PLACE Act of 2019

Bill # H.R. 652: Comprehensive Care for Seniors Act Bill # H.R. 1329: Medicaid Reentry Act. Partially lifts the Medicaid Inmate Exclusion Bill # H.R. 1763 and S348: Resident Physician Shortage Reduction Act of 2019. Create 15,000 new Medicare-supported residency slots by 2024 Bill # H.R. 2552: Protecting Local Access to Care for Everyone Act. Halts CMS' site neutrality policy Bill # H.R. 3022: Patient Access Protection Act.To protect hospitals from Medicaid DSH cuts Bill # H.R. 4932 and S2741: CONNECT for Health Act. Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act to expand access to telehealth services Bill #S. 296: Home Health Care Planning Improvement Act of 2019.Revises conditions of and limitations on Medicare payment for home health care services Bill HR7791 Makes improvements to the ACO program, including modifying risk adjustment and ensuring fair benchmarks, removes barriers to participation for rural ACOs, and further incentivizes participation in advanced alternative payment models Bill HR 7663 Protecting Access to Post-COVID-19 Telehealth Act To authorize the HHS Secretary to waive or modify application of Medicare requirements with respect to telehealth services during any emergency period Bill HR 7292 The COVID-19 Hospital Forgiveness Act To provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program Supply chain coordination and transparency in response to COVID-19.

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Navy, Dept of, SENATE

Medicaid Fiscal Accountability Regulation Rural hospital policies; HHS Rural Action Plan 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; H.R. 748, CARES Act; H.R.8337, Continuing Appropriations Act, 2021 and Other Extensions Act) Medicare sequestration (H.R. 748, CARES Act) Federal Medical Assistance Percentage increase (H.R. 6201, Families First Coronavirus Response Act; H.R. 748, CARES Act; H.R. 6800; S. 4108, Coronavirus Medicaid Response 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; all coronavirus relief packages - H.R. 6074, H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800, HEALS Act, S. 4775; physician fee schedule proposed rule Medicare hospital accelerated payment program (coronavirus relief packages-H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800, HEALS Act, S. 4775; H.R. 6837/S. 3750, Medicare Accelerated and Advance Payments Improvement Act; H.R. 7292, COVID-19 Hospital and Health Provider Loan Forgiveness Act of 2020) Post-acute care flexibilities (coronavirus relief packages - H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800, HEALS Act, S. 4775) Stark law reform Site neutral payment policy included in outpatient prospective payment system rule (H.R.2552, Protecting Local Access to Care for Everyone Act of 2019) OPPS and physician fee schedule rules Interim Final Rule establishing a Medicare Condition of Participation for COVID-19 Data Reporting (Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments (CLIA), and Patient Protection and Affordable Care Act; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency)

COVID-19 crisis - Engaged with Congress and the administration to advocate for greater regulatory flexibility and appropriate reimbursement for hospitals through development, passage and ongoing implementation of coronavirus relief legislation: HEROES Act (HR 6800) Heroes Act 2.0 (H.R. 925) Health, Economic Assistance, Liability Protection and Schools (HEALS) Act S. 178 Telehealth - Urged Congress and the administration to make permanent telehealth flexibilities related to distant site and geographic limitations, expanding provider types and services available to consumers and maintaining Medicare reimbursement parity. Accelerated and Advanced Payment Program - Advocated for Congress and the administration to offer forgiveness for accelerated and advanced payments during the COVID-19 public health emergency. Offered support for reduced interest rates, extended loan repayment period and reduced recoupment amounts (S. 3750/H.R. 6837/ H.R. 8337). Medicaid Disproportionate Share Hospital (DSH) Payments - Urged Congress to end implementation of Medicaid DSH payment cuts. Medicare Sequester - urged Congress to end ongoing Medicare sequestration reimbursement reductions. Site-neutral Payments - Urged Congress to end site-neutral payment reductions. Supported passage of the PLACE Act (H.R. 2552) which would reverse site-neutral payments cuts implemented by the Centers for Medicare and Medicaid Services. Price Transparency - Urged Congress and the administration to delay implementation of regulation requiring hospitals to post payor-specific pricing information for goods and services. Enhanced Federal Medical Assistance Percentage (FMAP) - Urged Congress to extend the increased Medicaid FMAP matching rate beyond the public health emergency and increase the enhanced percentage. Medicaid Fiscal Accountability Regulation - Urged CMS to withdraw the Medicaid Fiscal Accountability Regulation and advocated for Congress to rescind the proposal. COVID-19 Data Reporting Requirements for Hospitals - requested HHS ease burden of COVID-19 mandatory reporting requirements and clarify aspects of reporting. Resident Physician Shortage Reduction Act (S. 348) - Urged Congress to pass the Resident Physician Shortage Reduction Act.

