Critical Access Hospital Relief Act of 2019

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act H.R. 7059: Coronavirus Provider Protection Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 - End Surprise Billing Act H.R. 3630 - No Surprises Act H.R. 3502 - Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 - Lower Health Care Costs Act S. 967 - Reducing Costs for Out of Network Services Act S. 1266 - Protecting Patients from Surprise Medical Bills Act S. 1531 - Stopping the Outrageous Practice of Surprise Bills Act S. 1607 - Medical Billing Fairness Act H. R. - 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 H.R. 5855 - Bipartisan Solution to Cyclical Violence Act of 2020 H.R. 6953 - Pandemic Responder Service Award Act H.R. 6644/S. 3741 - Telehealth legislation/The Health Care at Home Act H.R. 6365/S. 3559 - Immediate Relief for Rural Facilities Act H.R. 7255 - Coronavirus Health Care Worker Wellness Act S. 3741 - Health Care at Home Act S. 3750/H.R. 6837 - Medicare Accelerated and Advanced Payments Improvement Act H.R.133 - Consolidated Appropriations Act, 2021 Phase 4 COVID-19 relief legislation H. R. 8702 - Holding Providers Harmless from Medicare Cuts During COVID-19 Act Federal Incentive Programs COVID-Safely Returning to Work and School in the Fall COVID-PPE Shortages Mental Health Issues Health Care Disparities Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) MIPS Value Pathways (MVPs) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $308,000 · Firm income: Not reported

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

Prevention Initiatives for Fraud and Abuse in the Medicare program NCCI Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Medicare appeals process Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act (AIM) IMPACT Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting SNF 3-Day rule Administrative Burden PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking DMEPOS competitive bidding Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Technical expert panel nominations Reducing Health Care costs REAADI & DRMA Acts S. 433 Home Health Payment Innovation Act HR 3107 Improving Seniors Timely Access to Care Act of 2019 HR 1948/S. 518 Lymphedema Treatment Act of 2019 Improving Access to Medicare Coverage Act of 2019 (HR 7682/S 753) Critical Access Hospital Relief Act of 2019 (HR 1041/S 586) Medicare Opt-Out HR 4932/S 2741 CONNECT for Health Act of 2019 Medicare Fee Schedule HR 5693 Primary Health Services Enhancement Act Unified post-acute care prospective payment system Medicare Accelerated and Advanced Payments Program

Client expense: $236,490 · 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), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019; Comment on provisions of HR 2328,Reauthorizing and Extending Americas Community Health (REACH) Act, support for the Medicaid disproportionate share hospital(DSH) program provisions included in Title III; comments on Title IV, which contains provisions of the No Surprises Act and concern with the legislations approach to determining reimbursement for out-of-network providers; Support HR 3107 Seniors Timely Access to Care Act of 2019, this legislation would establish requirements for the use of prior authorization under Medicare Advantage plans; Meeting with the Senate finance committee to discuss changes to drug bill; Meeting with CMS to discuss changes to prior authorization; Meeting with Department of Labor to discuss issues with ERISA health plans; Met with CMS staff on rural hospital issues; Regulatory burden related to new CMS guidance on documenting Crossover bad debt; Sent a Comment letter to CMS on a final rule on program integrity enhancements to the provider enrollment process for Medicare, Medicaid and Children's Health Insurance Programs; Oppose S. 2860 Patient Access to Higher Quality Health Care Act of 2019, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 4996, Helping MOMS Act of 2019, a bill amend title XIX of the Social Security Act to provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individuals, and for other purposes; Addressing hospital concerns about HR 3 Lower Drug Costs Now Act, a bill to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes; Sent comment letter requesting that CMS withdraw the proposed regulation related to Medicaid Program: Medicaid Fiscal Accountability Regulation ( MFAR) financing and supplemental payments. Given that the proposal would severely curtail the availability of health care services to millions of individuals and because many of its provisions are not legally permissible; Discussion with CMS for rural hospitals and critical access hospitals about the Medicare accelerated payment program, which is intended to provide necessary funds to providers, including rural hospitals and critical access hospitals, when there is a disruption in claims submission and/or claims processing; Submitted comments on CMSs proposed rule on Medicare Advantage and Part D prescription drug program for Contract Years 2021 and 2022. The letter focuses on several proposals addressing network adequacy; Letter sent to HHS, CDC, CMS, and SAMHSA requesting specialized guidance and assistance for providers who care for patients with behavioral health disorders; Support resetting the Improving Medicare Post- Acute Care Transformation (IMPACT) Act of 2014 in the next COVID-19 relief package. The IMPACT Acts implementation is behind schedule and does not take into account extensive payment reforms already underway in each post-acute care setting; Letter urging HHS to release substantial additional emergency funds to all hospitals in an expedited manner. This second wave of funding to all hospitals, targeted relief is necessary for hospitals in hot spots, hospitals with a high percentage of payments under Medicare Advantage, hospitals caring for high numbers of Medicaid patients, and rural hospitals; Support HR 6693 Critical Access Hospital Expansion Act of 2020, a bill to amend title XVIII of the Social Security Act to allow States to certify certain hospitals as necessary providers for purposes of designating such hospitals as critical access hospitals under the Medicare program; Support HR 6753/ S 3615 Rural Community Hospital Demonstration Extension Act of 2020, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the rural community hospital demonstration program; Letter urging CMS to use its authority to extend to LTCHs the existing 20% hospital add-on payment for Medicare beneficiaries diagnosed with COVID-19; Letter to CMS urging the agency to temporarily extend certain waivers and make others permanent beyond the COVID-19 public health emergency to allow hospitals to provide better and more cost effective care to their patients and communities; Sent comment letter to CMS about our concerns with the timeline proposed for implementation as well as the potential for penalties for noncompliance within this timeline on the Medicare Program: Electronic Prescribing of Controlled Substances; Sent comment letter on the FY 2021 Inpatient PPS proposed rule addressing CMS proposals related to payer-specific negotiated rate data collection, Medicare DSH payments, CAR T, bad debt, MS-DRG classifications, and quality programs, among other topics. Letter requesting that the CMS delay the implementation of the Appropriate Use Criteria for Advanced Diagnostic Imaging Services program to allow providers the opportunity to implement and test operational changes and acquire the education necessary to achieve compliance with the program; Sent comments to the CMS on the agencys long-term care hospital prospective payment system proposed policy changes and fiscal year 2021 rates; Letter to CMS asking for a delay in the start of repayments associated with the Medicare Accelerated and Advance Payment (AAP) Programs; Letter urging the CMS to continue its suspension of medical review activities throughout the ongoing COVID-19 public health emergency; Letter urging CMS to allow periodic interim payment (PIP) hospitals to carry out their accelerated payment repayment at cost settlement, as was initially communicated by the agency and also request that the agency make alternative repayment approaches available, such as direct payments to the Medicare Administrative Contractor (MAC), for all hospitals; Comment letter on CY 2021 Home Health Prospective Payment System Rate Update proposed rule. While we continue to support the PDGM objective of increasing HH PPS payment accuracy, we remain concerned that CY 2020s large behavioral offset, 4.36%, was implemented on a prospective basis; Letter urging the CMS to withdraw the condition of participation (CoP) that hospitals report daily COVID-19 data and request that CMS immediately release detailed interpretive guidance so hospitals can take the necessary steps to come into compliance; Urged CMS to withdraw its Medicaid fiscal accountability proposed rule from its regulatory agenda because it would "severely curtail the availability of health care services to millions of individuals" and "many of its provisions are not legally permissible."

