap S. 3702, Right Rebate Act (Wyden-Grassley) - Medicaid drug rebate program Draft Bill: Medicare Long-Term Care Services and Supports Act (Pallone) - Long-Term Services and Supports Program H.R. 6, SUPPORT Patients and Families Act (Walden) - opioid initiatives, Medicare and Medicaid issues, budget offsets H.R. 695, Continuing Appropriations Act (Schiff) - Money Follows the Person demonstration, spousal impoverishment protections H.R. 849, Protecting Seniors Access to Medicare Act (Roe) - Independent Payment Advisory Board H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1148, FAST Act (Griffith) - access to telehealth-eligible stroke services under Medicare H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 2556, CONNECT For Health Act (Black) - telehealth H.R. 2575, BENES Act (Ruiz) - notifications of Medicare eligibility H.R. 2644, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Marino) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 2687, Medicaid CARE Act (Foster-Fitzpatrick) - changes to Medicaid IMD exclusion H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) H.R. 3263, Medicare Independence at Home Model of Care (Burgess) - demonstration program H.R. 3325, ACE Kids Act (Barton) - health homes for children with complex medical conditions H.R. 3360, Telehealth Enhancement Act (Harper) - telehealth in Medicare H.R. 3635, Local Coverage Determination Clarification Act (Jenkins) - procedures for Medicare administrative contractors H.R. 3727, Increasing Telehealth Access in Medicare Act (Black) - telehealth in MA plans H.R. 4143, Dialysis PATIENTS Demonstration Act (Smith) - alternative care delivery models and payment methodologies for patients with end-stage renal disease H.R. 4952, Improving Seniors Access to Quality Benefits Act (Kelly) - MA benchmark cap study H.R. 5306, EMPOWER Care Act (Guthrie) - extension of Money Follows the Person demonstration H.R. 5603, Access to Telehealth Services for Substance Use Disorders Act (Matsui) - opioid issues H.R. 5605, Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act (Ruiz) - opioid issues H.R. 5675, drug management programs for at-risk Medicare beneficiaries (Bilirakis) - opioid issues H.R. 5676, SENIOR Communities Protection Act (MacArthur) - preventing fraudulent opioid prescriptions H.R. 5684, Protecting Seniors from Opioid Abuse Act (Kelly) - opioid issues H.R. 5685, Medicare Opioid Safety Education Act (Faso) - opioid issues H.R. 5686, Medicare Clear Health Options in Care for Enrollees Act (Paulsen) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - communication between Medicare plan sponsors and CMS H.R. 5773, Preventing Addiction for Susceptible Seniors Act (Roskam) - opioid issues H.R. 5797, IMD CARE Act (Walters) - Medicaid IMD exclusion H.R. 5798, Opioid Screening and Chronic Pain Management Alternatives for Seniors Act (Bucshon) - opioid issues H.R. 5799, Medicaid Drug Review, Utilization, Good Governance Improvement Act (Blackburn) - opioid issues H.R. 5800, Medicaid IMD ADDITIONAL INFO Act (Upton) - opioid issues H.R. 5804, Post-Surgical Injections as an Opioid Alternative Act (Shimkus) - opioid issues H.R. 5808, Medicaid Pharmaceutical Home Act (Bilirakis) - opioid issues H.R. 5809, Postoperative Opioid Prevention Act (Peters) - opioid issues H.R. 5810, Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act (Lance) - opioid issues H.R. 5812, Improving Medicaid Data Timeliness Act (Griffith) - opioid issues H.R. 6431, Medigap Consumer Protection Act (Levin) - reforms to Medicare supplemental insurance H.R. 6561, Comprehensive Care for Seniors Act (Walorski) -- Program of All-Inclusive Care for the Elderly H.R. 6563, Lower Out-of-Pocket Costs for Seniors Act (Pallone-Neal) - Medicare Part D cliff H.R. 6662, Empowering Seniors Decision Enrollment Act (Paulsen) - special enrollment period for non-deemed Medicare Cost Plan enrollees H.R. 6690, Fighting Fraud to Protect Care for Seniors Act (Roskam) - Medicare pilot program for smart card technology H.R. 7122, Shared Accountability for Improved Patient Outcomes Act (Paulsen) - value-based payment and delivery arrangements H.R. 7217, IMPROVE Act (Barton) - Money Follows the Person demonstration, ACE Kids Act, Medicare drug rebate program, spousal impoverishment protections H.R. 7223, Right Rebate Act (Schrader-Welch) - Medicaid drug rebate program H.R. 7247, Incentivizing Shared Risk in Medicare Advantage Act (Brady) - MA prior authorization H.R. 7249, Better Prior Authorization Notification Act (Reed) - MA prior authorization H.R. 7250, Prior Authorization Improvement Act (Kelly) - MA prior authorization Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2019 Rate Notice and Call Letter; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; 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

HR 7217 , Improve Act - Rep. Joe Barton (D-TX)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES

Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 (P.L. 114-10) including policies related to the Quality Payment Program Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options H.R. 1160 - ACO Assignment Improvement Act of 2017 H.R. 3178 - Medicare Part B Improvement Act of 2017 H.R. 3635 - Local Coverage Determination Clarification Act of 2017 H.R. 5306/S. 2227 - Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources (EMPOWER) and Care Act H.R. 7217 - Improving Medicaid Programs and Opportunities for Eligible Beneficiaries (IMPROVE) Act S. 445/H.R. 1825 - Home Health Care Planning Improvement Act of 2017 S. 428/H.R. 3325 - Advancing Care for Exceptional Kids (ACE Kids) Act S. 870 - Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 S. 1227/H.R. 2628 - Stabilize Medicaid and CHIP Coverage Act of 2017 S. 3067/H.R. 1617 - Promoting Access to Diabetic Shoes Act