H.R. 3062/S. 2860 - "Patient Access to Higher Quality Health Care Act of 2019" - Oppose efforts to repeal certain provisions relating to the Medicare exception to the prohibition on certain physician referrals for hospitals. H.R. 2552 - "Protecting Local Access to Care for Everyone (PLACE) Act" - Support legislation to prevent site neutral cuts. Support access to affordable prescription drugs. H.R. 3107 - "Improving Seniors' Timely Access to Care Act" - Support legislation that streamlines and standardizes prior authorization under the Medicare Advantage program. Sought moratorium on proposed Medicaid Fiscal Accountability Regulation H.R. 6800 Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act - Support Division C, Health Provisions for Medicare and Medicaid that support health care providers and patients Post-Acute Care - Refresh the unified PAC PPS timeline and process under the IMPACT Act, Sought Congressional support for an IMPACT Act implementation/ unified payment timeline reset Qualifying APM Professional Threshold - Support request of House Leadership to address impending MACRA changes that could derail the movement to value-based health care and alternative payment models H.R. 7663 - "Protecting Access to Post-COVID-19 Telehealth Act of 2020" - Support broader access to Medicare telehealth services

Client expense: $700,000 · Firm income: Not reported

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

Medicaid Fiscal Accountability Regulation Rural hospital policies 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; H.R. 748, CARES Act) Medicare sequestration (H.R. 748, CARES Act) Federal Medical Assistance Percentage increase (H.R. 6201, Families First Coronavirus Response Act; H.R. 748, CARES Act, H.R. 6800; S. 4108, Coronavirus Medicaid Response 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; all coronavirus relief packages - H.R. 6074, H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Medicare hospital accelerated payment program (coronavirus relief packages-H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800; H.R. 6837/S. 3750, Medicare Accelerated and Advance Payments Improvement Act; H.R. 7292, COVID-19 Hospital and Health Provider Loan Forgiveness Act of 2020) Site neutral payment policy included in outpatient prospective payment system rule (H.R.2552, Protecting Local Access to Care for Everyone Act of 2019) OPPS and physician fee schedule rules

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

H.R. 3062/S. 2860 - "Patient Access to Higher Quality Health Care Act of 2019" - Oppose efforts to repeal certain provisions relating to the Medicare exception to the prohibition on certain physician referrals for hospitals. Bad Debt Payments to Hospitals - Oppose effort to lower bad debt payments to hospitals for Medicare beneficiaries who do not pay their cost-sharing for treatments provided by the hospital. H.R. 2552 - "Protecting Local Access to Care for Everyone (PLACE) Act" - Support legislation to prevent site neutral cuts. H.R. 1763/ S. 348 - "Resident Physician Shortage Reduction Act of 2019", H.R. 3414/S. 2892 - Opioid Workforce Act - Support GME legislation to reduce resident physician shortage. Support access to affordable prescription drugs. H.R. 3107 - "Improving Seniors' Timely Access to Care Act" - Support legislation that streamlines and standardizes prior authorization under the Medicare Advantage program. Sought moratorium on proposed Medicaid Fiscal Accountability Regulation H.R. 748 Coronavirus Aid, Relief, and Economic Security (CARES) Act - Advocated in support of funding and programs for hospitals and post-acute care providers to respond to COVID-19 H.R. 6800 Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act - Supported legislation

