Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/ H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Public Law 114-255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2508 - Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); H.R. 4945 - Safeguarding Medicare Access to Respiratory Therapy Act of 2019; H.R. 1865 - Further Consolidated Appropriations Act, 2020 (Public Law 116-94); H.R. 748 - CARES Act (Public Law 116-136); H.R. 6201 - Family First Coronavirus Response Act (Public Law 116-127); and H.R. 8158 - To amend title XVIII of the Social Security Act to waive budget neutrality for oxygen under the Medicare program, and for other purposes; H.R. 133 - Consolidated Appropriations Act, 2021 (Public Law 116-260).

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

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

The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753) National Defense Authorization Act of 2018 (H.R. 2810) S. AMDT. 621 (H.R. 2810)--Authorization of Physical Therapist Assistants and Occupational Therapy Assistants to Provide Services Under the TRICARE Program Trusted Exchange Framework and Common Agreement (TEFCA) CONNECT for Health Act of 2017 (H.R. 2556/S. 1016) The Laboratory Access for Beneficiaries (LAB) Act of 2019 (H.R. 3584) The Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 (H.R. 2408) The Protecting Access to Wheelchairs Act of 2019 (H.R. 2293) The Protecting Beneficiary Access to Complex Rehab Technology Act of 2019 (S. 1223) The Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019 (H.R.3417) The Creating Opportunities Now and Effective Care Technologies (CONNECT) Act of 2019 (S.2741) The Safeguarding Medicare Access to Respiratory Therapy (SMART) Act of 2019 (H.R.4945) The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020(H.R.6074) The Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 (S.3548) The Outpatient Therapy Modernization and Stabilization Act (H.R.7154) The Nursing Home COVID-19 Protection and Prevention Act (S.3768) The Infection Control Training and Support Act (H.R.7254)

Client expense: $39,516 · Firm income: Not reported

H.R. 985, Fair Access for Safe and Timely Generics Act of 2019 (FAST Generics Act), support passage. H.R. 2035/S. 995, Lifespan Respite Care Reauthorization Act, support reauthorization H.R. 3208/ S.1755 - Real Emergency Access for Aging and Disability Inclusion for Disasters Act, support passage H.R. 2781 - Empower for Health Act of 2019, support passage H.R. 2296/S.1391 - FAIR Drug Pricing Act of 2019, support passage H.R. 3630 - No Surprises Act, support passage H.R. 1010, To provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect, support passage. H.R. 986, The Protecting Americans with Preexisting Conditions Act of 2019, support passage. H.R.1386, Expand Navigators Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019, support passage. H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation technology Act, support passage. H.R 3 - Lower Drug Costs Now Act of 2019, support passage H.R. 19 - Lower Costs, More Cures Act of 2019, support passage H.R. 2387, the Stop The Overuse of Petitions and Get Affordable Medicines to Enter Soon (STOP GAMES) Act of 2019, support passage H.R. 6417, Protecting Cures Act of 2020, support passage H.R. 5800, Ban Surprise Billing Act, support passage H.R. 1595, Secure and Fair Enforcement Banking Act (SAFE Banking Act), support passage S. 1935, Family Coverage Act, support passage. S.1556, No Junk Plans Act, support passage. S.475, Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2019 (RX Cap Act), support passage S. 637, Combatting Unreasonable Rises and Excessively High Drug Prices Act (CURE High Drug Prices Act), support passage S.366, Forcing Limits on Abusive and Tumultuous Prices (FLAT Prices) Act, support passage S. 63, Preserve Access to Affordable Generics and Biosimilars Act, support passage S. 659, Biologic Patent Transparency Act, support passage S.1895 - Lower Health Care Costs Act, support passage S. 2543 - Prescription Drug Price Reduction Act of 2019 - support passage S. 1801, Low Cost Generics Act of 2019, support passage H.R. 1425 Patient Protection and Affordable Care Enhancement Act, support H.R. 6514, Worker Health Coverage Protection Act, Support H.R. 3832, S. 1257, Legacy IRA Act, Support H.R. 6408 - Save the Organizations that Serve America Act S.3544/H.R.6305 - Coronavirus Relief for Seniors and People with Disabilities Act of 2020, support S. 3815, RESTART Act, Oppose S. 3833/H.R. 7010/H.R.6886, Paycheck Protection Program Flexibility Act of 2020, Support S. 4032/H.R. 7324, Universal Giving Pandemic Response Act. Support passage H.R. 6892-Help Charities Protect Communities Act, Support - S.Amdt. 1566 to the CARES Act, Charitable Giving oAmendment Increases the $300 limit on the charitable giving deduction to one-third of the standard deduction ($4,000 for an individual filer/$8,000 for married joint filers) for the remainder of 2020. Support. H.R. 7663-Protecting Access to Post-COVID-19 Telehealth Act, support passage H.R. 6644/S. 3741 - Health Care At Home Act, support passage H.R. 7391- the Protect Telehealth Access Act, support passage S. 3998- the Enhancing Preparedness Through Telehealth Act, support passage

No bill: Support inclusion of occupational therapy services via telehealth under Medicare Part B, Medicare Advantage and any demonstration programs such as telehealth within accountable care organizations. HR 3127/S 1725 - The Home Health Flexibility Act: Support the ability of occupational therapists to conduct the initial and comprehensive assessments for Medicare Home Health cases. S 518/HR 1948 - Lymphedema Treatment Act - Support passage. No bill: Advocate for Congressional oversight of new Medicare payment models - PDPM & PDGM. No bill: Support for Congressional attention to the issue of falls related injuries and falls prevention. No bill: Advocated to stop proposed cuts to therapy services in the 2021 Physician Fee Schedule. HR 4932/S 2741 - CONNECT for Health Act of 2019: Support expanded coverage for services provided to Medicare patients via telehealth, including occupational therapy and other therapy services. HR 1329 - Medicaid Reentry Act (mental health and Medicaid policy): Support passage S 1754/HR 3215 - The Disaster Relief Medicaid Act (DRMA): Support passage No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, that support caregivers for people with dementia. No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, to support aging in place. S 1202 - Independence At Home Act: support passage HR2408 - Ensuring Access to Complex Rehabilitation Technology Act of 2019: support passage HR 748, CARES Act: Advocated to include occupational therapy practitioners as eligible Medicare telehealth service providers for both the duration of the COVID-19 public health emergency and on a permanent basis. HR 7154 - Outpatient Therapy Modernization and Stabilization Act: Support passage. HR 6634 - Emergency COVID Telehealth Response Act: Support introduction and passage. No bill #: Support for waiving statutory budget neutrality requirements, or exempting certain provider specialties from the application of budget neutrality, for the implementation of new Evaluation and Management Codes in the 2021 Medicare Physician Fee Schedule, and inclusion of this waiver in any COVID-19 legislation. HR 6365/3559 -Immediate Relief for Rural Facilities and Providers Act of 2020: Support passage. CMS - Met with CMS to discuss Medicare Part B payment reductions to therapy provider payments proposed in the 2021 physician fee schedule: Participants included Demetrios Kouzoukas, Director of Medicare. S. 4375 - Telehealth Modernization Act: Support , particularly for provisions that would allow the Secretary of Health and Human Services to permanently add occupational therapy practitioners to the Medicare telehealth benefit. Support various House and Senate proposals to extend and make permanent the Public Health Emergency provisions that enable occupational therapists to provide services to Medicare patients via telehealth.