Client expense: Not reported · Firm income: $23,450

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

H.R. 242: Medicare Prescription Drug Price Negotiation Act of 2017 - Provisions related to Part D and drug pricing negotiation H.R. 1316: Prescription Drug Price Transparency Act - Provisions related to transparency of payment methodologies HR 1892 - Bipartisan Budget Act of 2018, provision related to Medicare Part D Doughnut Hole H.R. 3192: CHIP Mental Health Parity Act H.R. 4005: Medicaid Reentry Act H.R. 5150: Protecting Medicare from Excessive Price Increases Act of 2018 - To require drug manufacturers to pay a Medicare part B rebate for certain drugs 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. H.R. 5797: Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Executive Act H.R. 5799: Medicaid Drug Review, Utilization, Good Governance Improvement Act H.R. 5801: Medicaid PARTNERSHIP Act H.R. 5808: Medicaid Pharmaceutical Home Act of 2018 H.R. 6505: Medicare Negotiation and Competitive Licensing Act of 2018 - Drug pricing H.R. 6642: To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs H.R. 7217: Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act or IMPROVE Act S. 41: Medicare Prescription Drug Price Negotiation Act of 2017 - Provisions related to Part D and drug pricing negotiation S. 348: Prescription Drug and Health Improvement Act of 2017 - Provisions related to Part D S. 637: Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017 - Provisions related to transparency of prescription drug pricing and pharmacy benefit managers S. 870: CHRONIC Care Act of 2017 - Provisions related to Medicare and chronic care S. 1348: Stopping the Pharmaceutical Industry from Keeping Drugs Expensive (SPIKE) Act of 2017 - Provisions related to increases in the wholesale acquisition costs of prescription drugs S. 1688: Empowering Medicare Seniors to Negotiate Drugs Prices Act of 2017 - Part D and non-interference provisions Medicare Access and Childrens Health Insurance Program (CHIP) reauthorization policy issues Department of Health and Human Services (HHS) drug policy issues and regulatory policy issues Part D policy issues including non-interference and rebates policy issues Part B reform including MedPAC recommendations and other policy issues and local coverage decisions Drug cost and pricing policy issues Transparency policy issues Alternative payment models policy issues Value-based purchasing arrangements policy issues Anti-Kickback Statute policy issues False Claims Act policy issues Center for Medicare and Medicaid Innovation (CMMI) policy issues Medicaid rebates and waiver policy issues Prescription drug abuse policy issues ANPRM; Medicare Program; International Pricing Index Model for Medicare Part B Drugs (CMS-5528-ANPRM) Proposed Rule; Medicare and Medicaid Programs; Regulation To Require Drug Pricing Transparency (CMS-4187-P) Proposed Rule; Contract Year (CY) 2020 Medicare Advantage and Part D Drug Pricing (CMS-4180-P) Request for Information: Medicare and State Health Care Programs: Fraud and Abuse; Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements CMP; 83 Fed. Reg. 43607 (Aug. 27, 2018) Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection (RIN 0936-AA08) Final Rule; Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System changes for 2019 (CMS-1695-FC) Contract Year (CY) 2020 Medicare Advantage and Part D Drug Pricing Proposed Rule (CMS-4180-P) Medicare Part D/Medicare Part B Medicaid Protected Classes

Client expense: $920,000 · Firm income: Not reported

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

Supports H.R. 750 The Ensuring Access to Quality Complex Rehabilitation Technology (CRT) Act. Supports S. 486 Protecting Beneficiary Access to Complex Rehab Technology Act of 2017 Supports H.R. 3730 (To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative manual wheelchairs and accessories) was introduced by Representatives Lee Zeldin (R-NY) and John Larson (D-CT) to stop CMS from using Competitive Bid pricing for accessories used with CRT manual wheelchairs. Discussed with CMS, the issue of power wheelchair standing and seat elevation devices and the need for appropriate coverage under Medicare. Discussed with CMS, the need for excluding ostomy and urology supplies from CMS' competitive bidding program. Sent letter to CMS re: the National Coverage Decision on Blood Pressure Monitoring to account for the specific needs of the SCI population. Sent letter to CMS on appropriate coding for powered orthotic and prosthetic devices for the SCI/D population. Spoke with CMS on the issue of catheter-associated UTIs and to ask CMS to look at the policy around removing indwelling catheters from individuals with SCI in a hospital setting. Removing catheters from SCI individuals is a very complex decision. Supported HR 7217 - the IMPROVE Act. Supported additional telehealth benefits in Medicare Advantage as United Spinal, and as a member of the Coalition, PCHAlliance. And provided comments to CMS on digital health and need the innovation to CMMI as part of PCHAlliance. Continued to provide comments on appropriate access to assistive technology and medical devices, as part of the ITEM Coalition on behalf of the SCI community and on appropriate rehabilitation as part of the Coalition to Preserve Rehabilitation.

Client expense: Not reported · Firm income: Not reported

Government targets: AMTRAK - Natl Railroad Passenger Corporation, Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS)

H.R. 5963/S. 3063 - Health Insurance Tax Relief Act of 2018 - provisions related to the annual fee on health insurance providers. H.R. 7217, Improving Medicaid Programs and Opportunities for Eligible Beneficiaries (IMPROVE) Act - provisions related to access to services for medically complex children, temporary reauthorization of the Money Follows the Person program and temporary extension of the ACA Spousal Impoverishment protections. Medicaid Managed Care - matters relating to financing and administration thereof. Medicare Advantage (MA) - matters related to financing and administration thereof. Medicare Part D - matters related to financing and administration thereof.

Client expense: $620,000 · 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), SENATE

S. 3079, H.R. 6619, the Medicare Secondary Payer and Workers' Compensation Settlement Agreements Act of 2018 - provisions to establish clear criteria for when a set-aside may be reviewed by Medicare, provides a time frame for CMS to review set-aside submissions and provides an optional direct payment of set-aside amounts to Medicare. H.R. 7217, Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act or the IMPROVE Act - provisions providing for extension of spousal impoverishment protections

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

Government targets: Commerce, Dept of (DOC), Congressional Budget Office (CBO), Consumer Financial Protection Bureau (CFPB), Education, Dept of, Federal Deposit Insurance Corporation (FDIC), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), White House Office

Access to Contraception for Women Servicemembers and Dependents Act (H.R. 2180) Health Equity and Accountability Act of 2018 (H.R. 5942/S. 3660) 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". (S.J. Res 63) 21st Century Women's Act (Not Yet Introduced) ENROLL Act (H.R. 7102) Preventing Maternal Deaths Act of 2017 (H.R. 1318) Maternal Health Accountability Act (S. 1112) Right Rebate Act of 2018 (S. 3702) IMPROVE Act (H.R. 7217) Improving Access to Maternity Care Act (H.R. 315) Excellence in Mental Health and Addiction Treatment Expansion Act (S. 1905)