Client expense: $640,000 · Firm income: Not reported

2020 Q2 Lobbying Report - April 1-June 30 HCR The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074) Families First Coronavirus Response Act (H.R. 6201) The Coronavirus Aid, Relief, and Economic Security Act (H.R. 748, S. 3548) Paycheck Protection Program Flexibility Act of 2020 (H.R. 7010) Health and Economic Recovery Omnibus Emergency Solutions Act (H.R. 6800) Public Health and Social Services Emergency Fund (coronavirus relief packages-H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Regulatory relief in light of coronavirus (all coronavirus relief packages - H.R. 6074, H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Hospital Price Transparency (surprise medical bills; public posting of hospital charges; Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First; Final Rule on Price Transparency; Transparency in Coverage Proposed Rule) Surprise Medical Bills (coronavirus relief packages-H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Liability relief (all coronavirus relief packages - H.R. 6074, H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Hospital preparedness program (H.R. 6074) 340B Drug Pricing Program Drug pricing policy and drug shortages MMM Medicaid Fiscal Accountability Regulation Rural hospital policies 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; H.R. 748, CARES Act) Medicare sequestration (H.R. 748, CARES Act) Federal Medical Assistance Percentage increase (H.R. 6201, Families First Coronavirus Response Act; H.R. 748, CARES Act, H.R. 6800; 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; all coronavirus relief packages - H.R. 6074, H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Medicare hospital accelerated payment program (coronavirus relief packages-H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800; H.R. 6837/S. 3750, Medicare Accelerated and Advance Payments Improvement Act; H.R. 7292, COVID-19 Hospital and Health Provider Loan Forgiveness Act of 2020) Post-acute care flexibilities (coronavirus relief packages - H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Stark law reform Site neutral payment policy included in outpatient prospective payment system rule (H.R.2552, Protecting Local Access to Care for Everyone Act of 2019) OPPS and physician fee schedule rules Critical Access Hospitals, H.R. 6693 BUD FY 2021 Appropriations bills Submitted Comments [CMS-5529-P] Medicare Program: Comprehensive Care for Joint Replacement Model Three-Year Extension and Changes to Episode Definition and Pricing [CMS-1729-P] Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2021

H.R. 3062/S. 2860 - "Patient Access to Higher Quality Health Care Act of 2019" - Oppose efforts to repeal certain provisions relating to the Medicare exception to the prohibition on certain physician referrals for hospitals. Bad Debt Payments to Hospitals - Oppose effort to lower bad debt payments to hospitals for Medicare beneficiaries who do not pay their cost-sharing for treatments provided by the hospital. H.R. 2552 - "Protecting Local Access to Care for Everyone (PLACE) Act" - Support legislation to prevent site neutral cuts. H.R. 1763/ S. 348 - "Resident Physician Shortage Reduction Act of 2019", H.R. 3414/S. 2892 - Opioid Workforce Act - Support GME legislation to reduce resident physician shortage. Support access to affordable prescription drugs. H.R. 3107 - "Improving Seniors' Timely Access to Care Act" - Support legislation that streamlines and standardizes prior authorization under the Medicare Advantage program. Sought moratorium on proposed Medicaid Fiscal Accountability Regulation H.R. 748 Coronavirus Aid, Relief, and Economic Security (CARES) Act - Advocated in support of funding and programs for hospitals and post-acute care providers to respond to COVID-19 H.R. 6800 Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act - Supported legislation