H.R. 884, the Medicare Mental Health Access Act H.R. 2293, the Protecting Access to Wheelchairs Act H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 H.R. 3429, the HEARTS and Rural Relief Act (Section 4) H.R. 4386/S. 2496, the Stop the Wait Act H.R. 4945, the Safeguarding Medicare Access to Respiratory Therapy (SMART) Act H.R. 5262, the Medicare Orthotic and Prosthetics Patient Centered Care Act H.R. 5429/S. 3010, the SENIOR CARE Act S. 1223, the Protecting Beneficiary Access to Complex Rehabilitation Technology Act of 2019 S. 3277, the HCBS Infrastructure Improvement Act S. 3544, the Coronavirus Relief for Seniors and People with Disabilities Act of 2020 Medicaid block grants Potential expansion of Medicare

Client expense: $78,368 · Firm income: Not reported

Government targets: AMTRAK - Natl Railroad Passenger Corporation, Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Social Security Administration (SSA), Transportation Security Administration (TSA), Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), Veterans Employment & Training Service

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); legislation to amend Title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/H.R. 3429); issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Public Law 114-255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2508 - Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); H.R. 4945 - Safeguarding Medicare Access to Respiratory Therapy Act of 2019; H.R. 1865 - Further Consolidated Appropriations Act, 2020 (Public Law 116-94); H.R. 748 - CARES Act (Public Law 116-136); H.R. 6201 - Family First Coronavirus Response Act (Public Law 116-127); H. R. 8158 - Legislation to address a payment disparity for stationary oxygen products stemming from the application of outdated budget neutrailty provision in the 1997 Balanced Budget Act.

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/ H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Public Law 114-255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2508 - Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); H.R. 4945 - Safeguarding Medicare Access to Respiratory Therapy Act of 2019; H.R. 1865 - Further Consolidated Appropriations Act, 2020 (Public Law 116-94); H.R. 748 - CARES Act (Public Law 116-136); H.R. 6201 - Family First Coronavirus Response Act (Public Law 116-127); and H.R. 8158 - To amend title XVIII of the Social Security Act to waive budget neutrality for oxygen under the Medicare program, and for other purposes.

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

- H.R. 985, Fair Access for Safe and Timely Generics Act of 2017 (FAST Generics Act), support passage. -H.R. 2035/S. 995, Lifespan Respite Care Reauthorization Act, support reauthorization - H.R. 3208/ S.1755 - Real Emergency Access for Aging and Disability Inclusion for Disasters Act, support passage - H.R. 3215/ S. 1754 - Disaster Relief Medicaid Act, support passage - S.2400/ H.R. 4322 - Expanding Cannabis Research and Information Act, support passage - H.R. 3439 - Reauthorization of the Patient Centered Outcomes Research Institute, support reauthorization. -H.R. 2781 - Empower for Health Act of 2019, support passage -H.R. 2296/S.1391 - FAIR Drug Pricing Act of 2019, support passage - H.R. 3630 - No Surprises Act, support passage -H.R. 1010, To provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect, support passage. -H.R. 986, The Protecting Americans with Preexisting Conditions Act of 2019, support passage. -H.R.1386, Expand Navigators Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019, support passage. -H.R. 2293, the Protecting Access to Wheelchairs Act, support passage. -H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation technology Act, support passage. -H.R 3 - Lower Drug Costs Now Act of 2019, support passage -H.R. 19 - Lower Costs, More Cures Act of 2019, support passage - H.R. 2387, the Stop The Overuse of Petitions and Get Affordable Medicines to Enter Soon (STOP GAMES) Act of 2019, support passage - H.R. 3107, Improving Seniors Timely Access to Care Act of 2019, support passage - H.R. 6417, Protecting Cures Act of 2020, support passage - H.R. 5800, Ban Surprise Billing Act, support passage H.R. 1595, Secure and Fair Enforcement Banking Act (SAFE Banking Act), support passage -S. 1935, Family Coverage Act, support passage. -S.1556, No Junk Plans Act, support passage. -S. 1223, the Protecting Beneficiary Access to Complex Rehab Technology Act, support passage - S.475, Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2019 (RX Cap Act), support passage - S. 637, Combatting Unreasonable Rises and Excessively High Drug Prices Act (CURE High Drug Prices Act), support passage - S.366, Forcing Limits on Abusive and Tumultuous Prices (FLAT Prices) Act, support passage -S. 63, Preserve Access to Affordable Generics and Biosimilars Act, support passage -S. 659, Biologic Patent Transparency Act, support passage -S.1895 - Lower Health Care Costs Act, support passage - S. 1280/HR 2477 - Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, support passage - S. 691 - Medicare Extra Rx Help Act- support passage - S. 2543 - Prescription Drug Price Reduction Act of 2019 - support passage - Menendez - Lankford- Cardin-Daines Amendment 1 Incentivizing Generic and Biosimilar Use in Medicare Part D - support adoption Menendez -Lankford - Cardin --Daines Amendment 2 Incentivizing Generic Use in Medicare Part D - support adoption S, 1801, Low Cost Generics Act of 2019, support passage S.2911, the Seniors Prescription Drug Relief Act of 2019, support passage. - H.R. 1425 Patient Protection and Affordable Care Enhancement Act, support - H.R. 6514, Worker Health Coverage Protection Act, Support - H.R. 3832, S. 1257, Legacy IRA Act, Support - H.R. 6408 - Save the Organizations that Serve America Act - S.3544/H.R.6305 - Coronavirus Relief for Seniors and People with Disabilities Act of 2020, support -RESTART Act (S. 3814), Oppose - Paycheck Protection Program Flexibility Act of 2020(S. 3833/H.R. 7010/H.R.6886) Support -Help Charities Protect Communities Act (Rep. Beatty), bill number to be determined. Support - S.Amdt. 1566 to the CARES Act,Charitable Giving Amendment.Increases the $300 limit on the charitable giving deduction to one-third of the standard deduction ($4,000 for an individual filer/$8,000 for married joint filers) for the remainder of 2020. Support.