Client expense: $4,860,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

HEROES Act H.R. 6800/ COVID 4 Supplemental Appropriations - Medicare Disproportionate Share Hospital Payments - provisions related to "medicaid shortfall" and third-party payments H.R. 1041/S. 586 Critical Access Hospital Relief Act

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

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

Support for inclusion of funding and programs to help hospitals and health systems respond to COVID-19 pandemic in Health and Economic Recovery Omnibus Emergency Solutions Act or the HEROES Act (H.R. 6800) Support for healthcare provisions in Continuing Appropriations Act, 2021 and Other Extensions Act (H.R. 8319) Support for legislation to continue expansion of telehealth services during and beyond COVID-19 pandemic Support for fair and accurate distribution of CARES Act Provider Relief Funds Support for the COVID-19 Hospital Forgiveness Act (H.R. 7292) Opposition to proposed Medicaid Fiscal Accountability Rule [CMS-2393-P] Support for Graduate Medical Education (GME) funding including the Resident Physician Shortage Reduction Act of 2019 (S. 348/H.R. 1763) and the Opioid Workforce Act of 2018 (H.R. 5818/S. 2843) and Advancing Medical Resident Training in Community Hospitals Act (H.R. 1358) Support for delay of impending Medicaid Disproportionate Share Hospital payment cuts Support for full protection of Critical Access Hospital payments including the Critical Access Hospital Relief Act of 2019 (H.R. 1041) Support for changes to Medicare Volume Decrease Adjustment calculation including the Access for Rural Communities Act (H.R. 3672) Support for Protecting Local Access to Care for Everyone Act (H.R. 2552) Support for Protecting Rural Access to Care Act (H.R. 8025)

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

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

Prevention Initiatives for Fraud and Abuse in the Medicare program NCCI Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Medicare appeals process Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act (AIM) IMPACT Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting SNF 3-Day rule Administrative Burden PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking DMEPOS competitive bidding Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Technical expert panel nominations Reducing Health Care costs REAADI & DRMA Acts S. 433 Home Health Payment Innovation Act HR 3107 Improving Seniors Timely Access to Care Act of 2019 HR 1948/S. 518 Lymphedema Treatment Act of 2019 Improving Access to Medicare Coverage Act of 2019 (HR 7682/S 753) Critical Access Hospital Relief Act of 2019 (HR 1041/S 586) Medicare Opt-Out HR 4932/S 2741 CONNECT for Health Act of 2019 Medicare Fee Schedule HR 5693 Primary Health Services Enhancement Act Unified post-acute care prospective payment system Medicare Accelerated and Advanced Payments Program

Client expense: $236,490 · 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), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act H.R. 7059: Coronavirus Provider Protection Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 - End Surprise Billing Act H.R. 3630 - No Surprises Act H.R. 3502 - Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 - Lower Health Care Costs Act S. 967 - Reducing Costs for Out of Network Services Act S. 1266 - Protecting Patients from Surprise Medical Bills Act S. 1531 - Stopping the Outrageous Practice of Surprise Bills Act S. 1607 - Medical Billing Fairness Act H. R. - 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 H.R. 5855 - Bipartisan Solution to Cyclical Violence Act of 2020 H.R. 6953 - Pandemic Responder Service Award Act H.R. 6644/S. 3741 - Telehealth legislation/The Health Care at Home Act H.R. 6365/S. 3559 - Immediate Relief for Rural Facilities Act H.R. 7255 - Coronavirus Health Care Worker Wellness Act S. 3741 - Health Care at Home Act S. 3750/H.R. 6837 - Medicare Accelerated and Advanced Payments Improvement Act Phase 4 COVID-19 relief legislation Federal Incentive Programs COVID-Safely Returning to Work and School in the Fall COVID-PPE Shortages Mental Health Issues Health Care Disparities Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) MIPS Value Pathways (MVPs) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

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

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act H.R. 7059: Coronavirus Provider Protection Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 - End Surprise Billing Act H.R. 3630 - No Surprises Act H.R. 3502 - Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 - Lower Health Care Costs Act S. 967 - Reducing Costs for Out of Network Services Act S. 1266 - Protecting Patients from Surprise Medical Bills Act S. 1531 - Stopping the Outrageous Practice of Surprise Bills Act S. 1607 - Medical Billing Fairness Act H. R. - 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 H.R. 5855 - Bipartisan Solution to Cyclical Violence Act of 2020 H.R. 6953 - Pandemic Responder Service Award Act H.R. 6644/S. 3741 - Telehealth legislation/The Health Care at Home Act H.R. 6365/S. 3559 - Immediate Relief for Rural Facilities Act H.R. 7255 - Coronavirus Health Care Worker Wellness Act S. 3741 - Health Care at Home Act S. 3750/H.R. 6837 - Medicare Accelerated and Advanced Payments Improvement Act Phase 4 COVID-19 relief legislation Federal Incentive Programs COVID-Safely Returning to Work and School in the Fall COVID-PPE Shortages Mental Health Issues Health Care Disparities Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) MIPS Value Pathways (MVPs) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

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

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act H.R. 7059: Coronavirus Provider Protection Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 - End Surprise Billing Act H.R. 3630 - No Surprises Act H.R. 3502 - Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 - Lower Health Care Costs Act S. 967 - Reducing Costs for Out of Network Services Act S. 1266 - Protecting Patients from Surprise Medical Bills Act S. 1531 - Stopping the Outrageous Practice of Surprise Bills Act S. 1607 - Medical Billing Fairness Act H. R. - 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 H.R. 5855 - Bipartisan Solution to Cyclical Violence Act of 2020 H.R. 6953 - Pandemic Responder Service Award Act H.R. 6644/S. 3741 - Telehealth legislation/The Health Care at Home Act H.R. 6365/S. 3559 - Immediate Relief for Rural Facilities Act H.R. 7255 - Coronavirus Health Care Worker Wellness Act S. 3741 - Health Care at Home Act S. 3750/H.R. 6837 - Medicare Accelerated and Advanced Payments Improvement Act Phase 4 COVID-19 relief legislation Federal Incentive Programs COVID-Safely Returning to Work and School in the Fall COVID-PPE Shortages Mental Health Issues Health Care Disparities Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) MIPS Value Pathways (MVPs) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $260,000 · Firm income: Not reported