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

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

Medicaid Fiscal Accountability Regulation Rural hospital policies 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; H.R. 748, CARES Act) Medicare sequestration (H.R. 748, CARES Act) Federal Medical Assistance Percentage increase (H.R. 6201, Families First Coronavirus Response Act; H.R. 748, CARES Act, H.R. 6800; S. 4108, Coronavirus Medicaid Response 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; all coronavirus relief packages - H.R. 6074, H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Medicare hospital accelerated payment program (coronavirus relief packages-H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800; H.R. 6837/S. 3750, Medicare Accelerated and Advance Payments Improvement Act; H.R. 7292, COVID-19 Hospital and Health Provider Loan Forgiveness Act of 2020) Post-acute care flexibilities (coronavirus relief packages - H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Stark law reform Site neutral payment policy included in outpatient prospective payment system rule (H.R.2552, Protecting Local Access to Care for Everyone Act of 2019) OPPS and physician fee schedule rules

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

COVID-19 crisis - Engaged with Congress and the administration to advocate for greater regulatory flexibility and appropriate reimbursement for hospitals through development, passage and ongoing implementation of coronavirus relief legislation: Coronavirus Aid Relief and Economic Security (CARES) Act (H.R. 748) Coronavirus Preparedness and Response Supplemental Appropriations Act (H.R. 6074) Families First Coronavirus Response Act (H.R. 6201) Paycheck Protection Act and Health Care Enhancement Act (H.R. 266) HEROES Act (HR 3) Telehealth - Urged Congress and the administration to make permanent telehealth flexibilities related to distant site and geographic limitations, expanding provider types and services available to consumers and maintaining Medicare reimbursement parity. Accelerated and Advanced Payment Program - Advocated for Congress and the administration to offer forgiveness for accelerated and advanced payments during the COVID-19 public health emergency. Offered support for reduced interest rates, extended loan repayment period and reduced recoupment amounts (S. 3750/H.R. 6837) Medicaid Disproportionate Share Hospital (DSH) Payments - Urged Congress to end implementation of Medicaid DSH payment cuts. Medicare Sequester - urged Congress to end ongoing Medicare sequestration reimbursement reductions. Site-neutral Payments - Urged Congress to end site-neutral payment reductions. Supported passage of the PLACE Act (H.R. 2552) which would reverse site-neutral payments cuts implemented by the Centers for Medicare and Medicaid Services. Medicare Indirect Medical Education - Urged Congress to hold harmless teaching hospital IME funding to respond to the COVID-19 crisis. Urged Congress to expand enhanced Medicare reimbursement for COVID-19 patients for long-term care hospitals. Price Transparency - Urged Congress and the administration to delay implementation of regulation requiring hospitals to post payor-specific pricing information for goods and services. Enhanced Federal Medical Assistance Percentage (FMAP) - Urged Congress to extend the increased Medicaid FMAP matching rate beyond the public health emergency and increase the enhanced percentage. Medicaid Fiscal Accountability Regulation - Urged CMS to withdraw the Medicaid Fiscal Accountability Regulation and advocated for Congress to rescind the proposal.

Medicaid Fiscal Accountability Regulation Rural hospital policies 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; H.R. 748, CARES Act) Medicare sequestration (H.R. 748, CARES Act) Federal Medical Assistance Percentage increase (H.R. 6201, Families First Coronavirus Response Act; H.R. 748, CARES Act, H.R. 6800; 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; all coronavirus relief packages - H.R. 6074, H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Medicare hospital accelerated payment program (coronavirus relief packages-H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800; H.R. 6837/S. 3750, Medicare Accelerated and Advance Payments Improvement Act; H.R. 7292, COVID-19 Hospital and Health Provider Loan Forgiveness Act of 2020) Post-acute care flexibilities (coronavirus relief packages - H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800) Stark law reform Site neutral payment policy included in outpatient prospective payment system rule (H.R.2552, Protecting Local Access to Care for Everyone Act of 2019) OPPS and physician fee schedule rules