No bill: Support inclusion of occupational therapy services via telehealth under Medicare Part B, Medicare Advantage and any demonstration programs such as telehealth within accountable care organizations. HR 3127/S 1725 - The Home Health Flexibility Act: Support the ability of occupational therapists to conduct the initial and comprehensive assessments for Medicare Home Health cases. S 518/HR 1948 - Lymphedema Treatment Act - Support passage. No bill: Advocate for Congressional oversight of new Medicare payment models - PDPM & PDGM. No bill: Support for Congressional attention to the issue of falls related injuries and falls prevention. No bill: Advocated to stop proposed cuts to therapy services in the 2021 Physician Fee Schedule. HR 4932/S 2741 - CONNECT for Health Act of 2019: Support expanded coverage for services provided to Medicare patients via telehealth, including occupational therapy and other therapy services. HR 1329 - Medicaid Reentry Act (mental health and Medicaid policy): Support passage S 1754/HR 3215 - The Disaster Relief Medicaid Act (DRMA): Support passage No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, that support caregivers for people with dementia. No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, to support aging in place. S 1202 - Independence At Home Act: support passage HR2408 - Ensuring Access to Complex Rehabilitation Technology Act of 2019: support passage HR 748, CARES Act: Advocated to include occupational therapy practitioners as eligible Medicare telehealth service providers for both the duration of the COVID-19 public health emergency and on a permanent basis. HR 7154 - Outpatient Therapy Modernization and Stabilization Act: Support introduction and passage. HR 6634 - Emergency COVID Telehealth Response Act: Support introduction and passage. No bill #: Support for waiving statutory budget neutrality requirements, or exempting certain provider specialties from the application of budget neutrality, for the implementation of new Evaluation and Management Codes in the 2021 Medicare Physician Fee Schedule, and inclusion of this waiver in any COVID-19 legislation. HR 6365/3559 -Immediate Relief for Rural Facilities and Providers Act of 2020: Support passage. Meeting with CMS officials from Division of Non-Institutional Quality Standards both Mary Rossi-Coajou, Senior Nurse Consultant and Maria Hammel, Director; from Division of Continuing and Acute Care Providers both James Cowher, Branch Manager and Tara Lemons, RDN,RN,MA,MSN; and from Division of Home Health, Hospice and HCPCS Kelly Vontran, Acting Deputy Director: Advocated making permanent the public health emergency provisions that enable occupational therapists to open Medicare home health therapy cases. CMS - Met with Demetrios Kouzoukas, Director of Medicare, Ing-Jyu Cheng, Acting Director of Hospital and Ambulatory Policy Group, and Gift Tee, Director of the Division of Practitioner Services: Discussed Medicare Part B payment reductions to therapy provider payments proposed for the 2021 physician fee schedule in 84 FR 62568. GAO - Met with officials from the Office of Management and Budget and official from the Office of Information and Regulatory Affairs: Discussed Medicare Part B payment reductions to therapy provider payments proposed for the 2021 physician fee schedule in 84 FR 62568

H.R. 2293, the Protecting Access to Wheelchairs Act H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 H.R. 3429, the HEARTS and Rural Relief Act (Section 4) H.R. 4386/S. 2496, the Stop the Wait Act H.R. 4945, the Safeguarding Medicare Access to Respiratory Therapy (SMART) Act H.R. 5262, the Medicare Orthotic and Prosthetics Patient Centered Care Act H.R. 5429/S. 3010, the SENIOR CARE Act S. 1223, the Protecting Beneficiary Access to Complex Rehabilitation Technology Act of 2019 S. 3277, the HCBS Infrastructure Improvement Act S. 3544, the Coronavirus Relief for Seniors and People with Disabilities Act of 2020 Medicaid block grants Potential expansion of Medicare

Client expense: $71,212 · Firm income: Not reported

Government targets: AMTRAK - Natl Railroad Passenger Corporation, Architectural & Transportation Barriers Compliance Board, Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Social Security Administration (SSA), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Veterans Affairs, Dept of (VA), Veterans Employment & Training Service

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/ H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Public Law 114-255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2508 - Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); H.R. 4945 - Safeguarding Medicare Access to Respiratory Therapy Act of 2019; H.R. 1865 - Further Consolidated Appropriations Act, 2020 (Public Law 116-94); H.R. 748 - CARES Act (Public Law 116-136); H.R. 6201 - Family First Coronavirus Response Act (Public Law 116-127).

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

The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753) National Defense Authorization Act of 2018 (H.R. 2810) S. AMDT. 621 (H.R. 2810)--Authorization of Physical Therapist Assistants and Occupational Therapy Assistants to Provide Services Under the TRICARE Program Trusted Exchange Framework and Common Agreement (TEFCA) CONNECT for Health Act of 2017 (H.R. 2556/S. 1016) The Laboratory Access for Beneficiaries (LAB) Act of 2019 (H.R. 3584) The Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 (H.R. 2408) The Protecting Access to Wheelchairs Act of 2019 (H.R. 2293) The Protecting Beneficiary Access to Complex Rehab Technology Act of 2019 (S. 1223) The Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019 (H.R.3417) The Creating Opportunities Now and Effective Care Technologies (CONNECT) Act of 2019 (S.2741) The Safeguarding Medicare Access to Respiratory Therapy (SMART) Act of 2019 (H.R.4945) The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020(H.R.6074) The Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 (S.3548) The Outpatient Therapy Modernization and Stabilization Act (H.R.7154) The Nursing Home COVID-19 Protection and Prevention Act (S.3768) The Infection Control Training and Support Act (H.R.7254)

Client expense: $39,516 · Firm income: Not reported

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend Title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Pub.L. 114-255 114-255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2508 -The Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); H.R. 4945 - Safeguarding Medicare Access to Respiratory Therapy Act of 2019; H.R. 1865 - Further Consolidated Appropriations Act, 2020; H.R. 748 - CARES Act; H.R. 6201 - Family First Coronavirus Response Act.