Client expense: $57,905 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage (risk adjustment, coding intensity, encounter data, dual-eligible members, reauthorization of special need plans, star ratings, normalization factors, stars contract consolidation) Mental health and substance use (42 CFR Part 2) The Bipartisan Budget Act of 2018 (H.R. 1892) Medicaid managed care Medicaid expansion Medicaid reform (block grants, per capita caps) Medicaid and CHIP reauthorization Long-term services and supports Medicare Part D prescription drug program and Medicare Part D coverage gap (donut hole) Clinical decision support Opioid addiction issues and response (prescription drug monitoring programs) Medicaid medical loss ratio remittance and IMD exclusion for inpatient Medicaid payments Medicaid non-emergency medical transportation ACE Kids Act (H.R. 3325) Dialysis Patient Access to Integrated-care, Empowerment, Nephrologists, Treatment, and Services (PATIENTS) Demonstration Act of 2017 (H.R. 4143) Improving Medicaid Programs and Opportunities for Eligible Beneficiaries (IMPROVE) Act (H.R. 7217)

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

H.R. 242: Medicare Prescription Drug Price Negotiation Act of 2017 - Provisions related to Part D and drug pricing negotiation H.R. 1316: Prescription Drug Price Transparency Act - Provisions related to transparency of payment methodologies H.R. 3192: CHIP Mental Health Parity Act H.R. 4005: Medicaid Reentry Act H.R. 5150: Protecting Medicare from Excessive Price Increases Act of 2018 - To require drug manufacturers to pay a Medicare part B rebate for certain drugs H.R. 5590: Opioid Addiction Action Plan Act H.R. 5605: Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act 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. H.R. 5797: Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Executive Act H.R. 5799: Medicaid Drug Review, Utilization, Good Governance Improvement Act H.R. 5801: Medicaid PARTNERSHIP Act H.R. 5808: Medicaid Pharmaceutical Home Act of 2018 H.R. 5810: Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act H.R. 6505: Medicare Negotiation and Competitive Licensing Act of 2018 - Drug pricing H.R. 6642: To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs H.R. 7217: Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act or IMPROVE Act S. 41: Medicare Prescription Drug Price Negotiation Act of 2017 - Provisions related to Part D and drug pricing negotiation S. 348: Prescription Drug and Health Improvement Act of 2017 - Provisions related to Part D S. 637: Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017 - Provisions related to transparency of prescription drug pricing and pharmacy benefit managers S. 870: CHRONIC Care Act of 2017 - Provisions related to Medicare and chronic care S. 1348: Stopping the Pharmaceutical Industry from Keeping Drugs Expensive (SPIKE) Act of 2017 - Provisions related to increases in the wholesale acquisition costs of prescription drugs S. 1688: Empowering Medicare Seniors to Negotiate Drugs Prices Act of 2017 - Part D and non-interference provisions Medicare Access and Childrens Health Insurance Program (CHIP) reauthorization policy issues Department of Health and Human Services (HHS) drug policy issues and regulatory policy issues Part D policy issues including non-interference and rebates policy issues Part B reform including MedPAC recommendations and other policy issues and local coverage decisions Drug cost and pricing policy issues Transparency policy issues Alternative payment models policy issues Value-based purchasing arrangements policy issues Anti-Kickback Statute policy issues False Claims Act policy issues Center for Medicare and Medicaid Innovation (CMMI) policy issues Medicaid rebates and waiver policy issues Changes to the Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs Prescription drug abuse policy issues ANPRM; Medicare Program; International Pricing Index Model for Medicare Part B Drugs (CMS-5528-ANPRM) Proposed Rule; Medicare and Medicaid Programs; Regulation To Require Drug Pricing Transparency (CMS-4187-P) Proposed Rule; Contract Year (CY) 2020 Medicare Advantage and Part D Drug Pricing (CMS-4180-P) Request for Information: Medicare and State Health Care Programs: Fraud and Abuse; Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements CMP; 83 Fed. Reg. 43607 (Aug. 27, 2018) Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection (RIN 0936-AA08)

Client expense: $6,030,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, U.S. Trade Representative (USTR)

Education on the importance of maintaining the competitive elements of the Part D prescription drug program and to oppose efforts to impose mandatory government rebates in that program and concerns about beneficiary out of pocket costs. H.R.1892: Bipartisan Budget Act 2018 as it relates to a Part D donut hole provision. H.R.7217: ACE Kids Act. H.R.6642: To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs.

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

Government targets: HOUSE OF REPRESENTATIVES

H.R.7217: IMPROVE Act.