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act H.R. 7059: Coronavirus Provider Protection Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 - End Surprise Billing Act H.R. 3630 - No Surprises Act H.R. 3502 - Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 - Lower Health Care Costs Act S. 967 - Reducing Costs for Out of Network Services Act S. 1266 - Protecting Patients from Surprise Medical Bills Act S. 1531 - Stopping the Outrageous Practice of Surprise Bills Act S. 1607 - Medical Billing Fairness Act H. R. - 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 H.R. 5855 - Bipartisan Solution to Cyclical Violence Act of 2020 H.R. 6953 - Pandemic Responder Service Award Act H.R. 6644/S. 3741 - Telehealth legislation/The Health Care at Home Act H.R. 6365/S. 3559 - Immediate Relief for Rural Facilities Act H.R. 7255 - Coronavirus Health Care Worker Wellness Act S. 3741 - Health Care at Home Act S. 3750/H.R. 6837 - Medicare Accelerated and Advanced Payments Improvement Act Phase 4 COVID-19 relief legislation Federal Incentive Programs COVID-Safely Returning to Work and School in the Fall COVID-PPE Shortages Mental Health Issues Health Care Disparities Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) MIPS Value Pathways (MVPs) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $260,000 · Firm income: Not reported

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

HEROES Act H.R. 6800/ COVID 4 Supplemental Appropriations - Medicare Disproportionate Share Hospital Payments - provisions related to "medicaid shortfall" and third-party payments H.R. 7663 - provisions related to expansion of telehealth reimbursement H.R. 1041/S. 586 Critical Access Hospital Relief Act S. 895 - Rural Hospital Regulatory Relief Act - provisions related to the reduction of direct supervision requirements

Client expense: Not reported · Firm income: $9,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019; Comment on provisions of HR 2328,Reauthorizing and Extending Americas Community Health (REACH) Act, support for the Medicaid disproportionate share hospital(DSH) program provisions included in Title III; comments on Title IV, which contains provisions of the No Surprises Act and concern with the legislations approach to determining reimbursement for out-of-network providers; Support HR 3107 Seniors Timely Access to Care Act of 2019, this legislation would establish requirements for the use of prior authorization under Medicare Advantage plans; Meeting with the Senate finance committee to discuss changes to drug bill; Meeting with CMS to discuss changes to prior authorization; Meeting with Department of Labor to discuss issues with ERISA health plans; Met with CMS staff on rural hospital issues; Regulatory burden related to new CMS guidance on documenting Crossover bad debt; Sent a Comment letter to CMS on a final rule on program integrity enhancements to the provider enrollment process for Medicare, Medicaid and Children's Health Insurance Programs; Oppose S. 2860 Patient Access to Higher Quality Health Care Act of 2019, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 4996, Helping MOMS Act of 2019, a bill amend title XIX of the Social Security Act to provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individuals, and for other purposes; Addressing hospital concerns about HR 3 Lower Drug Costs Now Act, a bill to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes; Sent comment letter requesting that CMS withdraw the proposed regulation related to Medicaid Program: Medicaid Fiscal Accountability Regulation ( MFAR) financing and supplemental payments. Given that the proposal would severely curtail the availability of health care services to millions of individuals and because many of its provisions are not legally permissible; Discussion with CMS for rural hospitals and critical access hospitals about the Medicare accelerated payment program, which is intended to provide necessary funds to providers, including rural hospitals and critical access hospitals, when there is a disruption in claims submission and/or claims processing; Submitted comments on CMSs proposed rule on Medicare Advantage and Part D prescription drug program for Contract Years 2021 and 2022. The letter focuses on several proposals addressing network adequacy; Letter sent to HHS, CDC, CMS, and SAMHSA requesting specialized guidance and assistance for providers who care for patients with behavioral health disorders; Support resetting the Improving Medicare Post- Acute Care Transformation (IMPACT) Act of 2014 in the next COVID-19 relief package. The IMPACT Acts implementation is behind schedule and does not take into account extensive payment reforms already underway in each post-acute care setting; Letter urging HHS to release substantial additional emergency funds to all hospitals in an expedited manner. This second wave of funding to all hospitals, targeted relief is necessary for hospitals in hot spots, hospitals with a high percentage of payments under Medicare Advantage, hospitals caring for high numbers of Medicaid patients, and rural hospitals; Support HR 6693 Critical Access Hospital Expansion Act of 2020, a bill to amend title XVIII of the Social Security Act to allow States to certify certain hospitals as necessary providers for purposes of designating such hospitals as critical access hospitals under the Medicare program; Support HR 6753/ S 3615 Rural Community Hospital Demonstration Extension Act of 2020, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the rural community hospital demonstration program; Letter urging CMS to use its authority to extend to LTCHs the existing 20% hospital add-on payment for Medicare beneficiaries diagnosed with COVID-19; Letter to CMS urging the agency to temporarily extend certain waivers and make others permanent beyond the COVID-19 public health emergency to allow hospitals to provide better and more cost effective care to their patients and communities.

Client expense: $4,260,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

HEROES Act H.R. 6800/ COVID 4 Supplemental Appropriations - Medicare Disproportionate Share Hospital Payments - provisions related to "medicaid shortfall" and third-party payments H.R. 7663 - provisions related to expansion of telehealth reimbursement H.R. 1041/S. 586 Critical Access Hospital Relief Act S. 895 - Rural Hospital Regulatory Relief Act - provisions related to the reduction of direct supervision requirements

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

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

HEROES Act H.R. 6800/ COVID 4 Supplemental Appropriations - Medicare Disproportionate Share Hospital Payments - provisions related to "medicaid shortfall" and third-party payments H.R. 1041/S. 586 Critical Access Hospital Relief Act S. 895 - Rural Hospital Regulatory Relief Act - provisions related to the reduction of direct supervision requirements