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

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

H.R. 2293, the Protecting Access to Wheelchairs Act H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 H.R. 3429, the HEARTS and Rural Relief Act (Section 4) H.R. 4386/S. 2496, the Stop the Wait Act H.R. 4945, the Safeguarding Medicare Access to Respiratory Therapy (SMART) Act H.R. 5262, the Medicare Orthotic and Prosthetics Patient Centered Care Act H.R. 5429/S. 3010, the SENIOR CARE Act S. 1223, the Protecting Beneficiary Access to Complex Rehabilitation Technology Act of 2019 S. 3277, the HCBS Infrastructure Improvement Act S. 3544, the Coronavirus Relief for Seniors and People with Disabilities Act of 2020 Medicaid block grants Potential expansion of Medicare

Client expense: $74,586 · Firm income: Not reported

Government targets: AMTRAK - Natl Railroad Passenger Corporation, Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Transportation Security Administration (TSA), Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), Veterans Employment & Training Service

No bill: Support inclusion of occupational therapy services via telehealth under Medicare Part B, Medicare Advantage and any demonstration programs such as telehealth within accountable care organizations. HR 3127/S 1725 - The Home Health Flexibility Act: Support the ability of occupational therapists to conduct the initial and comprehensive assessments for Medicare Home Health cases. S 518/HR 1948 - Lymphedema Treatment Act - Support passage. No bill: Advocate for Congressional oversight of new Medicare payment models - PDPM & PDGM. No bill: Support for Congressional attention to the issue of falls related injuries and falls prevention. No bill: Advocated to stop proposed cuts to therapy services in the 2021 Physician Fee Schedule. HR 4932/S 2741 - CONNECT for Health Act of 2019: Support expanded coverage for services provided to Medicare patients via telehealth, including occupational therapy and other therapy services. HR 1329 - Medicaid Reentry Act (mental health and Medicaid policy): Support passage S 1754/HR 3215 - The Disaster Relief Medicaid Act (DRMA): Support passage No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, that support caregivers for people with dementia. No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, to support aging in place. HR 1109 - Mental Health Services for Students Act: Support passage HR 4564 - Suicide Prevention Lifeline Improvement Act: Support passage HR 1767 - Excellence in Mental Health and Addiction Treatment Expansion Act: Support passage HR 4861 - Effective Suicide Screening and Assessment in the Emergency Department Act: Support passage HR 4309 - Barriers to Suicide Act: Support passage S 995 - Lifespan Respite Care Reauthorization Act: Support passage S 1202 - Independence At Home Act: support passage HR2408 - Ensuring Access to Complex Rehabilitation Technology Act of 2019: support passage HR 748, CARES Act: Asked that occupational therapy practitioners and other therapy providers be made eligible to provide Medicare telehealth services under emergency waivers. CMS - Met with Gift Tee, Director of the Division of Practitioner Services; Kathy Bryant; and Pam West: Discussed Medicare Part B payment reductions to therapy provider payments proposed for the 2021 physician fee schedule. We discussed proposals that would allow the changes to evaluation and management (E&M) codes to proceed without adversely affecting specialties that do not bill E&M codes. HR 6365/3559 -Immediate Relief for Rural Facilities and Providers Act of 2020: Support passage.

- H.R. 985, Fair Access for Safe and Timely Generics Act of 2017 (FAST Generics Act), support passage. -H.R. 2035/S. 995, Lifespan Respite Care Reauthorization Act, support reauthorization - H.R. 3208/ S.1755 - Real Emergency Access for Aging and Disability Inclusion for Disasters Act, support passage - H.R. 3215/ S. 1754 - Disaster Relief Medicaid Act, support passage - S.2400/ H.R. 4322 - Expanding Cannabis Research and Information Act, support passage - H.R. 3439 - Reauthorization of the Patient Centered Outcomes Research Institute, support reauthorization. -H.R. 2781 - Empower for Health Act of 2019, support passage -H.R. 2296/S.1391 - FAIR Drug Pricing Act of 2019, support passage - H.R. 3630 - No Surprises Act, support passage -H.R. 1010, To provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect, support passage. -H.R. 986, The Protecting Americans with Preexisting Conditions Act of 2019, support passage. -H.R.1386, Expand Navigators Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019, support passage. -H.R. 2293, the Protecting Access to Wheelchairs Act, support passage. -H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation technology Act, support passage. -H.R 3 - Lower Drug Costs Now Act of 2019, support passage -H.R. 19 - Lower Costs, More Cures Act of 2019, support passage - H.R. 2387, the Stop The Overuse of Petitions and Get Affordable Medicines to Enter Soon (STOP GAMES) Act of 2019, support passage - H.R. 3107, Improving Seniors Timely Access to Care Act of 2019, support passage - H.R. 6417, Protecting Cures Act of 2020, support passage - H.R. 5800, Ban Surprise Billing Act, support passage H.R. 1595, Secure and Fair Enforcement Banking Act (SAFE Banking Act), support passage -S. 1935, Family Coverage Act, support passage. -S.1556, No Junk Plans Act, support passage. -S. 1223, the Protecting Beneficiary Access to Complex Rehab Technology Act, support passage - S.475, Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2019 (RX Cap Act), support passage - S. 637, Combatting Unreasonable Rises and Excessively High Drug Prices Act (CURE High Drug Prices Act), support passage - S.366, Forcing Limits on Abusive and Tumultuous Prices (FLAT Prices) Act, support passage -S. 63, Preserve Access to Affordable Generics and Biosimilars Act, support passage -S. 659, Biologic Patent Transparency Act, support passage -S.1895 - Lower Health Care Costs Act, support passage - S. 1280/HR 2477 - Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, support passage - S. 691 - Medicare Extra Rx Help Act- support passage - S. 2543 - Prescription Drug Price Reduction Act of 2019 - support passage - Menendez - Lankford- Cardin-Daines Amendment 1 Incentivizing Generic and Biosimilar Use in Medicare Part D - support adoption Menendez -Lankford - Cardin --Daines Amendment 2 Incentivizing Generic Use in Medicare Part D - support adoption S, 1801, Low Cost Generics Act of 2019, support passage S.2911, the Seniors Prescription Drug Relief Act of 2019, support passage.

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/ H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Public Law 114-255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2508 - Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); H.R. 4945 - Safeguarding Medicare Access to Respiratory Therapy Act of 2019; H.R. 1865 - Further Consolidated Appropriations Act, 2020 (Public Law 116-94); H.R. 748 - CARES Act (Public Law 116-136); H.R. 6201 - Family First Coronavirus Response Act (Public Law 116-127).

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend Title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Pub.L. 114-255 114-255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2508 -The Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); H.R. 4945 - Safeguarding Medicare Access to Respiratory Therapy Act of 2019; H.R. 1865 - Further Consolidated Appropriations Act, 2020; H.R. 748 - CARES Act; H.R. 6201 - Family First Coronavirus Response Act.