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

Government targets: HOUSE OF REPRESENTATIVES

Legislation: S.103-Local Zoning Decisions Protection Act of 2017-Issues Lobbied: Racial justice, housing. S.367-Probation Officer Protection Act of 2017-Issues Lobbied: Law enforcement. S.411-End Racial and Religious Profiling Act of 2017 (ERRPA)-Issues Lobbied: Racial justice, racial profiling. S.642-Fifth Amendment Integrity Restoration Act-Issues Lobbied: Civil asset forfeiture. S.811-Child Welfare Provider Inclusion Act-Issues Lobbied: LGBT rights, religious liberty. S.860-Juvenile Justice and Delinquency Prevention Reauthorization Act of 2017-Issues Lobbied: Juvenile justice, racial justice. S.1006-Equality Act-Issues Lobbied: LGBT rights, womens rights, reproductive freedom, racial justice. S.1419-Voting Rights Advancement Act-Issue Lobbied: Voting rights. S.1588-Democracy Restoration Act-Issue Lobbied: Racial justice, voting. S.1593-Pretrial Integrity and Safety Act-Issue Lobbied: Bail Reform. S.1820-A bill to provide for the retention and service of transgender members of the Armed Forces-Issues Lobbied: LGBT rights. S.1856-Stop Militarizing Law Enforcement Act-Issues Lobbied: Law enforcement. S.1917-Sentencing Reform and Corrections Act of 2017-Issues Lobbied: Criminal justice reform. S.2525-First Amendment Defense Act-Issues Lobbied: LGBT rights, religious liberty. S.2584-Student Non-Discrimination Act of 2018-Issues Lobbied: LGBT rights. S.J. Res. 59-Authorization for Use of Military Force of 2018 - Issues Lobbied: National security. S.3195-Law Enforcement Trust and Integrity Act-Issues Lobbied: Law enforcement. S.2918-Do No Harm Act-Issues Lobbied: Religious liberty, LGBT rights, reproductive freedom. S.170 - Combating BDS Act of 2017-Issues Lobbied: Free speech. S.3109-DHS Appropriations for FY 2019-Issues Lobbied: Immigration, border enforcement. S.1519-National Defense Authorization Act for FY 2019-Issues Lobbied: National security. S.3158- Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 2019-Issues Lobbied: Racial justice, education, desegregation, reproductive rights, abortion coverage restrictions, Title X family planning program, Conscience Protection Act, fetal tissue research, sexual health education. S.2754-Handle with Care Act of 2018-Issues Lobbied: Racial justice, juvenile justice. S.2227-EMPOWER Care Act-Issues Lobbied: Disability rights. S.2952 - Congressional Accountability Act of 1995 Reform Act-Issues Lobbied: Sexual harassment and discrimination, womens rights. S.2795 and S.756-FIRST STEP Act-Issues Lobbied: Criminal law reform, religious liberty, immigrant rights. S.2261-Secure Elections Act-Issues Lobbied: Racial justice, voting. S.3271 - No Money Bail Act-Issues Lobbied: Bail reform. S.1918-Police CAMERA Act of 2017-Issues Lobbied: Law enforcement. S.1305-CBP HiRe Act-Issues Lobbied: CBP enforcement. S.720-Israel Anti-Boycott Act-Issues Lobbied: Free speech. S.3538-DHS Body-Worn Camera Act of 2018-Issues Lobbied: CBP accountability. S.1101-Pregnant Workers Fairness Act-Issues Lobbied: Womens rights. S.3744-Data Care Act of 2018-Issues Lobbied: Privacy. S.3749-Congressional Accountability Act of 1995 Reform Act-Issues Lobbied: Sexual harassment and discrimination. S.3626-Keeping All Students Safe Act-Issues Lobbied: Disability rights. S.3107-Financial Services and General Government Appropriations Act, 2019-Issues Lobbied: Reproductive rights, abortion coverage restrictions, Reproductive Health Non-Discrimination Act. S.3112- Dignity for Detained Immigrants Act of 2018-Issues Lobbied: Immigration detention, due process for immigrants. S.2520- Inmate Calling Technical Corrections Act of 2018-Issues Lobbied: Prison phone rates, affordable telephone calls from prisons. S.2-Effective Prosecution of Possession of Biological Toxins and Agents Act of 2018-Issues Lobbied: Possession of dangerous chemical and biological agents. H.R.482-Local Zoning Decisions Protection Act of 2017-Issues Lobbied: Racial justice, housing. H.R.1039-Probation Officer Protection Act of 2017-Issues Lobbied: Law enforcement. H.R.1498-End Racial Profiling Act of 2017-Issues Lobbied: Racial justice, racial profiling. H.R.1555-Fifth Amendment Integrity Restoration Act-Issues Lobbied: Civil asset forfeiture. H.R.1556-Stop Militarizing Law Enforcement Act-Issues Lobbied: Law enforcement militarization. H.R.1809-Juvenile Justice Reform Act of 2017-Issues Lobbied: Juvenile justice, racial justice. H.R.1881-Child Welfare Provider Inclusion Act of 2017-Issues Lobbied: LGBT rights, religious liberty. H.R.2133-Community Lending Enhancement and Regulatory Relief (CLEARR) Act of 2017-Issues Lobbied: Housing, racial justice. H.R.2152- Citizens Right to Know Act of 2018-Issues Lobbied: Bail reform. H.R.2228-Law Enforcement Mental Health and Wellness Act of 2017-Issues Lobbied: Law enforcement. H.R.2282-Equality Act-Issues Lobbied: LGBT rights, womens rights, reproductive freedom, racial justice. H.R.2437-Back the Blue Act of 2017-Issue Lobbied: Law enforcement. H.R.2676-Police Reporting Information, Data, and Evidence (PRIDE) Act of 2017-Issues Lobbied: Law enforcement. H.R.2899-Second Chance Act Reauthorization Act of 2017-Issues Lobbied: Reentry. H.R.2978-Voting Rights Advancement Act of 2017-Issues Lobbied: Voting rights. H.R.3060-Preventing Tragedies Between Police and Communities Act of 2017-Issues Lobbied: Law enforcement. H.R.3222-Do No Harm Act-Issues Lobbied: Religious liberty, LGBT rights, reproductive freedom. H.R.3354-Make America Secure and Prosperous Appropriations Act-Issues Lobbied: Racial justice, census, desegregation. H.R.3944-Police CAMERA Act of 2017-Issues Lobbied: Law enforcement. H.R.4019-Pretrial Integrity and Safety Act of 2017-Issues Lobbied: Bail reform. H.R.4041-A bill to provide for the retention and service of transgender members of the Armed Forces-Issues Lobbied: LGBT rights. H.R.4508-The Promoting Real Opportunity, Success, and Prosperity through Education Reform (PROSPER) Act-Issues Lobbied: Racial justice, higher education. H.R.4833-The Bail Fairness Act of 2018-Issues Lobbied: Bail. H.R.5374-Student Non-Discrimination Act of 2018-Issues Lobbied: LGBT rights. H.R.5682 - FIRST STEP Act-Issues Lobbied: Prison reform, intersection of criminal justice and immigration. H.R.1437- No Money Bail Act-Issue Lobbied: Bail reform. H.R.5698 - Protect and Serve Act of 2018-Issues Lobbied: Law enforcement. H.R.3249-Protect Safe Neighborhoods Grant Program Authorization Act of 2018-Issues lobbied: Law enforcement. H.R.5515- John S. McCain National Defense Authorization Act for FY 19-Issues Lobbied: National security. H.R.5199-Education Savings Accounts for Military Families Act of 2018-Issues Lobbied: Racial justice, education. H.R.5242- School Resource Officer Assessment Act of 2018- Issues Lobbied: Racial justice, school-to-prison pipeline. H.R.6122-Save Voters Act-Issues Lobbied: Racial justice, voting. H.R.5306-EMPOWER Care Act-Issues Lobbied: Disability rights. H.R.4924-Congressional Accountability Act of 1995 Reform Act-Issues Lobbied: Sexual harassment and discrimination, womens rights. H.R.6659-Screening with Dignity Act of 2018-Issues Lobbied: LGBT rights, privacy & technology. H.R.12-Voter Empowerment Act of 2017-Issues Lobbied: Racial justice, voting. H.R.2840-Automatic Voter Registration Act-Issues Lobbied: Racial justice, voting. H.R.5011-Election Security Act-Issues Lobbied: Racial justice, voting. H.R.5793-Housing Choice Voucher Mobility Demonstration Act of 2018-Issues Lobbied: Racial justice, housing. H.R.6723-Ensuring American Voters Act of 2018-Issues Lobbied: Racial justice, voting. H.R.6011-To amend title 18, United States Code, to authorize a court to reduce the term of imprisonment imposed on certain defendants convicted as an adult for an offense committed and completed before the defendant attained 18 years of age, and for other purposes.