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

Bill # H.R. 652: Comprehensive Care for Seniors Act Bill # H.R. 1329: Medicaid Reentry Act. Partially lifts the Medicaid Inmate Exclusion Bill # H.R. 1763 and S348: Resident Physician Shortage Reduction Act of 2019. Create 15,000 new Medicare-supported residency slots by 2024 Bill # H.R. 2552: Protecting Local Access to Care for Everyone Act. Halts CMS' site neutrality policy Bill # H.R. 3022: Patient Access Protection Act.To protect hospitals from Medicaid DSH cuts Bill # H.R. 4932 and S2741: CONNECT for Health Act. Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act to expand access to telehealth services Bill #S. 296: Home Health Care Planning Improvement Act of 2019.Revises conditions of and limitations on Medicare payment for home health care services

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), 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

Children's Hospital Graduate Medical Education - Urged Congress to increase funding for CHGME. Medicaid Disproportionate Share Hospital (DSH) Payments - Urged Congress to extend delay of implementation of Medicaid DSH payment cuts. Site-neutral Payments - Supported passage of the PLACE Act (H.R. 2552) which would reverse site-neutral payments cuts implemented by the Centers for Medicare and Medicaid Services. Resident Physician Shortage Reduction Act (S. 348) - Supported passage of the Resident Physician Shortage Reduction Act to support an increase in the number of Medicare-supported graduate medical education residents. Rural ACO Improvement Act (S. 2642/H.R. 5212) - Supported passage of the Rural ACO Improvement Act.

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

Bill # H.R. 652: Comprehensive Care for Seniors Act Bill # H.R. 1329: Medicaid Reentry Act. Partially lifts the Medicaid Inmate Exclusion Bill # H.R. 1763 and S348: Resident Physician Shortage Reduction Act of 2019. Create 15,000 new Medicare-supported residency slots by 2024 Bill # H.R. 2552: Protecting Local Access to Care for Everyone Act. Halts CMS' site neutrality policy Bill # H.R. 3022: Patient Access Protection Act.To protect hospitals from Medicaid DSH cuts Bill # H.R. 4932 and S2741: CONNECT for Health Act. Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act to expand access to telehealth services Bill #S. 296: Home Health Care Planning Improvement Act of 2019.Revises conditions of and limitations on Medicare payment for home health care services

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3062/S. 2860 - "Patient Access to Higher Quality Health Care Act of 2019" - Oppose efforts to repeal certain provisions relating to the Medicare exception to the prohibition on certain physician referrals for hospitals. Bad Debt Payments to Hospitals - Oppose any effort to lower bad debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. H.R. 2552 - "Protecting Local Access to Care for Everyone (PLACE) Act" - Support legislation to prevent site neutral cuts. H.R. 1763/ S. 348 - "Resident Physician Shortage Reduction Act of 2019" - Support GME legislation to reduce resident physician shortage. H.R. 3414/S. 2892 - Opioid Workforce Act - Support GME legislation to reduce resident physician shortage. Support access to affordable prescription drugs. H.R. 3107 - "Improving Seniors' Timely Access to Care Act" - Support legislation that streamlines and standardizes prior authorization under the Medicare Advantage program. Sought moratorium on proposed Medicaid Fiscal Accountability Regulation H.R. 748 Coronavirus Aid, Relief, and Economic Security (CARES) Act - Advocated in support of lifting sequester, increasing DRG payments, DSH cut delay, accelerated payment program, and waiving IRF and LTCH Medicare payment requirements in response to COVID-19. H.R. 4899/S. 2406 - Rural America Health Corps Act, H.R. 4900/S. 2408 - Telehealth Across State Lines Act of 2019, H.R. 4898/S. 2411 - Rural Health Innovation Act of 2019 - support expanded access to telehealth and broadband.