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

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

The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753) National Defense Authorization Act of 2018 (H.R. 2810) S. AMDT. 621 (H.R. 2810)--Authorization of Physical Therapist Assistants and Occupational Therapy Assistants to Provide Services Under the TRICARE Program Trusted Exchange Framework and Common Agreement (TEFCA) CONNECT for Health Act of 2017 (H.R. 2556/S. 1016) The Laboratory Access for Beneficiaries (LAB) Act of 2019 (H.R. 3584) The Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 (H.R. 2408) The Protecting Access to Wheelchairs Act of 2019 (H.R. 2293) The Protecting Beneficiary Access to Complex Rehab Technology Act of 2019 (S. 1223) The Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019 (H.R.3417) The Creating Opportunities Now and Effective Care Technologies (CONNECT) Act of 2019 (S.2741) The Safeguarding Medicare Access to Respiratory Therapy (SMART) Act of 2019 (H.R.4945) The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020(H.R.6074) The Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 (S.3548)

Client expense: $39,516 · Firm income: Not reported

- H.R. 965/ S. 340, Creating and Restoring Equal Access To Equivalent Samples Act of 2017 (CREATES Act), support passage. - H.R. 985, Fair Access for Safe and Timely Generics Act of 2017 (FAST Generics Act), support passage. -H.R. 2035/S. 995, Lifespan Respite Care Reauthorization Act, support reauthorization - H.R. 3208/ S.1755 - Real Emergency Access for Aging and Disability Inclusion for Disasters Act, support passage - H.R. 3215/ S. 1754 - Disaster Relief Medicaid Act, support passage - S.2400/ H.R. 4322 - Expanding Cannabis Research and Information Act, support passage - H.R. 3439 - Reauthorization of the Patient Centered Outcomes Research Institute, support reauthorization. -H.R. 2781 - Empower for Health Act of 2019, support passage -H.R. 2035, Lifespan Respite Care Reauthorization Act of 2019, support passage -H.R. 2296/S.1391 - FAIR Drug Pricing Act of 2019, support passage - H.R. 3630 - No Surprises Act, support passage -H.R. 1010, To provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect, support passage. -H.R. 986, The Protecting Americans with Preexisting Conditions Act of 2019, support passage. -H.R.1386, Expand Navigators Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019, support passage. -H.R. 2293, the Protecting Access to Wheelchairs Act, support passage. -H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation technology Act, support passage. -H.R 3 - Lower Drug Costs Now Act of 2019, support passage - H.R. 2387, the Stop The Overuse of Petitions and Get Affordable Medicines to Enter Soon (STOP GAMES) Act of 2019, support passage - H.R. 3107, Improving Seniors Timely Access to Care Act of 2019, support passage -S. 1935, Family Coverage Act, support passage. -S.1556, No Junk Plans Act, support passage. -S. 1223, the Protecting Beneficiary Access to Complex Rehab Technology Act, support passage - S.475, Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2019 (RX Cap Act), support passage - S. 637, Combatting Unreasonable Rises and Excessively High Drug Prices Act (CURE High Drug Prices Act), support passage - S.366, Forcing Limits on Abusive and Tumultuous Prices (FLAT Prices) Act, support passage -S. 63, Preserve Access to Affordable Generics and Biosimilars Act, support passage -S. 659, Biologic Patent Transparency Act, support passage -S.1895 - Lower Health Care Costs Act, support passage - S. 1280/HR 2477 - Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, support passage - S. 691 - Medicare Extra Rx Help Act- support passage - S. 2543 - Prescription Drug Price Reduction Act of 2019 - support passage - Menendez - Lankford- Cardin-Daines Amendment 1 Incentivizing Generic and Biosimilar Use in Medicare Part D - support adoption -Menendez -Lankford - Cardin --Daines Amendment 2 Incentivizing Generic Use in Medicare Part D - support adoption -S, 1801, Low Cost Generics Act of 2019, support passage -S.2911, the Seniors Prescription Drug Relief Act of 2019, support passage.

United Spinal supports H.R. 2293 introduced by Representatives John Larson and Lee Zeldin - Protecting Access to Wheelchairs Act. United Spinal supports S. 1223 introduced by Senators Bob Casey and Rob Portman. - Protecting Beneficiary Access to Complex Rehab Technology Act of 2019. United Spinal supports HR 2408 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019. Signed onto a CMS letter on "Methods for Assuring Access to Covered Medicaid Services- rulemaking. Support Disaster Relief Medicaid Act - S. 1754/H.R. 3215. Support CONNECT for Health Act of 2019. Support permanent reauthorization of Money Follows the Person and HCBS spousal impoverishment protections. Support the Safeguarding Medicare Access to Respiratory Therapy Act of 2019. Support Medicare coverage of standing wheelchairs and seat elevation. Support HR 1865, manual complex rehabilitation technology provisions. Sent in comments to CMS on physician self-referral rulemaking, sent in comments to CMS regarding safe harbors as part of Personal Connected Health Alliance, sent in comments on PreventionX - which modernizes prevention, improves the health of our nation, and advance evidence-based connected health and wellness; sent in comments on the Cures 2.0 initiative on health information and technology and signed onto comments submitted by the Healthcare Information and Management Systems Society; as a member of PCHA Alliance, supported comments to the FDA on clinical decision support software.

Client expense: Not reported · Firm income: $75,000

Congressional and regulatory efforts related to competitive bidding and complex rehabilitation technology; H.R.2293, Protecting Access to Wheelchairs Act; S.1223, Protecting Beneficiary Access to Complex Rehab Technology Act of 2019; H.R.2408, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019. General Medicare reimbursement issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Passage of federal legislation H.R. 2293, H.R. 2408, and S. 2196 to protect access to Complex Rehab Technology used by Medicare beneficiaries with disabilities.

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

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

Passage of H.R. 2293, H.R. 2408, and S. 2196 to protect access to Complex Rehab Technology for Medicare beneficiaries

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

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

H.R. 2293, the Protecting Access to Wheelchairs Act H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 H.R. 3429, the HEARTS and Rural Relief Act (Section 4) H.R. 4386/S. 2496, the Stop the Wait Act H.R. 4945, the Safeguarding Medicare Access to Respiratory Therapy (SMART) Act H.R. 5262, the Medicare Orthotic and Prosthetics Patient Centered Care Act S. 1223, the Protecting Beneficiary Access to Complex Rehabilitation Technology Act of 2019 Medicaid block grants Potential expansion of Medicare

Client expense: $72,261 · Firm income: Not reported

Government targets: AMTRAK - Natl Railroad Passenger Corporation, Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA)