-Issues Lobbied: Racial justice, juvenile justice. H.R.1697-Israel Anti-Boycott Act-Issues Lobbied: Free speech. H.R.5952- Commerce, Justice, Science, and Related Agencies Appropriations Act, 2019-Issues Lobbied: Census. H.R.2-Agriculture Improvement Act of 2018-Issues Lobbied: SNAP benefits, reentry. H.R.3799- Demanding Oversight from Justice Act-Issues Lobbied: Law enforcement. H.R.6776-Department of Homeland Security Appropriations Act, 2019-Issues Lobbied: Appropriations, immigration, border enforcement. H.R.6470-Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019-Issues Lobbied: Reproductive rights, abortion coverage restrictions, Title X family planning program, Conscience Protection Act, fetal tissue research, sexual health education. H.R.6157-Department of Defense and Labor, Health and Human Services, and Education Appropriations Act of 2019 and Continuing Appropriations Act, 2019-Issues Lobbied: Reproductive rights, abortion coverage restrictions, Title X family planning program, Conscience Protection Act, fetal tissue research, sexual health education. H.R.6545- Violence Against Women Reauthorization Act of 2018-Issues Lobbied: Womens rights. HR 2417-Pregnant Workers Fairness Act-Issues Lobbied: Womens rights. H.R.1-To expand Americans' access to the ballot box, reduce the influence of big money in politics, and strengthen ethics rules for public servants, and for other purposes-Issues Lobbied: Racial justice, voting rights, campaign finance. H.R.7156-Federal Police Camera and Accountability Act of 2018-Issues Lobbied: Law enforcement, criminal justice reform. H.R.7281-Driver and Officer Safety Education Act-Issues Lobbied: Law enforcement. H.R.7209-School Resource Officer Act of 2018-Issues Lobbied: Juvenile justice, school safety, school-to-prison pipeline. H.R.7124- Keeping All Students Safe Act-Issues Lobbied: Disability rights. H.R.7217-IMPROVE Act-Issues Lobbied: Disability rights. H.R.6258-Financial Services and General Government Appropriations Act, 2019-Issues Lobbied: Reproductive rights, abortion coverage restrictions, Reproductive Health Non-Discrimination Act. H.R.6714-Electronic Court Records Reform Act of 2018-Issues Lobbied: Transparency. H.R.2856-Combating BDS Act of 2017-Issues Lobbied: Free speech. H.R.7059-Build the Wall, Enforce the Law Act of 2018-Issues Lobbied: Border wall. H.R.3923-Dignity for Detained Immigrants Act of 2017-Issues Lobbied: Immigration detention, due process for immigrants. H.R.7093- Clean Up the Code Act of 2018-Issues Lobbied: Criminal penalties, criminal justice reform. H. Res.653- Recognizing the 69th anniversary of the Universal Declaration of Human Rights and the celebration of "Human Rights Day"-Issues Lobbied: Recognizing the 70th Anniversary of UNDHR. H.R.2825-DHS Authorization Act-Issues Lobbied: Immigration and border enforcement. Amendment to H.R.695-Department of Defense Appropriations Act of 2018, Further Additional Continuing Appropriations Act-Issues Lobbied: Department of Homeland Security Budget Continuing Resolution. H.R.5896- Border Patrol Agent Pay Reform Amendments Act of 2018-Issues Lobbied: CBP enforcement. H.R.505-Border Security Technology Accountability Act of 2017-Issues Lobbied: Border security. H.R.6691-Community Safety and Security Act of 2018-Issues Lobbied: Intersection of criminal justice and immigration. Legislation with No Bill Number: House bill version - Law Enforcement Trust and Integrity Act-Issues Lobbied: Law enforcement. Brett Kavanaugh nomination-Issues Lobbied: Civil liberties and civil rights, abortion. Amendment to Immigration and Nationality Act-Issues Lobbied: Muslim Ban, immigration. Oversight over counterterrorism policy and practices-Issues Lobbied: Torture, detention, drones, war authority. Draft legislation on Congressional Ethics-Issues Lobbied: Ethics, free speech. Draft House bill-Voter signature mismatch-Issues Lobbied: Voting rights. Draft Senate bill-Prosecutorial Reform-Issues Lobbied: Prosecutorial reform. Federal court-related disclosure form-Issues Lobbied: Ethics. Consumer Data Protection Act of 2017-Issues Lobbied: Privacy. Section 215 Reauthorization-Issues Lobbied: National security, surveillance. Possible changes to the Family Educational Rights and Privacy Act-Issues Lobbied: Student privacy. Continuing resolution for FY19 spending-Issues Lobbied: Civil liberties and civil rights. Appropriations Act for FY20-Issues Lobbied: Abortion coverage restrictions. Election Assistance Commission-Issues Lobbied: Juvenile life without parole. NO BAN Act-Issues Lobbied: Immigration. Administration Legislative Proposal-Making Affordable Housing Work Act of 2018-Issues Lobbied: Racial justice, fair housing, rent increase. Additional legislation not yet introduced - online privacy reform, use of force by federal law enforcement, immigration. Agencies: Agency-Defense-Issues Lobbied: LGBT rights, Guantanamo detention policy. Agency-Education-Issues Lobbied: Racial justice, equal education, CRDC data collection, school-to-prison pipeline, Every Student Succeeds Act, Workforce Innovation and Opportunity Act, student loans, civil rights investigations, sex discrimination, disability rights, LGBT rights, Affirmative Action. Agency-Health and Human Services-Issues Lobbied: Reproductive rights, abortion coverage, birth control, Patient Protection and Affordable Care Act, Exchange Program Integrity, Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act, Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act, Compliance with Statutory Program Integrity Requirements, religious liberty, LGBT rights, Medicaid Home and Community Based Services Settings Rule. Agency-Homeland Security-Issues Lobbied: Womens rights, disability rights, Build the Wall, Enforce the Law Act of 2018, border wall, Dignity for Detained Immigrants Act, immigration detention, due process for immigrants, DHS budget, immigration, denaturalization, Custom and Border Protection - border enforcement, CBP oversight, Immigration and Customs Enforcement - deportation and detention practices. Agency-Housing and Urban Development-Issues Lobbied: Fair housing, the disparate impact rule, AFFH rule, regulatory reform, discriminatory lending, disaster relief, rent increases. Agency-Justice-Issues Lobbied: LGBT rights, Dignity for Detained Immigrants Act, immigrant detention, due process for immigrants, First Step Act, Community Safety and Security Act of 2018, immigration, denaturalization, law enforcement, racial profiling, juvenile justice, school-to-prison pipeline, Bureau of Prisons - changes to the transgender offender manual, LGBT rights and prisoners rights. Agency-EOP-Issues Lobbied: Civil rights enforcement. Agency-OMB-Issues Lobbied: Preschool suspensions, school-to-prison pipeline, data collection. Agency-Commerce-Issues Lobbied: Racial justice, census. Agency-Labor-Issues Lobbied: Religious liberty, LGBT rights, drug testing. Agency-U.S. Commission on Civil Rights-Issues Lobbied: Womens rights, disability rights.