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

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

Support for inclusion of funding and programs to help hospitals and health systems respond to COVID-19 pandemic in Families First Coronavirus Response Act (H.R.6201) and Coronavirus Aid, Relief, and Economic Security (CARES) Act (H.R. 748) Support for fair and accurate distribution of CARES Act Provider Relief Funds Support for the COVID-19 Hospital Forgiveness Act (H.R. 7292) Opposition to proposed Medicaid Fiscal Accountability Rule [CMS-2393-P] Advocacy on various surprise billing bills (S. 1895, H.R.3502, H.R.3630, H.R.5826) Opposition to setting rates or bundling ER payments to address disputes between insurers and hospitals for surprise bills. Support for Graduate Medical Education (GME) funding including the Resident Physician Shortage Reduction Act of 2019 (S. 348/H.R. 1763) and the Opioid Workforce Act of 2018 (H.R. 5818/S. 2843) and Advancing Medical Resident Training in Community Hospitals Act (H.R. 1358) Support for delay of impending Medicaid Disproportionate Share Hospital payment cuts Support for full protection of Critical Access Hospital payments including the Critical Access Hospital Relief Act of 2019 (H.R. 1041) Support for changes to Medicare Volume Decrease Adjustment calculation including the Access for Rural Communities Act (H.R. 3672) Support for correction of erroneous reductions of GME residency positions Support for Protecting Local Access to Care for Everyone Act (H.R. 2552)

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

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 H.R. 5855: Bipartisan Solution to Cyclical Violence Act of 2020 H.R. 6953: Pandemic Responder Service Award Act Phase 4 COVID-19 relief legislation COVID-Safely Returning to Work and School in the Fall COVID-PPE Shortages Mental Health Issues Health Care Disparities Telehealth legislation/The Health Care at Home Act (H.R. 6644/S. 3741) H.R. 6365/S. 3559 - Immediate Relief for Rural Facilities Act H.R. 7255 - Coronavirus Health Care Worker Wellness Act S. 3741 - Health Care at Home Act S. 3750/H.R. 6837 - Medicare Accelerated and Advanced Payments Improvement Act Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $13,521 · Firm income: Not reported

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 H.R. 5855: Bipartisan Solution to Cyclical Violence Act of 2020 H.R. 6953: Pandemic Responder Service Award Act Phase 4 COVID-19 relief legislation COVID-Safely Returning to Work and School in the Fall COVID-PPE Shortages Mental Health Issues Health Care Disparities Telehealth legislation/The Health Care at Home Act (H.R. 6644/S. 3741) H.R. 6365/S. 3559 - Immediate Relief for Rural Facilities Act H.R. 7255 - Coronavirus Health Care Worker Wellness Act S. 3741 - Health Care at Home Act S. 3750/H.R. 6837 - Medicare Accelerated and Advanced Payments Improvement Act Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $13,521 · Firm income: Not reported

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 H.R. 5855: Bipartisan Solution to Cyclical Violence Act of 2020 H.R. 6953: Pandemic Responder Service Award Act Phase 4 COVID-19 relief legislation COVID-Safely Returning to Work and School in the Fall COVID-PPE Shortages Mental Health Issues Health Care Disparities Telehealth legislation/The Health Care at Home Act (H.R. 6644/S. 3741) H.R. 6365/S. 3559 - Immediate Relief for Rural Facilities Act H.R. 7255 - Coronavirus Health Care Worker Wellness Act S. 3741 - Health Care at Home Act S. 3750/H.R. 6837 - Medicare Accelerated and Advanced Payments Improvement Act Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $243,713 · Firm income: Not reported

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 H.R. 5855: Bipartisan Solution to Cyclical Violence Act of 2020 H.R. 6953: Pandemic Responder Service Award Act Phase 4 COVID-19 relief legislation COVID-Safely Returning to Work and School in the Fall COVID-PPE Shortages Mental Health Issues Health Care Disparities Telehealth legislation/The Health Care at Home Act (H.R. 6644/S. 3741) H.R. 6365/S. 3559 - Immediate Relief for Rural Facilities Act H.R. 7255 - Coronavirus Health Care Worker Wellness Act S. 3741 - Health Care at Home Act S. 3750/H.R. 6837 - Medicare Accelerated and Advanced Payments Improvement Act Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $243,713 · Firm income: Not reported

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

Prevention Initiatives for Fraud and Abuse in the Medicare program Electronic health records/health information technology incentives for Physical Therapists NCCI Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Health Information Technology Essential Health Benefits Medicare improvement standards Medicare appeals process Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth APTA Registry/QCDR measures Medicare Quality Programs Accelerating Innovation in Medicine Act (AIM) IMPACT Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting SNF 3-Day rule PT Outcomes Registry Administrative Burden PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Certified EHR technology DMEPOS competitive bidding Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Technical expert panel nominations Reducing Health Care costs REAADI & DRMA Acts S. 433 Home Health Payment Innovation Act HR 3107 Improving Seniors Timely Access to Care Act of 2019 HR 1948/S. 518 Lymphedema Treatment Act of 2019 Improving Access to Medicare Coverage Act of 2019 (HR 7682/S 753) Critical Access Hospital Relief Act of 2019 (HR 1041/S 586) Medicare Opt-Out HR 4932/S 2741 CONNECT for Health Act of 2019 Medicare Fee Schedule HR 5693 Primary Health Services Enhancement Act

Client expense: $236,490 · 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), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office

Prevention Initiatives for Fraud and Abuse in the Medicare program Electronic health records/health information technology incentives for Physical Therapists NCCI Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Health Information Technology Essential Health Benefits Medicare improvement standards Medicare appeals process Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth APTA Registry/QCDR measures Medicare Quality Programs Accelerating Innovation in Medicine Act (AIM) IMPACT Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting SNF 3-Day rule PT Outcomes Registry Administrative Burden PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Certified EHR technology DMEPOS competitive bidding Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Technical expert panel nominations Reducing Health Care costs REAADI & DRMA Acts S. 433 Home Health Payment Innovation Act of 2019 HR 3107 Improving Seniors Timely Access to Care Act of 2019 HR 1948/S. 518 Lymphedema Treatment Act of 2019 Improving Access to Medicare Coverage Act of 2019 (HR 7682/S 753) Critical Access Hospital Relief Act of 2019 (HR 1041/S 586) Medicare Opt-Out Home Health Payment Innovation Act (S 433) HR 4932/S 2741 CONNECT for Health Act of 2019 Medicare Fee Schedule HR 5693 Primary Health Services Enhancement Act