Client expense: $640,000 · Firm income: Not reported

H.R. 3062 - "Patient Access to Higher Quality Health Care Act of 2019" - Oppose efforts to repeal certain provisions relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals. Bad Debt Payments to Hospitals - Oppose any effort to lower bad debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. H.R. 2552 - "Protecting Local Access to Care for Everyone (PLACE) Act" - Support legislation to prevent site neutral cuts. H.R. 506 - "Hospital Competition Act" - Oppose legislation as it adversely affects hospitals. H.R. 1763/ S. 348 - "Resident Physician Shortage Reduction Act of 2019" - Support GME legislation to reduce resident physician shortage. Support access to affordable prescription drugs. Medicaid DSH - Supported action taken by E&C Committee to rescind and delay Medicaid DSH cuts. H.R. 3107 - "Improving Seniors' Timely Access to Care Act" - Support legislation that streamlines and standardizes prior authorization under the Medicare Advantage program.

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

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

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

Bill # H.R. 652: Comprehensive Care for Seniors Act Bill # H.R. 1329: Medicaid Reentry Act. Partially lifts the Medicaid Inmate Exclusion Bill # H.R. 1763 and S348: Resident Physician Shortage Reduction Act of 2019. Create 15,000 new Medicare-supported residency slots by 2024 Bill # H.R. 2552: Protecting Local Access to Care for Everyone Act. Halts CMS' site neutrality policy Bill # H.R. 3022: Patient Access Protection Act.To protect hospitals from Medicaid DSH cuts Bill # H.R. 4932 and S2741: CONNECT for Health Act. Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act to expand access to telehealth services Bill #S. 296: Home Health Care Planning Improvement Act of 2019.Revises conditions of and limitations on Medicare payment for home health care services

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid Disproportionate Share Hospital (DSH) Payments - Urged Congress to approve legislation to delay implementation of Medicaid DSH payment cuts. Site-neutral Payments - Supported passage of the PLACE Act (H.R. 2552) which would reverse site-neutral payments cuts implemented by the Centers for Medicare and Medicaid Services. Resident Physician Shortage Reduction Act (S. 348) - Supported passage of the Resident Physician Shortage Reduction Act to support an increase in the number of Medicare-supported graduate medical education residents. Opioid Workforce Act (S. 2892) - Supported passage of the Opioid Workforce Act. Rural ACO Improvement Act (S. 2642/H.R. 5212) - Supported passage of the Rural ACO Improvement Act.

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

Delay of Medicaid Disproportionate Share Hospital Payment Cuts (H.R. 3022, Patient Access Protection 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) 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) 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) Proposed AWI changes in inpatient prospective payment system proposed rule OPPS and physician fee schedule proposed rule

Client expense: $270,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

H.R. 3062 - "Patient Access to Higher Quality Health Care Act of 2019" - Oppose efforts to repeal certain provisions relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals. Bad Debt Payments to Hospitals - Oppose any effort to lower bad debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. H.R. 2552 - "Protecting Local Access to Care for Everyone (PLACE) Act" - Support legislation to prevent site neutral cuts. H.R. 506 - "Hospital Competition Act" - Oppose legislation as it adversely affects hospitals. H.R. 1763/ S. 348 - "Resident Physician Shortage Reduction Act of 2019" - Support GME legislation to reduce resident physician shortage. Support access to affordable prescription drugs. Medicaid DSH - Supported action taken by E&C Committee to rescind and delay Medicaid DSH cuts.