- H.R. 965/ S. 340, Creating and Restoring Equal Access To Equivalent Samples Act of 2017 (CREATES Act), support passage. - H.R. 985, Fair Access for Safe and Timely Generics Act of 2017 (FAST Generics Act), support passage. -H.R. 2035/S. 995, Lifespan Respite Care Reauthorization Act, support reauthorization - H.R. 3208/ S.1755 - Real Emergency Access for Aging and Disability Inclusion for Disasters Act, support passage - H.R. 3215/ S. 1754 - Disaster Relief Medicaid Act, support passage - S.2400/ H.R. 4322 - Expanding Cannabis Research and Information Act, support passage - H.R. 3439 - Reauthorization of the Patient Centered Outcomes Research Institute, support reauthorization. -H.R. 2781 - Empower for Health Act of 2019, support passage -H.R. 2035, Lifespan Respite Care Reauthorization Act of 2019, support passage -H.R. 2296/S.1391 - FAIR Drug Pricing Act of 2019, support passage - H.R. 3630 - No Surprises Act, support passage -H.R. 1010, To provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect, support passage. -H.R. 986, The Protecting Americans with Preexisting Conditions Act of 2019, support passage. -H.R.1386, Expand Navigators Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019, support passage. -H.R. 2293, the Protecting Access to Wheelchairs Act, support passage. -H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation technology Act, support passage. -H.R 3 - Lower Drug Costs Now Act of 2019, support passage - H.R. 2387, the Stop The Overuse of Petitions and Get Affordable Medicines to Enter Soon (STOP GAMES) Act of 2019, support passage - H.R. 3107, Improving Seniors Timely Access to Care Act of 2019, support passage -S. 1935, Family Coverage Act, support passage. -S.1556, No Junk Plans Act, support passage. -S. 1223, the Protecting Beneficiary Access to Complex Rehab Technology Act, support passage - S.475, Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2019 (RX Cap Act), support passage - S. 637, Combatting Unreasonable Rises and Excessively High Drug Prices Act (CURE High Drug Prices Act), support passage - S.366, Forcing Limits on Abusive and Tumultuous Prices (FLAT Prices) Act, support passage -S. 63, Preserve Access to Affordable Generics and Biosimilars Act, support passage -S. 659, Biologic Patent Transparency Act, support passage -S.1895 - Lower Health Care Costs Act, support passage - S. 1280/HR 2477 - Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, support passage - S. 691 - Medicare Extra Rx Help Act- support passage - S. 2543 - Prescription Drug Price Reduction Act of 2019 - support passage - Menendez - Lankford- Cardin-Daines Amendment 1 Incentivizing Generic and Biosimilar Use in Medicare Part D - support adoption -Menendez -Lankford - Cardin --Daines Amendment 2 Incentivizing Generic Use in Medicare Part D - support adoption -S, 1801, Low Cost Generics Act of 2019, support passage -S.2911, the Seniors Prescription Drug Relief Act of 2019, support passage.

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend Title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Pub.L. 114-255 114-255) competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2508 -The Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); H.R. 4945 Legislation regarding the inclusion of non-invasive vents in the DMEPOS Competitive Bidding Program; H.R. 1865 - Further Consolidated Appropriations Act, 2020.

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

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/ H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Pub.L. 114 - 255 114 - 255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2508 - The Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); H.R. 4945 - Safeguarding Medicare Access to Respiratory Therapy Act of 2019; H.R. 1865 - Further Consolidated Appropriations Act, 2020.

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

The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753) National Defense Authorization Act of 2018 (H.R. 2810) S. AMDT. 621 (H.R. 2810)--Authorization of Physical Therapist Assistants and Occupational Therapy Assistants to Provide Services Under the TRICARE Program Trusted Exchange Framework and Common Agreement (TEFCA) CONNECT for Health Act of 2017 (H.R. 2556/S. 1016) The Laboratory Access for Beneficiaries (LAB) Act of 2019 (H.R. 3584) The Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 (H.R. 2408) The Protecting Access to Wheelchairs Act of 2019 (H.R. 2293) The Protecting Beneficiary Access to Complex Rehab Technology Act of 2019 (S. 1223) The Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019 (H.R.3417) The Creating Opportunities Now and Effective Care Technologies (CONNECT) Act of 2019 (S.2741) The Safeguarding Medicare Access to Respiratory Therapy (SMART) Act of 2019 (H.R.4945)

Client expense: $39,516 · Firm income: Not reported

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

The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753) National Defense Authorization Act of 2018 (H.R. 2810) S. AMDT. 621 (H.R. 2810)--Authorization of Physical Therapist Assistants and Occupational Therapy Assistants to Provide Services Under the TRICARE Program Trusted Exchange Framework and Common Agreement (TEFCA) CONNECT for Health Act of 2017 (H.R. 2556/S. 1016) The Laboratory Access for Beneficiaries (LAB) Act of 2019 (H.R. 3584) The Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 (H.R. 2408) The Protecting Access to Wheelchairs Act of 2019 (H.R. 2293) The Protecting Beneficiary Access to Complex Rehab Technology Act of 2019 (S. 1223) The Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019 (H.R.3417) The Creating Opportunities Now and Effective Care Technologies (CONNECT) Act of 2019 (S.2741) The Safeguarding Medicare Access to Respiratory Therapy (SMART) Act of 2019 (H.R.4945)