Client expense: $236,490 · 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), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019; Comment on provisions of HR 2328,Reauthorizing and Extending Americas Community Health (REACH) Act, support for the Medicaid disproportionate share hospital(DSH) program provisions included in Title III; comments on Title IV, which contains provisions of the No Surprises Act and concern with the legislations approach to determining reimbursement for out-of-network providers; Support HR 3107 Seniors Timely Access to Care Act of 2019, this legislation would establish requirements for the use of prior authorization under Medicare Advantage plans; Meeting with the Senate finance committee to discuss changes to drug bill; Meeting with CMS to discuss changes to prior authorization; Meeting with Department of Labor to discuss issues with ERISA health plans; Met with CMS staff on rural hospital issues; Regulatory burden related to new CMS guidance on documenting Crossover bad debt; Sent a Comment letter to CMS on a final rule on program integrity enhancements to the provider enrollment process for Medicare, Medicaid and Children's Health Insurance Programs; Oppose S. 2860 Patient Access to Higher Quality Health Care Act of 2019, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 4996, Helping MOMS Act of 2019, a bill amend title XIX of the Social Security Act to provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individuals, and for other purposes; Addressing hospital concerns about HR 3 Lower Drug Costs Now Act, a bill to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes; Sent comment letter requesting that CMS withdraw the proposed regulation related to Medicaid Program: Medicaid Fiscal Accountability Regulation ( MFAR) financing and supplemental payments. Given that the proposal would severely curtail the availability of health care services to millions of individuals and because many of its provisions are not legally permissible.

Client expense: $5,940,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Medicaid Fiscal Accountability Regulation (CMS-2393-P) Medicare Disproportionate Share Hospital Payments - provisions related to "medicaid shortfall" and third-party payments H.R. 748; S. 3548 Coronavirus Aid, Relief, and Economic Security (CARES) Act, provisions related to telehealth service reimbursement, expansion of services allowed; restrictions on use H.R. 1041/S. 586 Critical Access Hospital Relief Act S. 895 - Rural Hospital Regulatory Relief Act - provisions related to the reduction of direct supervision requirements Medicare 340B Drug Discount Program

Client expense: Not reported · Firm income: $9,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid Fiscal Accountability Regulation (CMS-2393-P) Medicare Disproportionate Share Hospital Payments - provisions related to "medicaid shortfall" and third-party payments H.R. 748; S. 3548 Coronavirus Aid, Relief, and Economic Security (CARES) Act, provisions related to telehealth service reimbursement, expansion of services allowed; restrictions on use H.R. 1041/S. 586 Critical Access Hospital Relief Act S. 895 - Rural Hospital Regulatory Relief Act - provisions related to the reduction of direct supervision requirements Medicare 340B Drug Discount Program

Client expense: Not reported · Firm income: $26,400

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

Medicaid Fiscal Accountability Regulation (CMS-2393-P) Medicare Disproportionate Share Hospital Payments - provisions related to "medicaid shortfall" and third-party payments H.R. 748; S. 3548 Coronavirus Aid, Relief, and Economic Security (CARES) Act, provisions related to telehealth service reimbursement, expansion of services allowed; restrictions on use H.R. 1041/S. 586 Critical Access Hospital Relief Act S. 895 - Rural Hospital Regulatory Relief Act - provisions related to the reduction of direct supervision requirements Medicare 340B Drug Discount Program

Client expense: $95,154 · Firm income: Not reported

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

Medicaid Fiscal Accountability Regulation Rural hospital policies (S. 586/H.R. 1041, Critical Access Hospital Relief Act of 2019; H.R. 1052; S. 895, Rural Hospital Regulatory Relief Act of 2019; S. 948/H.R. 2895, Conrad 30 and Physician Access Act; H.R. 3429, the HEARTS and Rural Relief Act; Rural Hospital Closure Relief Act (S. 3101/H.R. 5481) Ways and Means Health Task Force on Rural and Underserved Communities RFI Graduate Medical Education (GME) funding (S. 348/H.R. 1763, Resident Physician Shortage Reduction Act of 2019; H.R. 2349/H.R. 3414 Opioid Workforce Act) Delay of Medicaid Disproportionate Share Hospital payment cuts (H.R. 3022, Patient Access Protection Act) Telehealth payment (H.R. 1892, Bipartisan Budget Act of 2018; H.R. 6, SUPPORT for Patients and Communities Act; H.R. 3417 Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act) Extending the Medicaid demonstration program for certified community behavioral health clinics (H.R.3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019; S. 824/H.R. 1767, Excellence in Mental Health and Addiction Treatment Expansion Act) Stark law reform Hospital outpatient payment policy Site neutral payment policy included in outpatient prospective payment system rule (H.R.2552, Protecting Local Access to Care for Everyone Act of 2019) Improving Seniors Timely Access to Care Act (H.R. 3107) Chronic Care Management Improvement Act (H.R. 3436) OPPS and physician fee schedule rules Executive Order Protecting and Improving Medicare for our Nation's Seniors

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Hospital Group Purchasing - Advocated in support of hospital group purchasing organizations and maintaining the GPO safe harbor. Coronavirus relief Efforts - Supported passage of several bills to provide economic stability, financial relief and regulatory flexibility for hospitals in response to the COVID-19 crisis. H.R. 6074 - Coronavirus Preparedness and Response Supplemental Appropriations Act. H.R. 6201 - Families First Coronavirus Response Act H.R. 748 - Coronavirus Aid, Relief and Economic Stability (CARES) Act Offered recommendations to avoid supply chain disruptions of personal protective equipment and essential medications and supplies for hospitals for treating patients with COVID-19. Supported additional flexibilities to increase access to compounded medications. Urged DEA to expand aggregate production quotas for essential medications. Prescription Drug Pricing - Monitored ongoing negotiations to reduce prescription drug prices. Engaged to clarify provisions in the House (H.R. 3) and Senate (S. 2543) drug pricing bills. 340B Drug Pricing Program - Supported maintaining adequate reimbursement for hospitals purchasing prescription drugs through the 340B Drug Pricing Program. Advocated for preserving the current structure of the program. Surprise Billing - Supported inclusion of provisions to provide for an independent dispute resolution process in legislation to address surprise bills (H.R. 3630; H.R. 2328; S. 1895). Rural Health Care Issues - Offered support for the following legislation that would make improvements to rural health care access: Critical Access Hospital Regulatory Relief (S. 586/H.R. 1041) Rural Hospital Regulatory Relief Act (S. 895/H.R. 3416) Rural Health Clinic Modernization Act (S. 1037/H.R. 2788) Telehealth Across State Lines Act (S. 2408/H.R.4900) CONNECT For Health Act (S. 2741/H.R.4932) Conrad State 30 and Physician Access Reauthorization Act (S. 948/H.R.2895)

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

Government targets: Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of the Vice President of the United States, SENATE