Client expense: $380,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Defense, Dept of (DOD), Education, Dept of, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, U.S. Commission on Civil Rights

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

S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - PDP/MA-PD payments on clean claims from pharmacies S. 428, ACE Kids Act (Grassley) - coordinated care for children with complex medical conditions S. 1016, CONNECT For Health Act (Schatz) - telehealth S. 1169, Medicaid CARE Act (Durbin-Portman) - changes to Medicaid IMD exclusion S. 1688, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 1804, Medicare for All Act (Sanders) - single payer health system S. 1890, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Cardin) - Medigap coverage for beneficiaries with end-stage renal disease S. 1909, BENES Act (Casey) - notifications of Medicare eligibility S. 2027, Medicaid Third Party Liability Act (Portman) - Medicaid third party liability S. 2051, Medicare Care Coordination Improvement Act of 2017 (Portman) - barriers to payment reform models S. 2227, EMPOWER Care Act (Portman-Cantwell) - Medicaid Money Follows the Person Demonstration S. 2707, Informing Seniors About Opioids Act (Nelson) - opioid issues S. 2901, Expanding Telehealth Response to Ensure Addiction Treatment Act (Thune) - opioid issues S. 2904, Medicaid Substance Use Disorder Treatment Via Telehealth Act (Carper) - opioid issues S. 2908, Electronic Prior Authorization in Medicare Part D Act (Roberts) - opioid issues S. 3327, SENIOR Communities Protection Act (Cortez Masto) - preventing fraudulent opioid prescriptions S. 3496, Improving Seniors Access to Quality Benefits Act (Daines-King) - study on MA benchmark cap S. 3497, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap S. 3702, Right Rebate Act (Wyden-Grassley) - Medicaid drug rebate program Draft Bill: Medicare Long-Term Care Services and Supports Act (Pallone) - Long-Term Services and Supports Program H.R. 6, SUPPORT Patients and Families Act (Walden) - opioid initiatives, Medicare and Medicaid issues, budget offsets H.R. 695, Continuing Appropriations Act (Schiff) - Money Follows the Person demonstration, spousal impoverishment protections H.R. 849, Protecting Seniors Access to Medicare Act (Roe) - Independent Payment Advisory Board H.R. 908, Medicare Advantage Quality Payment Relief Act (Kelly) - MA payment cap H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (Griffith) - PDP/MA-PD payments on clean claims from pharmacies H.R. 1148, FAST Act (Griffith) - access to telehealth-eligible stroke services under Medicare H.R. 1316, Prescription Drug Price Transparency Act (Collins) - PBM standards for MA and PDP plans H.R. 1995, V-BID for Better Care Act (Black) - value-based insurance design in Medicare Advantage H.R. 2556, CONNECT For Health Act (Black) - telehealth H.R. 2575, BENES Act (Ruiz) - notifications of Medicare eligibility H.R. 2644, Chronic Kidney Disease Improvement in Research and Treatment and Medigap Access (Marino) - Medigap coverage for beneficiaries with end-stage renal disease H.R. 2687, Medicaid CARE Act (Foster-Fitzpatrick) - changes to Medicaid IMD exclusion H.R. 3044, Supplemental Benefits for Chronically Ill Medicare Advantage Enrollees (Meehan) H.R. 3263, Medicare Independence at Home Model of Care (Burgess) - demonstration program H.R. 3325, ACE Kids Act (Barton) - health homes for children with complex medical conditions H.R. 3360, Telehealth Enhancement Act (Harper) - telehealth in Medicare H.R. 3635, Local Coverage Determination Clarification Act (Jenkins) - procedures for Medicare administrative contractors H.R. 3727, Increasing Telehealth Access in Medicare Act (Black) - telehealth in MA plans H.R. 4143, Dialysis PATIENTS Demonstration Act (Smith) - alternative care delivery models and payment methodologies for patients with end-stage renal disease H.R. 4952, Improving Seniors Access to Quality Benefits Act (Kelly) - MA benchmark cap study H.R. 5306, EMPOWER Care Act (Guthrie) - extension of Money Follows the Person demonstration H.R. 5603, Access to Telehealth Services for Substance Use Disorders Act (Matsui) - opioid issues H.R. 5605, Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act (Ruiz) - opioid issues H.R. 5675, drug management programs for at-risk Medicare beneficiaries (Bilirakis) - opioid issues H.R. 5676, SENIOR Communities Protection Act (MacArthur) - preventing fraudulent opioid prescriptions H.R. 5684, Protecting Seniors from Opioid Abuse Act (Kelly) - opioid issues H.R. 5685, Medicare Opioid Safety Education Act (Faso) - opioid issues H.R. 5686, Medicare Clear Health Options in Care for Enrollees Act (Paulsen) - opioid issues H.R. 5715, Strengthening Partnerships to Prevent Opioid Abuse Act (Renacci) - communication between Medicare plan sponsors and CMS H.R. 5773, Preventing Addiction for Susceptible Seniors Act (Roskam) - opioid issues H.R. 5797, IMD CARE Act (Walters) - Medicaid IMD exclusion H.R. 5798, Opioid Screening and Chronic Pain Management Alternatives for Seniors Act (Bucshon) - opioid issues H.R. 5799, Medicaid Drug Review, Utilization, Good Governance Improvement Act (Blackburn) - opioid issues H.R. 5800, Medicaid IMD ADDITIONAL INFO Act (Upton) - opioid issues H.R. 5804, Post-Surgical Injections as an Opioid Alternative Act (Shimkus) - opioid issues H.R. 5808, Medicaid Pharmaceutical Home Act (Bilirakis) - opioid issues H.R. 5809, Postoperative Opioid Prevention Act (Peters) - opioid issues H.R. 5810, Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act (Lance) - opioid issues H.R. 5812, Improving Medicaid Data Timeliness Act (Griffith) - opioid issues H.R. 6431, Medigap Consumer Protection Act (Levin) - reforms to Medicare supplemental insurance H.R. 6561, Comprehensive Care for Seniors Act (Walorski) -- Program of All-Inclusive Care for the Elderly H.R. 6563, Lower Out-of-Pocket Costs for Seniors Act (Pallone-Neal) - Medicare Part D cliff H.R. 6662, Empowering Seniors Decision Enrollment Act (Paulsen) - special enrollment period for non-deemed Medicare Cost Plan enrollees H.R. 6690, Fighting Fraud to Protect Care for Seniors Act (Roskam) - Medicare pilot program for smart card technology H.R. 7122, Shared Accountability for Improved Patient Outcomes Act (Paulsen) - value-based payment and delivery arrangements H.R. 7217, IMPROVE Act (Barton) - Money Follows the Person demonstration, ACE Kids Act, Medicare drug rebate program, spousal impoverishment protections H.R. 7223, Right Rebate Act (Schrader-Welch) - Medicaid drug rebate program H.R. 7247, Incentivizing Shared Risk in Medicare Advantage Act (Brady) - MA prior authorization H.R. 7249, Better Prior Authorization Notification Act (Reed) - MA prior authorization H.R. 7250, Prior Authorization Improvement Act (Kelly) - MA prior authorization Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2019 Rate Notice and Call Letter; in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; 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