Client expense: $39,516 · Firm income: Not reported

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

United Spinal supports H.R. 2293 introduced by Representatives John Larson and Lee Zeldin - Protecting Access to Wheelchairs Act. United Spinal supports S. 1223 introduced by Senators Bob Casey and Rob Portman. - Protecting Beneficiary Access to Complex Rehab Technology Act of 2019. United Spinal supports HR 2408 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019. As a member of the ITEM Coalition Steering Committee, United Spinal, Christopher & Dana Reeve Foundation, Amputee Coalition, PVA and clinicians, SCI physicians and advocates met with Liz Richter, Deputy Director, Center for Medicare at CMS and others to discuss the need for standing feature and seat elevation components to be covered by Medicare. Medicaid Program; Methods for Assuring Access to Covered Medicaid Services - Rescission, RIN:0938-AT41 Adequate access to services under Medicaid is especially important to people with disabilities. CCD has commented on numerous iterations of this rule, including the original notice of proposed rulemaking in 2011,1 final rule with comment period in 2016,2 request for information in 2016,3 and proposed rulemaking in 2018.4 People with disabilities rely on Medicaid for access to basic health care services and for services that ensure their functioning, independence, and well-being, including: nursing and personal care services, specialized therapies, intensive mental health services, special education services, and other needed services that are unavailable through other insurance. Access to these services is a matter of life, death, and independence for the millions of people with disabilities on Medicaid and the protections provided by the equal access statute are of particular importance to our community. United Spinal signed onto the Durable Medical Equipment Prosthetics, Orthotics and Supplies CY 2020 Proposed Rule to raise concerns about pricing calculated from the 1980s on new technologies and new codes for medical equipment and prosthetics and orthotics which hinders companies from providing newer equipment or investing in developing new technologies and prevents consumer access to reasonably priced products. United Spinal signed onto a Congressional House letter in support of H.R. 3107, Improving Seniors Timely Access to Care Act which protects patients from unnecessary delays in care by supporting and seeks to streamline and standardize prior authorization under the Medicare Advantage program. United Spinal, as a member of the Personal Connected Health Alliance, supports a letter submitted to the Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; CY 2020 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; and Home Infusion Therapy Requirements; Proposed Rule. The letter read in part: Our comments focus on important connected care aspects of the home health prospective payment system and the home infusion therapy benefit, and we offer our comments to ensure efficacious, effective, and non-duplicative coverage for remote patient monitoring. United Spinal also commented as a member of ITEM Coalition's Steering Committee on (CMS-1711-P) Medicare and Medicaid Programs; CY 2020 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; and Home Infusion Therapy Requirements The Proposed Rule updates the home health prospective payment system (HH PPS) payment rates and implements the transition in the unit of payment from a 60-day episode of care to a 30-day episode of care, as required by the Bipartisan Budget Act of 2018. The Proposed Rule also implements the Patient-Driven Groupings Model (PDGM), proposed payment rate changes for home infusion therapy temporary transitional payments, and adjustments to the home infusion therapy benefit, and proposes to phase out the Request for Anticipated Payment (RAP). The Proposed Rule would also change the Home Health Value-Based Purchasing Model (HH VBP) and the Home Health Quality Reporting Program (HH QRP), among other things. Although some components of CMSs new home health payment reform were finalized last year, we continue to have concerns regarding the implementation of and rationale behind the new payment methodology. Our comments focussed largely on the proposed implementation of the PDGM, the proposed authorization of therapist assistants to provide maintenance therapy, and the impact of these proposals on patients receiving rehabilitative care in the home health setting.

Congressional and regulatory efforts related to competitive bidding and complex rehabilitation technology; H.R.2293, Protecting Access to Wheelchairs Act; S.1223, Protecting Beneficiary Access to Complex Rehab Technology Act of 2019; H.R.2408, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019. General Medicare reimbursement issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2293, the Protecting Access to Wheelchairs Act H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 H.R. 3429, the HEARTS and Rural Relief Act (Section 4) H.R. 4386/S. 2496, the Stop the Wait Act S. 1223, the Protecting Beneficiary Access to Complex Rehabilitation Technology Act of 2019 Medicaid block grants Potential expansion of Medicare

Client expense: $78,075 · Firm income: Not reported

Government targets: AMTRAK - Natl Railroad Passenger Corporation, Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Transportation, Dept of (DOT), Veterans Affairs, Dept of (VA)

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Pub.L. 114-255 114-255) competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2509 -The Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); Legislation regarding the inclusion of non-invasive vents in the DMEPOS Competitive Bidding Program.

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

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

- H.R. 965/ S. 340, Creating and Restoring Equal Access To Equivalent Samples Act of 2017 (CREATES Act), support passage. - H.R. 985, Fair Access for Safe and Timely Generics Act of 2017 (FAST Generics Act), support passage. -H.R. 2035/S. 995, Lifespan Respite Care Reauthorization Act, support reauthorization - H.R. 3208/ S.1755 - Real Emergency Access for Aging and Disability Inclusion for Disasters Act, support passage - H.R. 3215/ S. 1754 - Disaster Relief Medicaid Act, support passage - S.2400/ H.R. 4322 - Expanding Cannabis Research and Information Act, support passage - H.R. 3439 - Reauthorization of the Patient Centered Outcomes Research Institute, support reauthorization. -H.R. 2781 - Empower for Health Act of 2019, support passage -H.R. 2035, Lifespan Respite Care Reauthorization Act of 2019, support passage -H.R. 2296/S.1391 - FAIR Drug Pricing Act of 2019, support passage - H.R. 3630 - No Surprises Act, support passage -H.R. 1010, To provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect, support passage. -H.R. 986, The Protecting Americans with Preexisting Conditions Act of 2019, support passage. -H.R.1386, Expand Navigators Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019, support passage. -H.R. 2293, the Protecting Access to Wheelchairs Act, support passage. -H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation Technology Act, support passage. -H.R 3 - Lower Drug Costs Now Act of 2019, support passage -S. 1935, Family Coverage Act, support passage. -S.1556, No Junk Plans Act, support passage. -S. 1223, the Protecting Beneficiary Access to Complex Rehab Technology Act, support passage - S.475, Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2019 (RX Cap Act), support passage - S. 637, Combatting Unreasonable Rises and Excessively High Drug Prices Act (CURE High Drug Prices Act), support passage - S.366, Forcing Limits on Abusive and Tumultuous Prices (FLAT Prices) Act, support passage -S. 63, Preserve Access to Affordable Generics and Biosimilars Act, support passage -S. 659, Biologic Patent Transparency Act, support passage -S.1895 - Lower Health Care Costs Act, support passage - S. 1280/HR 2477 - Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, support passage - S. 691 - Medicare Extra Rx Help Act- support passage - S. 2543 - Prescription Drug Price Reduction Act of 2019 - support passage - Menendez - Lankford- Cardin-Daines Amendment 1 Incentivizing Generic and Biosimilar Use in Medicare Part D - support adoption -Menendez -Lankford - Cardin --Daines Amendment 2 Incentivizing Generic Use in Medicare Part D - support adoption

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/ H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Pub.L. 114 - 255 114 - 255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DMEPOS proposed and final rules; H.R. 2508 - The Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act); Legislation regarding the inclusion of non-invasive vents in the DMEPOS Competitive Bidding Program.