Support for inclusion of funding and programs to help hospitals and health systems respond to COVID-19 pandemic in Families First Coronavirus Response Act (H.R.6201) and Coronavirus Aid, Relief, and Economic Security (CARES) Act (H.R. 748). Opposition to proposed Medicaid Fiscal Accountability Rule [CMS-2393-P] Advocacy on various surprise billing bills (S. 1895, H.R.3502, H.R.3630, H.R.5826) Opposition to setting rates or bundling ER payments to address disputes between insurers and hospitals for surprise bills. Support for Graduate Medical Education (GME) funding including the Resident Physician Shortage Reduction Act of 2019 (S. 348/H.R. 1763) and the Opioid Workforce Act of 2018 (H.R. 5818/S. 2843) and Advancing Medical Resident Training in Community Hospitals Act (H.R. 1358) Support for delay of impending Medicaid Disproportionate Share Hospital payment cuts Support for full protection of Critical Access Hospital payments including the Critical Access Hospital Relief Act of 2019 (H.R. 1041) Support for changes to Medicare Volume Decrease Adjustment calculation including the Access for Rural Communities Act (H.R. 3672) Support for correction of erroneous reductions of GME residency positions Support for Protecting Local Access to Care for Everyone Act (H.R. 2552)

Client expense: $170,000 · Firm income: Not reported

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

Medicare Fiscal Accountability Regulation Price Transparency Final Rule Information Blocking and Interoperability Final Rule Rural hospital policies (S. 586/H.R. 1041, Critical Access Hospital Relief Act of 2019; H.R. 1052; S. 895, Rural Hospital Regulatory Relief Act of 2019; S. 948/H.R. 2895, Conrad 30 and Physician Access Act; H.R. 3429, the HEARTS and Rural Relief Act; Rural Hospital Closure Relief Act (S. 3101/H.R. 5481) (Ways and Means Health Task Force on Rural and Underserved Communities, RFI, Rural America Health Corps Act S.2406/H.R. 4899) Graduate Medical Education (GME) funding (S. 348/H.R. 1763, Resident Physician Shortage Reduction Act of 2019; S. 2892/H.R. 3414 Opioid Workforce Act) Delay of Medicaid Disproportionate Share Hospital payment cuts Telehealth payment (H.R. 1892, Bipartisan Budget Act of 2018; H.R. 6, SUPPORT for Patients and Communities Act; H.R. 3417 Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act Reform of the Stark Law and Anti-Kickback Statute Hospital outpatient payment policy (CY 2020 OPPS Proposed, Final Rule; Price Transparency Final Rule) Site neutral payment policy included in outpatient prospective payment system rule Improving Seniors Timely Access to Care Act (H.R. 3107) Chronic Care Management Improvement Act (H.R. 3436) Proposed AWI changes in inpatient prospective payment system proposed rule Executive Order on Improving Price and Quality Transparency Helping Medicaid Offer Maternity Services (MOMS) Act (H.R. 4996) Rural hospital policies (S. 586/H.R. 1041, Critical Access Hospital Relief Act of 2019; H.R. 1052; S. 895, Rural Hospital Regulatory Relief Act of 2019; S. 948/H.R. 2895, Conrad 30 and Physician Access Act; H.R. 3429, the HEARTS and Rural Relief Act; Rural Hospital Closure Relief Act (S. 3101/H.R. 5481) (Ways and Means Health Task Force on Rural and Underserved Communities, RFI, Rural America Health Corps Act S.2406/H.R. 4899) Graduate Medical Education (GME) funding (S. 348/H.R. 1763, Resident Physician Shortage Reduction Act of 2019; S. 2892/H.R. 3414 Opioid Workforce Act) Delay of Medicaid Disproportionate Share Hospital payment cuts Telehealth payment (H.R. 1892, Bipartisan Budget Act of 2018; H.R. 6, SUPPORT for Patients and Communities Act; H.R. 3417 Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act) Reform of the Stark Law and Anti-Kickback Statute Hospital outpatient payment policy (CY 2020 OPPS Proposed, Final Rule; Price Transparency Final Rule) Site neutral payment policy included in outpatient prospective payment system rule Improving Seniors Timely Access to Care Act (H.R. 3107) Chronic Care Management Improvement Act (H.R. 3436) Proposed AWI changes in inpatient prospective payment system proposed rule Executive Order on Improving Price and Quality Transparency Helping Medicaid Offer Maternity Services (MOMS) Act (H.R. 4996)

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

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $17,000 · Firm income: Not reported

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $17,000 · Firm income: Not reported

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $232,658 · Firm income: Not reported

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) PL 116-127/H.R. 6201 - Families First Coronavirus Response Act H.R. 6365/S. 3559 - The Immediate Relief for Rural Facilities and Providers Act H.R. 748/S. 3548 - Coronavirus Aid, Relief, and Economic Security (CARES) Act S. 1895 - Lower Health Care Costs Act H.R. 5800 - Ban Surprise Billing Act H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act H.R. 3630 - No Surprises Act H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $232,658 · Firm income: Not reported

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

Prevention Initiatives for Fraud and Abuse in the Medicare program Electronic health records/health information technology incentives for Physical Therapists NCCI Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Health Information Technology Essential Health Benefits Medicare improvement standards Medicare appeals process Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth APTA Registry/QCDR measures Medicare Quality Programs Accelerating Innovation in Medicine Act (AIM) IMPACT Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting SNF 3-Day rule PT Outcomes Registry Administrative Burden PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Certified EHR technology DMEPOS competitive bidding Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Technical expert panel nominations Reducing Health Care costs REAADI & DRMA Acts S. 433 Home Health Payment Innovation Act of 2019 HR 3107 Improving Seniors Timely Access to Care Act of 2019 HR 1948/S. 518 Lymphedema Treatment Act of 2019 Improving Access to Medicare Coverage Act of 2019 (HR 7682/S 753) Critical Access Hospital Relief Act of 2019 (HR 1041/S 586) Medicare Opt-Out Home Health Payment Innovation Act (S 433) HR 4932/S 2741 CONNECT for Health Act of 2019 Medicare Fee Schedule HR 5693 Primary Health Services Enhancement Act

Client expense: $271,987 · 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), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office

H.R. 1041/S. 586 Critical Access Hospital Relief Act S. 895 - Rural Hospital Regulatory Relief Act - provisions related to the reduction of direct supervision requirements Medicare Disproportionate Share Hospital Payments - law requiring DSH payment reductions Medicare 340B Drug Discount Program H.R. 3414 Opioid Workforce Act - provisions related to graduate medical education

Client expense: Not reported · Firm income: $8,500

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1041/S. 586 Critical Access Hospital Relief Act S. 895 - Rural Hospital Regulatory Relief Act - provisions related to the reduction of direct supervision requirements Medicare Disproportionate Share Hospital Payments - law requiring DSH payment reductions Medicare 340B Drug Discount Program H.R. 3414 Opioid Workforce Act - provisions related to graduate medical education

Client expense: $86,211 · Firm income: Not reported

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

H.R. 1041/S. 586 Critical Access Hospital Relief Act S. 895 - Rural Hospital Regulatory Relief Act - provisions related to the reduction of direct supervision requirements Medicare Disproportionate Share Hospital Payments - law requiring DSH payment reductions Medicare 340B Drug Discount Program H.R. 3414 Opioid Workforce Act - provisions related to graduate medical education

Client expense: Not reported · Firm income: $37,000

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

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Letter urging the Centers for Medicare & Medicaid Services (CMS)to consider alternative payment solutions for Chimeric Antigen Receptor T-cell (CAR T) therapy; Joint letter urging Congress to delay the start of the Medicaid disproportionate share hospital (DSH) cuts, which are scheduled to begin in fiscal year (FY) 2020; Comments to CMS on exploring ways continually to improve the Medicaid managed care program to ensure access to high-quality care for the Medicaid population; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019; Comment on provisions of HR 2328,Reauthorizing and Extending Americas Community Health (REACH) Act, support for the Medicaid disproportionate share hospital(DSH) program provisions included in Title III; comments on Title IV, which contains provisions of the No Surprises Act and concern with the legislations approach to determining reimbursement for out-of-network providers; Support HR 3107 Seniors Timely Access to Care Act of 2019, this legislation would establish requirements for the use of prior authorization under Medicare Advantage plans; Meeting with the Senate finance committee to discuss changes to drug bill; Meeting with CMS to discuss changes to prior authorization; Meeting with Department of Labor to discuss issues with ERISA health plans; Met with CMS staff on rural hospital issues; Regulatory burden related to new CMS guidance on documenting Crossover bad debt; Sent a Comment letter to CMS on a final rule on program integrity enhancements to the provider enrollment process for Medicare, Medicaid and Children's Health Insurance Programs; Oppose S. 2860 Patient Access to Higher Quality Health Care Act of 2019, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 4996, Helping MOMS Act of 2019, a bill amend title XIX of the Social Security Act to provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individuals, and for other purposes; Addressing hospital concerns about HR 3 Lower Drug Costs Now Act, a bill to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes.

Client expense: $6,610,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

2019 Q4 Lobbying Report - October 1-December 31 H.R. 1865 -- Further Consolidated Appropriations Act H.R. 986, Protecting Americans with Preexisting Conditions Act of 2019 H.R. 1010, To provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force; Oversight of final rules on short-term, limited duration insurance (STLDI) and Association Health Plans) Medicare X-Choice Proposal H.R. 1384, the Medicare for All Act of 2019 S. 1129, Medicare-for-all national health insurance program Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First S. 1895 Lower Health Care Costs Act of 2019 S. 1531 Stopping the Outrageous Practice of Surprise Medical Bills Act S. 1266 the Protecting Patients from Surprise Medical Bills Act S. 1497 the Health Care Price Check Act H.R.861the End Surprise Billing Act of 2019 S. 1688 - A bill to amend the Public Health Service Act to provide for the full disclosure of billing and service information to patients H.R. 3502 the Protecting People from Surprise Medical Bills Act H.R. 3630 No Surprises Act H.R. 2328 the Reauthorizing and Extending Americas Community Health Act S. 340/H.R. 965 CREATES Act H.R. 1499 Protecting Consumer Access to Generic Drugs Act H.R. 2375 Preserve Access to Affordable Generics and Biosimilars Act H.R. 2296 the More Efficient Tools to Realize Information for Consumers (METRIC) Act H.R. 2062 Overdose Prevention and Patient Safety Act H.R. 938 BLOCKING Act of 2019 (H.R. 938) S. 1173/H.R. 776 Emergency Medical Services for Children Program Reauthorization Act of 2019 S. 1199 Poison Center Network Enhancement Act of 2019 H.R. 2781 the Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) for Health Act of 2019 H.R. 728 the Title VIII Nursing Workforce Reauthorization Act Hospital Star Ratings S. 586/H.R. 1041 Critical Access Hospital Relief Act of 2019 H.R. 1052 To amend title XVIII of the Social Security Act to provide for direct payment to physician assistants under the Medicare program for certain services furnished by such physician assistants. S. 348/H.R. 1763 Resident Physician Shortage Reduction Act of 2019 H.R. 2349/H.R. 3414 Opioid Workforce Act H.R. 3022 Patient Access Protection Act H.R. 1892 Bipartisan Budget Act of 2018 H.R. 6 SUPPORT for Patients and Communities Act H.R. 3417 Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act S. 824/H.R. 1767 Excellence in Mental Health and Addiction Treatment Expansion Act Stark law reform Hospital outpatient payment policy Site neutral payment policy included in outpatient prospective payment system rule H.R.2552 Protecting Local Access to Care for Everyone Act of 2019 H.R. 3436 Chronic Care Management Improvement Act Proposed AWI changes in inpatient prospective payment system proposed rule OPPS and physician fee schedule proposed rules NIH funding Title VII health professions education and training programs FY 2020 Appropriations bills H.R. 4378 - Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 Public Charge proposed rule H.R. 3 - the Elijah Cummings Lower Drug Costs Now Act Submitted Comment Letters SUBJECT: CMS-1720-P, Medicare Program; Modernizing and Clarifying the Physician Self-Referral Regulations; Federal Register Vol. 84, No. 201, October 17, 2019 SUBJECT: OIG-0936-AA10-P, Medicare and State Healthcare Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements; Federal Register (Vol. 84, No. 201), October 17, 2019 SUBJECT: Docket Number FDA-2017-D-6569, Draft Guidance for Industry and Food and Drug Administration Staff: Clinical Decision Support Software SUBJECT: Public Comments on Competitive Bidding Surveys SUBJECT: Request for Information on the Future of Program Integrity SUBJECT: SAMHSA-4162-20, Confidentiality of Substance Use Disorder Patient Records, Proposed Rule, Federal Register (Vol. 84, No. 165), August 26, 2019

Client expense: $220,000 · Firm income: Not reported

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

Rural hospital policies (S. 586/H.R. 1041, Critical Access Hospital Relief Act of 2019; H.R. 1052; S. 895, Rural Hospital Regulatory Relief Act of 2019; S. 948/H.R. 2895, Conrad 30 and Physician Access Act; H.R. 3429, the HEARTS and Rural Relief Act) Graduate Medical Education (GME) funding (S. 348/H.R. 1763, Resident Physician Shortage Reduction Act of 2019; H.R. 2349/H.R. 3414 Opioid Workforce Act) Delay of Medicaid Disproportionate Share Hospital payment cuts (H.R. 3022, Patient Access Protection Act) Telehealth payment (H.R. 1892, Bipartisan Budget Act of 2018; H.R. 6, SUPPORT for Patients and Communities Act; H.R. 3417 Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act) Extending the Medicaid demonstration program for certified community behavioral health clinics (H.R.3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019; S. 824/H.R. 1767, Excellence in Mental Health and Addiction Treatment Expansion Act) Stark law reform Hospital outpatient payment policy Site neutral payment policy included in outpatient prospective payment system rule (H.R.2552, Protecting Local Access to Care for Everyone Act of 2019) Improving Seniors Timely Access to Care Act (H.R. 3107) Chronic Care Management Improvement Act (H.R. 3436) OPPS and physician fee schedule rules Executive Order Protecting and Improving Medicare for our Nation's Seniors

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Hospital Group Purchasing - Advocated in support of hospital group purchasing organizations and maintaining the GPO safe harbor. Prescription Drug Pricing - Engaged to clarify provisions in the House (H.R. 3) and Senate (S. 2543) drug pricing bills. Supported passage of legislation that would promote competition among prescription drug manufacturers: The CREATES Act (H.R. 965; S. 340); the FAST Generics Act (H.R. 985); the Biologic Patent Transparency Act (S.659); the Affordable Prescriptions for Patients Act (S. 1416). 340B Drug Pricing Program - Supported maintaining adequate reimbursement for hospitals purchasing prescription drugs through the 340B Drug Pricing Program. Advocated for preserving the current structure of the program and retaining the current prime vendor. Surprise Billing - Supported inclusion of provisions to provide for an independent dispute resolution process in legislation to address surprise bills (H.R. 3630; H.R. 2328; S. 1895). Health Care Costs - Monitored the development and release of the S. 1895, the Lower Health Care Costs Act. Health Care Data Utilization - conducted an educational briefing to illustrate how hospitals utilize data resources to identify health care quality improvement opportunities. Rural Health Care Issues - Offered support for the following legislation that would make improvements to rural health care access: Critical Access Hospital Regulatory Relief (S. 586/H.R. 1041) Rural Hospital Regulatory Relief Act (S. 895/H.R. 3416) Rural Health Clinic Modernization Act (S. 1037/H.R. 2788) Telehealth Across State Lines Act (S. 2408/H.R.4900) CONNECT For Health Act (S. 2741/H.R.4932) Conrad State 30 and Physician Access Reauthorization Act (S. 948/H.R.2895)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for Graduate Medical Education (GME) funding including the Resident Physician Shortage Reduction Act of 2019 (S. 348/H.R. 1763) and the Opioid Workforce Act of 2018 (H.R. 5818/S. 2843) and Advancing Medical Resident Training in Community Hospitals Act (H.R. 1358) Support for delay of impending Medicaid Disproportionate Share Hospital payment cuts Support for full protection of Critical Access Hospital payments including the Critical Access Hospital Relief Act of 2019 (H.R. 1041) Support for changes to Medicare Volume Decrease Adjustment calculation including the Access for Rural Communities Act (H.R. 3672) Support for correction of erroneous reductions of GME residency positions Support for Protecting Local Access to Care for Everyone Act (H.R. 2552) Opposition to 340B program reductions in Centers for Medicare and Medicaid Services (CMS) 2018 Outpatient Prospective Payment System (OPPS) proposed rule [CMS-1678-P] Opposition to site-neutral payment reductions to hospital outpatient departments proposed in CMS 2019 OPPS proposed rule [CMS-1695-P] Support for policies to preserve Medicare Disproportionate Share Hospital funding as part of CMS 2019 Inpatient Prospective Payment System proposed rule [CMS-1694-P] Opposition to setting rates or bundling ER payments to address disputes between insurers and hospitals for surprise bills. Advocacy on various surprise billing bills (S. 1895, H.R.3502, H.R.3630) Support for Reform of the Stark Law and Anti-Kickback Statute

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

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $28,257 · Firm income: Not reported

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $28,257 · Firm income: Not reported

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

PL 109-417 - Pandemic and All-Hazards Preparedness Act (PAHPA) H. R. 8 - Bipartisan Background Checks Act of 2019 H. R. 1418 - Competitive Health Insurance Reform Act of 2019 S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 S. 966 - Medicare Care Coordination Improvement Act of 2019 S. 2372 - VA MISSION Act of 2018 S. 741/H. R. 1730 - Cancer Drug Parity Act of 2019 H. R. 1379 - Ensuring Lasting Smiles Act H. R. 207 - Stop the Violence Act of 2019 H. R. 1841 - Ensuring Access to General Surgery Act of 2019 (and Senate version reintroduction) H. R. 1041 - Critical Access Hospital Relief Act of 2019 H.R. 3656/S. 1350 - ACCESS Act of 2019 H.R. 861 End Surprise Billing Act H.R. 3630 No Surprises Act H.R. 3502 Protecting People from Surprise Medical Bills Act H.R. 2550 - Prevent BLEEDing Act of 2019 H. R. 2143 - Promoting Integrity in Medicare Act of 2019 H. R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 H. R. 1332 - Fair Care Act of 2019 H.R. 2464 - End the Cycle of Violence Act of 2019 S. 1895 Lower Health Care Costs Act S. 967 Reducing Costs for Out of Network Services Act S. 1266 Protecting Patients from Surprise Medical Bills Act S. 1531 Stopping the Outrageous Practice of Surprise Bills Act S. 1607 Medical Billing Fairness Act H. R. 1763/S. 348 - Resident's Physician Shortage Reduction Act S. 1350 - Good Samaritan Health Professionals Act H. R. 2689/S. 1438 - Breast Cancer Research Stamp reauthorization H.R. 4350/S. 3085 - Ambulatory Surgical Center Quality and Access Act of 2019 Cures 2.0 E/M Global Code Issues Unique Patient Identifier Lower Health Care Costs Act Compromise Bleeding Control for the Injured (Stop The Bleed campaign) Qualified clinical data registry (QCDR) Firearms Safety and Research MACRA Implementation Merit-based Incentive Payment Systems (MIPS) Alternative Payment Models (APM) Outpatient Prospective Payment System (OPPS) Common Rule Medicare for All National Trauma Systems Legislation Drug Pricing Patient-Centered Outcomes Research Institute (PCORI) Measuring Surgical Quality Medicare Physician Reimbursement Cancer Research and Funding Trauma Research and Funding Opioids/Pain Management Legislation ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) Reauthorization of Patient-Centered Outcomes Research Institute (PCORI) 2020 CMS Proposed Fee Schedule Rare earth magnet legislation

Client expense: $227,176 · Firm income: Not reported

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