Mental Health and Substance Use treatment workers S 2700, HR 5545- Improving access to substance use disorder treatment, and treatment for those with dual diagnosis S 1905, HR 3931- Supporting Certified Community Behavioral Health Care Centers Protecting the rights of homecare workers HR 7217- Improving Medicaid programs Opposing shifting Rx drug costs in the donut hole onto retiree health care plans

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

Government targets: HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE

implementation of health care reform generally pertaining to pediatric health care and autism services Medicaid program reforms, including hospital outpatient department regulations S.3770 (Medicaid Drug Decisions Transparency Act), all provisions Section 340B Drug Pricing Program, including H.R. 4710 (340B PAUSE Act), All provisions, and H.R. 5598 (340B Optimization Act), all provisions and H.R. 6240 (drug Discount accountability act), all provisions Sickle Cell Disease Research funding generally Drug pricing reforms generally Department of Justice implementation of grant program for missing individuals with autism and developmental disabilities Department of Homeland Security rulemaking regarding public charge rule and Medicaid program implications S. 3429 (Neonatal Abstinence Intervention Act), all provisions H.R. 2410 (Sickle Cell Disease research, Surveillance, prevention and treatment act of 2017), all provisions S. 2465 (Sickle cell disease and other heritable blood disorders research, surveillance, Prevention and treatment act of 2018), all provisions H.R. 3325 (ACE kids Act), all provisions S. 428 (Ace Kids Act of 2017), all provisions H.R. 1676 (Palliative Care and Hospice Education and Training Act), all provisions Organ Transplant policy generally, including transplant distribution methodology H.R. 7217 (Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act - IMPROVE act), Title I, regarding coordinated care

Client expense: $132,091 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.5306/S.2227 Empower Care Act; H.R.7217 IMPROVE Act; H.R.181 re: Medicaid annuities; general education around home and community-based waiver and long-term services and supports issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid program reforms, including possible regulations involving hospital outpatient departments Implementation of health care reform Section 340B Drug Pricing Program Healthcare disparities issues generally Drug pricing reforms generally H.R. 6524 and S. 2415 (Accelerating Kids' Access to Care Act), all provisions H.R. 3325 (ACE Kids Act), all provisions S. 428 (ACE Kids Act of 2017), all provisions Department of Homeland Security rulemaking regarding public charge rule and Medicaid program implications S. 3429 (Neonatal Abstinence Intervention Act), all provisions H.R. 7217 (Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act - IMPROVE Act), Title I, regarding coordinated care S. 3770 (Medicaid Drug Decisions Transparency Act), all provisions Poison Control Center funding programs generally Implementation of Public Law 115-91 (National Defense Authorization Act for Fiscal Year 2018), Section 708, regarding TRICARE policies for patient referrals regarding pregnant women Medical interpreters and patient language access issues generally

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitored issues related to pharmaceutical prices. Monitored issues related to H.R 7217, IMPROVE Act. Issues related to ESRD payment. H.R. 6, SUPPORT for Patients and Communities Act, S. 2680, Opioid Crisis Response Act of 2018. Issues related to Pandemic and All-Hazards Preparedness, S. 2852 / H.R. 6378, Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 (PAHPA); monitored issues involving drug shortages. Issues regarding the Strategic National Stockpile inventory. Issues related to home dialysis.

Client expense: Not reported · Firm income: $45,000

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

Discussed nursing home bill (Senate, no bill number). P.L. 115-123, Bipartisan Budget Act- discussed longitudinal chronic care planning services (GAO). Submitted comments to CMS regarding the Massachusetts Medicare-Medicaid Integration Demonstration: Duals Demonstration 2.0. Discussed issues affecting dual eligibles and the Bipartisan Budget Act of 2018 (P.L. 115-123) - discussed provisions of the law and other issues affecting dual eligibles (CMS, ACL). Discussed CY 2020 Medicare Advantage and Part D Flexibility Proposed Rule (CMS, no bill number). Discussed comments regarding Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction proposed rule (Senate, no bill number). Discussed end of year package and Medicaid home and community-based services (HCBS) spousal impoverishment protections (no bill number at the time). H.R. 7217, The IMPROVE Act - discussed support for the legislation. S. 2227/H.R. 5306, EMPOWER Care Act - signed onto letter in support of the Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources, and Care Act. Signed onto letter in support of extending the Money Follows the Person Demonstration Project and the Medicaid home and community-based services (HCBS) spousal impoverishment protections (no bill number). H.R. 7149, Protecting Married Seniors from Impoverishment Act - Discussed Medicaid HCBS spousal impoverishment protections and extending them or making them permanent (Senate/House). Discussed proposed rule regarding nursing homes, Medicare and Medicaid requirements (OMB). Submitted comments to CMS regarding Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction proposed rule. H.J.R. 143, H.R. 695, Short-term Continuing Appropriations Act Resolution, 2019, H.R.6157, Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 - Lobbied in support of increased funding for CMS' state survey and certification program and in opposition to hostile policy riders regarding Patient Protection and Affordable Care Act, and various related medical care research and Older Americans Act programs. Sent letter of support to Senate regarding the Protecting Patients from Surprise Medical Bills Act (no bill number). Discussed Medicare Part D improvements and policies with House and Senate staff. Discussed Medicare Part B prescription drug policies with House and Senate staff.