Client expense: $980,000 · Firm income: Not reported

2019 Q3 Lobbying Report - July 1-September 30 H.R. 986, Protecting Americans with Preexisting Conditions Act of 2019 H.R. 987, Strengthening Health Care and Lowering Prescription Drug Costs 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) H.R. 3439 To amend the Internal Revenue Code of 1986 and title XI of the Social Security Act to extend appropriations and transfers to the Patient-Centered Outcomes Research Trust Fund and to extend certain health insurance fees for such transfers, and for other purposes 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. 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 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 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 H.R. 3107 Improving Seniors Timely Access to Care Act 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 Submitted Comment Letters SUBJECT: CMS-1717-P, Medicare Program: Proposed Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Price Transparency of Hospital Standard Charges; Proposed Revisions of Organ Procurement Organizations Conditions of Coverage; Proposed Prior Authorization Process and Requirements for Certain Covered Outpatient Department Services; Potential Changes to the Laboratory Date of Service Policy; Proposed Changes to Grandfathered Childrens Hospitals-Within-Hospitals; Proposed Rule, Federal Register (Vol. 84, No.154), August 9, 2019 SUBJECT: CMS-5527-P, Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures; Proposed Rule, Federal Register (Vol. 84, No.138), July 18, 2019 SUBJECT: CMS-3347-P, Medicare and Medicaid Programs; Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency, Federal Register (Vol. 84, No.138), July 18, 2019 SUBJECT: 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; Proposed Rule, Federal Register (Vol. 84, No.138), July 18, 2019 Subject: Proposed Rule: CMS 2406-P2/RIN 0938-AT41 Medicaid Program; Methods for Assuring Access to Covered Medicaid Services - Rescission (Vol. 84, No. 135, July 15, 2019) SUBJECT: CMS-6082-NC, Request for Information; Reducing Administrative Burden to put Patients over Paperwork; Federal Register (Vol. 84, No. 112), June 11, 2019

Medicaid Disproportionate Share Hospital (DSH) Payments - Urged Congress to approve legislation to delay implementation of Medicaid DSH payment cuts. Site-neutral Payments - Supported passage of the PLACE Act (H.R. 2552) which would reverse site-neutral payments cuts implemented by the Centers for Medicare and Medicaid Services. Resident Physician Shortage Reduction Act (S. 348) - Supported passage of the Resident Physician Shortage Reduction Act to support an increase in the number of Medicare-supported graduate medical education residents.

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

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

Delay of Medicaid Disproportionate Share Hospital Payment Cuts (H.R. 3022, Patient Access Protection 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) 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) 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) Proposed AWI changes in inpatient prospective payment system proposed rule OPPS and physician fee schedule proposed rule

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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) Proposed AWI changes in inpatient prospective payment system proposed rule OPPS and physician fee schedule proposed rules

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

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) 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) 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) 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. 3107, Improving Seniors Timely Access to Care Act H.R. 3436, Chronic Care Management Improvement Act Proposed AWI changes in inpatient prospective payment system proposed rule

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

Medicaid Disproportionate Share Hospital (DSH) Payments - Urged Congress to approve legislation to delay implementation of Medicaid DSH payment cuts. Site-neutral Payments - Supported passage of the PLACE Act (H.R. 2552) which would reverse site-neutral payments cuts implemented by the Centers for Medicare and Medicaid Services. Resident Physician Shortage Reduction Act (S. 348) - Supported passage of the Resident Physician Shortage Reduction Act to support an increase in the number of Medicare-supported graduate medical education residents. Home Infusion Therapy Reimbursement - Opposed CMS's implementation of unnecessary payment restrictions around Medicare's home infusion benefit. Urged Congress to act to expand access to home infusion therapy.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, U.S. Trade Representative (USTR)

Health and Human Services Appropriations - In support of funding for the National Institutes of Health, Area Health Education Centers Program, and Health Resources and Services Administration Title VII programs. In support of extension for 340B program and opposition to proposal to reduce Medicare Part B payments for drugs acquired through 340B program. In support of at least two years delay of cuts to hospitals serving a disproportionate share of Medicaid and uninsured patients. In support of a one-year moratorium on 340B regulations. In opposition to proposals to expand certain site-neutral payment policies to grandfathered off-campus hospital provider-based departments. In support of preventing full impact of payment reductions for clinic visits at hospital off-campus providers in H.R.2552, Protecting Local Access to Care for Everyone Act. In opposition to imposing arbitrary rates on providers via surprise balance billing. In opposition to Cassidy amendment to S.1895 that would make significant changes to 340B drug discount program.

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