Client expense: $160,000 · Firm income: Not reported

Congressional and regulatory efforts related to competitive bidding and complex rehabilitation technology. H.R.2293, Protecting Access to Wheelchairs Act. S.1223, Protecting Beneficiary Access to Complex Rehab Technology Act of 2019. H.R.2408, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Department of Health and Human Services (HHS) United Spinal, as a Steering Committee Co-Chair of both ITEM Coalition and the Coalition to Preserve Rehabilitation, met with HHS External Affairs team to discuss the need for specialized rehabilitation for our population and the importance of protections for customized wheelchair features such as standing wheelchairs and seat elevation. Continue to advocate for opposition to HHS competitive bidding program for customized wheelchairs and ventilators and medical supplies to be included in Medicares competitive bidding program. United Spinal signed on to and helped draft a letter to the Centers for Medicare and Medicaid Services (CMS) opposed to including ventilators in the competitive bidding program. As part of the ITEM Coalition and CPR Steering Committees and HAB Coalition membership, we also raised concerns in a letter to CMS on its proposal to expand the sale of health insurance across state lines which may leave adults and children, particularly those with disabilities and chronic health conditions, with less comprehensive coverage and higher out-of-pocket costs but we support the efforts of increasing coverage in general. Sent letters to CMS opposing inclusion of ventilators in Medicares competitive bidding program. Worked with PCHA, ResMed and helped draft letters for the ITEM Coalition for Congress. United Spinal supports H.R. 2293 introduced by Representatives John Larson and Lee Zeldin - Protecting Access to Wheelchairs Act. United Spinal supports S. 1223 introduced by Senators Bob Casey and Rob Portman. - Protecting Beneficiary Access to Complex Rehab Technology Act of 2019. United Spinal supports HR 2408 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019. United Spinal, as a member of the MAP Rx Coalition, signed onto a letter to leadership of the House Ways and Means Committee and the Energy & Commerce Committee supporting caps to out of pocket costs for Medicare Part D beneficiaries and other issues. CMS As a member of the Personal Connected Health Alliance (PCHAlliance), a non-profit membership association, United Spinal joined in comments on the Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans in the Federally-Facilitated Exchanges and Health Care Providers (CMS-9115-P) in an effort to advance CMS policy to enable consumers access to health information and administrative consumer information. United Spinal Association supports H.R.3215/S.1754 - Disaster Relief Medicaid Act which would ensure that Medicaid-eligible individuals displaced during a disaster are able to access those same services. United Spinal submitted a letter of support for H.R. 1839/ Medicaid Services Investment and Accountability Act of 2019, Public Law 116-16. This bill extends protection for Medicaid recipients of home and community-based services against spousal impoverishment as well as strengthens the Medicaid program for children with complex medical needs and protects seniors and people with disabilities. Medicares Competitive Bidding Program United Spinal, as a member of the ITEM Coalitions Steering Committee, United Spinal helped draft and singed on to letters to Congress supporting CRT bills and exemption of manual CRT accessories from competitive bidding as well as opposition to inclusion of ventilators in the competitive bidding program and helped with additional Congressional signatories to opposing including ventilators in the program.

H.R. 2293, the Protecting Access to Wheelchairs Act H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 H.R. 3429, the HEARTS and Rural Relief Act (Section 4) S. 1223, the Protecting Beneficiary Access to Complex Rehabilitation Technology Act of 2019 Medicaid block grants Potential expansion of Medicare

Client expense: $81,944 · Firm income: Not reported

Government targets: AMTRAK - Natl Railroad Passenger Corporation, Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Transportation, Dept of (DOT), Veterans Affairs, Dept of (VA)

- H.R. 965/ S. 340, Creating and Restoring Equal Access To Equivalent Samples Act of 2017 (CREATES Act), support passage. - H.R. 985, Fair Access for Safe and Timely Generics Act of 2017 (FAST Generics Act), support passage. -H.R. 2035/S. 995, Lifespan Respite Care Reauthorization Act, support reauthorization of the Lifespan Respite Care Program. - H.R. 3208/ S.1755 - Real Emergency Access for Aging and Disability Inclusion for Disasters Act, support passage - H.R. 3215/ S. 1754 - Disaster Relief Medicaid Act, support passage - H.R. 3439 - Reauthorization of the Patient Centered Outcomes Research Institute, support reauthorization. -H.R. 2781 - Empower for Health Act of 2019, support passage -H.R. 2035, Lifespan Respite Care Reauthorization Act of 2019, support passage -H.R. 2296/S.1391 - FAIR Drug Pricing Act of 2019, support passage - H.R. 3630 - No Surprises Act, support passage -H.R. 1010, To provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect, support passage. -H.R. 986, The Protecting Americans with Preexisting Conditions Act of 2019, support passage. -H.R.1386, Expand Navigators Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019, support passage. -H.R. 2293, the Protecting Access to Wheelchairs Act, support passage. H.R. 2408, the Ensuring Access to Quality Complex Rehabilitation Technology Act, support passage. -S. 1935, Family Coverage Act, support passage. -S.1556, No Junk Plans Act, support passage. -S. 1223, the Protecting Beneficiary Access to Complex Rehab Technology Act, support passage - S.475, Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2019 (RX Cap Act), support passage - S. 637, Combatting Unreasonable Rises and Excessively High Drug Prices Act (CURE High Drug Prices Act), support passage - S.366, Forcing Limits on Abusive and Tumultuous Prices (FLAT Prices) Act, support passage -S. 63, Preserve Access to Affordable Generics and Biosimilars Act, support passage -S. 659, Biologic Patent Transparency Act, support passage -S.1895 - Lower Health Care Costs Act, support passage - S. 1280 - Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, support passage - S. 691 - Medicare Extra Rx Help Act- support passage

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/ H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Pub.L. 114 - 255 114 - 255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DEMPOS proposed and final rules; H.R. 2508 - The Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act).

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/ H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality H.R. 2771; 21st Century Cures Act (Pub.L. 114-255 114-255) competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DEMPOS proposed and final rules; The Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act) H.R. 2508.

Client expense: Not reported · Firm income: $47,000

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, vents, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration; Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 2408); Legislation to amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories (H.R. 2293/S. 1223/ H.R. 3429); Issues related to reimbursement cuts in noncompetitive bidding areas and O2 Budget Neutrality; H.R. 2771 - Protecting Home Oxygen and Medical Equipment Act of 2019; 21st Century Cures Act (Pub.L. 114 - 255 114 - 255), competitive bidding issues; DME issues in the FY2020 President's Budget and CMS ESRD/DEMPOS proposed and final rules; H.R. 2508 - The Better Respiration through Expanding Access to Tele-Health Act (BREATHE Act).

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

The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753) National Defense Authorization Act of 2018 (H.R. 2810) S. AMDT. 621 (H.R. 2810)--Authorization of Physical Therapist Assistants and Occupational Therapy Assistants to Provide Services Under the TRICARE Program Trusted Exchange Framework and Common Agreement (TEFCA) CONNECT for Health Act of 2017 (H.R. 2556/S. 1016) The Laboratory Access for Beneficiaries (LAB) Act of 2019 (H.R. 3584) The Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 (H.R. 2408) The Protecting Access to Wheelchairs Act of 2019 (H.R. 2293) The Protecting Beneficiary Access to Complex Rehab Technology Act of 2019 (S. 1223)

Client expense: $39,516 · Firm income: Not reported

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