Client expense: $2,140,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Equal Employment Opportunity Commission (EEOC), Federal Highway Administration (FHA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Highway Traffic Safety Administration (NHTSA), SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of, White House Office

H.R. 7217 - IMPROVE Act; H.R. 3325/S. 428; Issues pertaining to Part D rebates; 2020 NBPP. H.R. 3325/S. 428 - "ACE Kids Act" - to amend title XIX of the Social Security Act to provide states with the option of providing coordinated care for children with complex medical conditions through a health home, regarding all provisions. S. 2554 - "Patients' Right to Know Drug Price Act of 2018", issues pertaining to drug pricing.

Client expense: $1,280,000 · Firm income: Not reported

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

Monitor and advocate on legislative and regulatory issues regarding healthcare. Legislative monitoring and outreach related to the H.R. 6, SUPPORT for Patients and Communities Act (P.L. 115-271). H.R. 6071, SERV Communities Act. H.R. 6082, Overdose Prevention and Patient Safety Act. Legislative monitoring and outreach related to the H.R. 6157, Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 (P.L. 115-245). H.R. 6733, Know the Cost Act of 2018. H.R. 7052, No Federal Funds for Public Charge Act of 2018. H.R. 7217, IMPROVE Act. S. 2553, Know the Lowest Price Act of 2018. S. 2554, Patient Right to Know Drug Prices Act. S. 2680, Opioid Crisis Response Act of 2018. S. 3120, HEAL Act of 2018. S. 3702, Right Rebate Act of 2018.

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

Government targets: HOUSE OF REPRESENTATIVES

Policies to enhance patient access to medicines in Medicaid; Policies to enhance patient access to medicines in Medicare; Review of proposed rule regarding testing of Medicare part B prescription drug models; Discussions related to rebates and Medicare part D; Proposals related to protected classes; Medicare payment proposals; H.R. 7217, IMPROVE Act; CMS guidance to Medicare Advantage Plans allowing the use of step-therapy; H.R. 6642, To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs; CMS guidance on 1332 waivers [CMS-9936-NC];

Client expense: $380,000 · Firm income: Not reported

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

-HR 7217, the IMPROVE Act, support inclusion and passage of the ACE Kids Act, reauthorization of Money Follows the Person and extension of spousal impoverishment protections. -H.R. 2077, Restoring the Patient's Voice Act, support passage. -CMS-4180-P, Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses, oppose weakening of Medicare's Six Protected Classes policy. -H.R. 2, Agriculture Improvement Act, educate about implications of hemp and hemp-derived cannabidiol (CBD) provisions.

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

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

HR 7217 the IMPROVE Act, S 486, HR 750, HR 4229, CMS-1687-IFC Durable Medical Equipment Fee Schedule adjustments, Implementation of Medicaid cuts for Durable Medical Equipment in the 21st Century Cures law to protect Complex Rehabilitation Technology (CRT), CMS proposed CY2019 proposed rule (CMS-1691-P) to protect access for patients with severe disabilities.

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

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

S.428/H.R. 3325, the ACE Kids Act. H.R. 7217, the IMPROVE Act Issues related to OPPS reimbursement cuts to 340B hospitals. Issues related to reforms of the Stark Law and Anti-Kickback statute. Issues related to site-neutral payment reductions for hospital providers.

Client expense: $135,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

Implementation of health care reform generally pertaining to pediatric health care and autism services Medicaid program reforms, including hospital outpatient department regulations S. 3770 (Medicaid Drug Decisions Transparency Act), all provisions Section 340B Drug Pricing Program, including H.R. 4710 (340B PAUSE Act), all provisions, H.R. 5598 (340B Optimization Act), all provisions, and H.R. 6240 (Drug Discount Accountability Act), all provisions Sickle cell disease research funding generally Drug pricing reforms generally Department of Justice implementation of grant program for missing individuals with autism and developmental disabilities Department of Homeland Security rulemaking regarding public charge rule and Medicaid program implications S. 3429 (Neonatal Abstinence Intervention Act), all provisions H.R. 2410 (Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2017), all provisions S. 2465 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2018), all provisions H.R. 3325 (ACE Kids Act), all provisions S. 428 (ACE Kids Act of 2017), all provisions H.R. 1676 (Palliative Care and Hospice Education and Training Act), all provisions Organ transplant policy generally, including liver transplant distribution methodology H.R. 7217 (Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act - IMPROVE Act), Title I, regarding coordinated care

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid program reforms, including possible regulations involving hospital outpatient departments Implementation of health care reform Section 340B Drug Pricing program Healthcare disparities issues generally Drug pricing reforms generally H.R. 6524 and S. 2415 (Accelerating Kids' Access to Care Act), all provisions H.R. 3325 (ACE Kids Act), all provisions S. 428 (ACE Kids Act of 2017), all provisions Department of Homeland Security rulemaking regarding public charge rule and Medicaid program implications S. 3429 (Neonatal Abstinence Intervention Act), all provisions H.R. 7217 (Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act - IMPROVE Act), Title I, regarding coordinated care S. 3770 (Medicaid Drug Decisions Transparency Act), all provisions Poison Control Center funding programs generally Implementation of Public Law 115-91 (National Defense Authorization Act for Fiscal Year 2018), Section 708, regarding TRICARE policies for patient referrals involving pregnant women

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health Insurer Tax (HIT); 42 CFR Part 2- Confidentiality of Substance Use Disorder Patient Records; H.R. 5795, Overdose Prevention and Patient Safety Act Medicaid IMD (Institutes for Mental Disease) Exclusion; Opioids, in general; H.R. 6, SUPPORT for Patients and Communities Act; H.R. 3325/S. 428, Advancing Care for Exceptional Kids Act (ACE Kids Act), included in H.R. 7217, Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act (IMPROVE Act); Medicaid Extenders Package

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE