Patient Access Protection Act

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)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Graduate Medical Education - HR 3414/ S. 2892, Opioid Workforce Act 340B drug pricing drug prices DSH cuts - HR 3022, Patient Access Protection Act HEROS Act - HR 6800

Client expense: $15,000 · Firm income: Not reported

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

2020 Q3 Lobbying Report - July 1-Sept. 30 HCR Continuing Appropriations Act, 2021 and Other Extensions Act (H.R. 8319) Coronavirus response legislation (H.R. 6800; S. 1624, S. 4775) Healthcare Workforce Resilience Act (S. 3599/H.R. 6788) Conrad State 30 & Physician Access Act (H.R. 2895) Public Health and Social Services Emergency Fund (coronavirus relief packages 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. 6800) Transparency (surprise medical bills; public posting of hospital charges; final price transparency rule; Transparency in Coverage Proposed Rule) Surprise medical billing (H.R. 5826; H.R. 3630; S. 1531) Liability relief (all coronavirus relief packages - H.R. 6800; S. 1624; S. 4775) 340B Drug Pricing Program Drug pricing policy and drug shortages MMM Public Health Emergency designation 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) Medicare sequestration Federal Medical Assistance Percentage increase (CARES Act, H.R. 6800) Telehealth flexibilities and payment (all coronavirus relief packages - H.R. 6800, S. 1624, S. 4775) Medicare hospital accelerated payment program (coronavirus relief packages; H.R. 8319; Medicare Accelerated and Advance Payments Improvement Act, H.R. 6836/S. 3750) Post-acute care flexibilities (coronavirus relief packages - H.R. 6800; S. 1624, S. 4775) Stark law reform Site neutral payment policy included in outpatient prospective payment system rule BUD FY 2021 Appropriations bills Submitted Comments CMS-1735-P, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2021 Rates; Quality Reporting and Medicare and Medicaid Promoting Interoperability Programs Requirements for Eligible Hospitals and Critical Access Hospitals; Proposed Rule, Federal Register (Vol. 85, No. 104) May 29, 2020 CMS-1730-P, Medicare and Medicaid Programs; CY 2021 Home Health Prospective Payment System Update: Home Health Quality Reporting Requirements; and Home Infusion Therapy Services Requirements, Federal Register (Vol. 85, No.126), June 30, 2020

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

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

Public Health Emergency designation 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) Medicare sequestration Federal Medical Assistance Percentage increase (CARES Act, H.R. 6800) Telehealth flexibilities and payment (all coronavirus relief packages - H.R. 6800, S. 1624, S. 4775, physician fee schedule proposed rule) Medicare hospital accelerated payment program (coronavirus relief packages; H.R. 8319; Medicare Accelerated and Advance Payments Improvement Act, H.R. 6836/S. 3750)) Post-acute care flexibilities (coronavirus relief packages - H.R. 6800; S. 1624, S. 4775) Stark law reform Site neutral payment policy included in outpatient prospective payment system rule OPPS, IPPS and physician fee schedule rules

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Graduate Medical Education - HR 3414/ S. 2892, Opioid Workforce Act 340B drug pricing drug prices DSH cuts - HR 3022, Patient Access Protection Act CARES Act - HR 748 HEROS Act - HR 6800

Client expense: $15,000 · Firm income: Not reported

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

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

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

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

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

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

Graduate Medical Education - HR 3414/ S. 2892, Opioid Workforce Act 340B drug pricing drug prices DSH cuts - HR 3022, Patient Access Protection Act CARES Act - HR 748

Client expense: $15,000 · Firm income: Not reported

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

ACA, Medicaid, long term care/home and community based services, including workforce issues, marketplace stabilization and premium and out of pocket costs (including third party premium payments) Prescription drug reform HR 748 HR 3 HR 1884 HR 3484/S.1129 HR 3022 HR 2452

Client expense: $156,359 · Firm income: Not reported

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

Medicaid Long term care/home and community based services, including workforce issues Medicare HR 3022 HR 1597 HR 1309 HR 1046

Client expense: $131,822 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

ACA, Medicaid, long term care/home and community based services, including workforce issues, marketplace stabilization and premium and out of pocket costs (including third party premium payments) Prescription drug reform HR 3 HR 3022 HR 5216/S 2943

Client expense: $263,014 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issue: Educate Congress and the administration on academic medicines missions, including education, research, patient care, GME, workforce, and physician shortages in rural and urban communities. H.R. 1763 / S. 348, Resident Shortage Physician Reduction Act of 2019 Issue: Support additional Medicare funding for graduate medical education H.R. 3414 // S. 2892, Opioid Workforce Act Issue: Support additional funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs P.L. 116-94, the Further Consolidated Appropriations Act, 2020, Division N P.L. 116-59, Continuing Appropriations Act 2020, and Health Extenders Act of 2019 H.R. 2328, Community Health Investment, Modernization, and Excellence Act of 2019 H.R. 3022, Patient Access Protection Act Issue: Support repeal or a delay in the implementation of the Medicaid disproportionate share hospital (DSH) cuts Issue: Educate Congress on concerns related to potentially burdensome Medicaid supplemental payment reporting proposals Issue: ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. S. 585, States Achieve Medicaid Expansion (SAME) Act of 2019 Issue: Support legislation to allow states that expanded Medicaid after 2014 to receive the same full federal matching funds as states that previously expanded Medicaid under the Affordable Care Act Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. S. 289, Rural Physician Workforce Production Act of 2019 Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals H.R.1358, Advancing Medical Resident Training in Community Hospitals Act of 2019 H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act Issue: Support Medicare GME per resident amount and cap-setting technical corrections and administrative relief. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Educate Congress and the Administration on role of academic medicine as it relates to price disclosure initiatives H.R. 5432, Medical Education for a Diverse America Act Issue: Support efforts to reduce unconscious bias in the medical field. H.R. 3107, Improving Seniors Timely Access to Care Act of 2019 Issue: Support protecting patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs HHS Rebate Rule Medicare Part D benefit re-design Issue: Support policies to reduce prescription drug prices Issue: Support implementation of the 21st Century Cures Act (Cures) interoperability and health data sharing provisions. Draft Cures 2.0 Legislation Issue: Support reforming medicare coding, coverage, and payment policies to promote innovation Issue: Support changes and improvements to the Medicare Shared Savings Program. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

Client expense: $1,137,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Director of National Intelligence (ODNI), Education, Dept of, Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Natl Science Foundation (NSF), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

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

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

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

Issues relating to white spaces. Issues relating to broadcast spectrum auctions. Issues relating to the Federal Communications Commission's rules governing broadcast ownership. H.R. 1367 Children and Media Research Advancement Act, all provisions. S. 583, Digital Accountability and Transparency to Advance Privacy Act, provisions relating to use of consumer data. Issues relating to emergency communications. Issues relating to FCC oversight. Issues relating to changes to Daylight Saving Time. H.R. 264, Financial Services and General Government Appropriations Act, 2019, provisions relating to FCC Appropriations. S. 189, Social Media Privacy Protection and Consumer Rights Act of 2019, provisions relating to use of consumer data. H.R. 1789, To eliminate the discount for UHF television stations for purposes of the limitation on the aggregate national audience reach of television broadcast stations in which a party may have a cognizable interest, all provisions. Issues relating to broadcast use within the c-band. Issues relating to children's television programming. S. 670, A bill to make daylight savings time permanent, and for other purposes, all provisions. H.R. 1556, Sunshine Protection Act of 2019, all provisions. H.R. 1601, To allow States to elect to observe daylight savings time for the duration of the year, and for other purposes, all provisions. H.R. 583, Preventing Illegal Radio Abuse Through Enforcement Act, all provisions. Pirate Radio, Issues relating to pirate radio stations. S. 1228, Preventing Illegal Radio Abuse Through Enforcement Act. H.R. 3255, Telecommunications Opportunities for Workers Engaging in Real Infrastructure Deployment Act of 2019. H.R. 3022, To provide for the carriage of certain broadcast stations, and for other purposes. H.R. 1220, Truth-in-Billing, Remedies, and User Empowerment over Fees Act of 2019. S. 510, Truth-in-Billing, Remedies, and User Empowerment over Fees Act of 2019. Issues relating to carriage of television broadcast signals. Issues relating to broadcast spectrum auctions. Issues relating to the ATSC 3.0 next generation television standard Department of Justices view of the broadcast television marketplace H.R. 3002, To provide for the carriage of certain broadcast stations, and for other purposes Issues relating to broadcast use within the 6GHz band H.R. 1865, Further Consolidated Appropriations Act, 2020, Provisions relating to the distant signal satellite license, good faith negotiation, and billing transparency H.R. 4856, Reliable Emergency Alert Distribution Improvement Act of 2019, Provisions relating to broadcast emergency alert systems S. 2693, Reliable Emergency Alert Distribution Improvement Act of 2019, Provisions relating to broadcast emergency alert systems H.R. 4401, Restore the Fairness Doctrine Act of 2019 S. 2789, Satellite Television Access Reauthorization Act of 2019 H.R. 5140, Satellite Television Community Protection and Promotion Act of 2019 H.R. 5035, Television Viewer Protection Act of 2019 S. 2829, Western Expanded In-State Television Access Act of 2019

Client expense: $2,840,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3, Lower Drug Costs Now Act, Entirety H.R. 1309/S.851, Workplace Violence Prevention for Health Care and Social Service Workers Act, Entirety H.R.748, Health Benefits Tax Repeal, Entirety Affordability of pharmaceuticals, generally S.684, Middle Class Health Benefits Tax Repeal, Entirety Treating gun violence as a public health epidemic related issues S.1357, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, Entirety Nurse Overtime and Patient Safety Act, Entirety Prescription Drug Affordability and Access Act, Entirety Affordable Drug Manufacturing Act, Entirety Monitor the following: H.R.1109, the Mental Health Services for Students Act of 2019, Entirety H.R.3022, Patient Access Protection Act, Entirety S.1770, Resilience Investment, Support, and Expansion from Trauma Act or the RISE from Trauma Act, Entirety H.R. 2328, Reauthorizing and Extending Americas Community Health Act , Title IV, No Surprises Act S.1895, Lower Health Care Costs Act, Entirety Universal healthcare generally H.R. 2328, Reauthorizing and Extending Americas Community Health Act , Title IV, No Surprises Act S.1895, Lower Health Care Costs Act, Entirety S.2675, Study, Treat, Observe, and Prevent Neglected Diseases of Poverty Act, Entirety H.R.934, Health Benefits for Miners Act, Entirety S.J.Res.52, A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury and the Secretary of Health and Human Services relating to "State Relief and Empowerment Waivers". H.R.1603, Ban Asbestos Now Act

Client expense: $450,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

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

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

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

Graduate Medical Education - HR 3414/ S. 2892, Opioid Workforce Act 340B drug pricing drug prices DSH cuts - HR 3022, Patient Access Protection Act

Client expense: $15,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), 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) OPPS and physician fee schedule rules Executive Order Protecting and Improving Medicare for our Nation's Seniors

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Client expense: $5,370,000 · Firm income: Not reported

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

H.R.3, Lower Drug Costs Now Act, Entirety H.R. 2328, Reauthorizing and Extending Americas Community Health Act , Title IV, No Surprises Act H.R. 1309/S.851, Workplace Violence Prevention for Health Care and Social Service Workers Act, Entirety S.1895, Lower Health Care Costs Act, Entirety H.R.748, Health Benefits Tax Repeal, Entirety Gun Violence Trauma related issues Affordability of pharmaceuticals, generally S.684, Middle Class Health Benefits Tax Repeal, Entirety Treating gun violence as a public health epidemic related issues Monitor the following: H.R.1597, National Nurse Act, Entirety H.R.986, Protecting Americans with Preexisting Conditions Act of 2019, Entirety H.R.987, Strengthening Health Care and Lowering Prescription Drug Costs Act, Entirety H.R. 2075/S.1013, the School-Based Health Centers Reauthorization Act of 2019, Entirety H.R.1109, the Mental Health Services for Students Act of 2019, Entirety H.R.3022, Patient Access Protection Act, Entirety H.R.1386, Expand Navigators' Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019, Entirety S.1770, Resilience Investment, Support, and Expansion from Trauma Act or the RISE from Trauma Act, Entirety S.1357, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, Entirety

Client expense: $350,000 · Firm income: Not reported

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, SENATE

Issues relating to white spaces. Issues relating to broadcast spectrum auctions. Issues relating to the Federal Communications Commission's rules governing broadcast ownership. H.R. 1367 Children and Media Research Advancement Act, all provisions. S. 583, Digital Accountability and Transparency to Advance Privacy Act, provisions relating to use of consumer data. Issues relating to emergency communications. Issues relating to FCC oversight. Issues relating to changes to Daylight Saving Time. H.R. 264, Financial Services and General Government Appropriations Act, 2019, provisions relating to FCC Appropriations. S. 189, Social Media Privacy Protection and Consumer Rights Act of 2019, provisions relating to use of consumer data. H.R. 1789, To eliminate the discount for UHF television stations for purposes of the limitation on the aggregate national audience reach of television broadcast stations in which a party may have a cognizable interest, all provisions. Issues relating to broadcast use within the c-band. Issues relating to children's television programming. S. 670, A bill to make daylight savings time permanent, and for other purposes, all provisions. H.R. 1556, Sunshine Protection Act of 2019, all provisions. H.R. 1601, To allow States to elect to observe daylight savings time for the duration of the year, and for other purposes, all provisions. H.R. 583, Preventing Illegal Radio Abuse Through Enforcement Act, all provisions. Pirate Radio, Issues relating to pirate radio stations. S. 1228, Preventing Illegal Radio Abuse Through Enforcement Act. H.R. 3255, Telecommunications Opportunities for Workers Engaging in Real Infrastructure Deployment Act of 2019. H.R. 3022, To provide for the carriage of certain broadcast stations, and for other purposes. H.R. 1220, Truth-in-Billing, Remedies, and User Empowerment over Fees Act of 2019. S. 510, Truth-in-Billing, Remedies, and User Empowerment over Fees Act of 2019. Issues relating to carriage of television broadcast signals. Issues relating to broadcast spectrum auctions. Issues relating to the ATSC 3.0 next generation television standard Department of Justices view of the broadcast television marketplace H.R. 3002, To provide for the carriage of certain broadcast stations, and for other purposes.

Client expense: $2,980,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

ACA, Medicaid, long term care/home and community based services, including workforce issues, marketplace stabilization and premium and out of pocket costs (including third party premium payments) Prescription drug reform HR 748 HR 3 HR 1884 HR 3484/S.1129 HR 3022 HR 2452

Client expense: Not reported · Firm income: $156,359

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

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

Client expense: $390,000 · Firm income: Not reported

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2328, Community Health Investment, Modernization, and Excellence Act of 2019 H.R. 3022, Patient Access Protection Act Issue: Support repeal or a delay in the implementation of the Medicaid disproportionate share hospital (DSH) cuts Issue: Educate Congress on concerns related to potentially burdensome Medicaid supplemental payment reporting proposals Issue: ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. S. 585, States Achieve Medicaid Expansion (SAME) Act of 2019 Issue: Support legislation to allow states that expanded Medicaid after 2014 to receive the same full federal matching funds as states that previously expanded Medicaid under the Affordable Care Act H.R. 1226 / S. 317, Advancing Care for Exceptional (ACE) Kids Act of 2019 Issue: Support legislation to improve health care for children with complex medical conditions on Medicaid H.R. 1763 / S. 348, Resident Shortage Physician Reduction Act of 2019 Issue: Support additional Medicare funding for graduate medical education H.R. 3414 / H.R. 2439, Opioid Workforce Act Issue: Support additional funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. S. 289, Rural Physician Workforce Production Act of 2019 Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals H.R.1358, Advancing Medical Resident Training in Community Hospitals Act of 2019 H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act Issue: Support Medicare Graduate Medical Education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts Issue: Oppose overly burdensome Medicaid GME transparency language. Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Educate Congress on role of academic medicine as it relates to price transparency initiatives H.R. 3107, Improving Seniors Timely Access to Care Act of 2019 Issue: Support protecting patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs HHS Rebate Rule Medicare Part D benefit re-design Issue: Support policies to reduce prescription drug prices Issue: Support implementation of the 21st Century Cures Act (Cures) interoperability and health data sharing provisions. Issue: Support changes and improvements to the Medicare Shared Savings Program. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

Client expense: $1,127,000 · Firm income: Not reported

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

Graduate Medical Education - HR 3414, Opioid Workforce Act 340B drug pricing drug prices DSH cuts - HR 3022, Patient Access Protection Act

Client expense: $15,000 · Firm income: Not reported

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

Issues relating to white spaces. Issues relating to broadcast spectrum auctions. Issues relating to the Federal Communications Commission's rules governing broadcast ownership. H.R. 1367 Children and Media Research Advancement Act, all provisions. H.R. 1282, Data Accountability and Trust Act, all provisions. S. 583, Digital Accountability and Transparency to Advance Privacy Act, provisions relating to use of consumer data. Issues relating to emergency communications. Issues relating to FCC oversight. Issues relating to changes to Daylight Saving Time. H.R. 264, Financial Services and General Government Appropriations Act, 2019, provisions relating to FCC Appropriations. S. 189, Social Media Privacy Protection and Consumer Rights Act of 2019, provisions relating to use of consumer data. H.R. 1789, To eliminate the discount for UHF television stations for purposes of the limitation on the aggregate national audience reach of television broadcast stations in which a party may have a cognizable interest, all provisions. Issues relating to broadcast use within the c-band. Issues relating to children's television programming. S. 670, A bill to make daylight savings time permanent, and for other purposes, all provisions. H.R. 1556, Sunshine Protection Act of 2019, all provisions. H.R. 1601, To allow States to elect to observe daylight savings time for the duration of the year, and for other purposes, all provisions. H.R. 1848, To amend the Communications Act of 1934 to direct the Federal Communications Commission to carry out a grant program to make grants for the establishment or expansion of job training programs for communications tower service, construction, and maintenance, all provisions. H.R. 1555, Transparency for Cable Consumers Act, all provisions. H.R. 583, PIRATE Act, all provisions. Pirate Radio, Issues relating to pirate radio stations. S. 1655, A bill to provide for the carriage of certain television broadcast stations, and for other purposes. S. 1228, Preventing Illegal Radio Abuse Through Enforcement Act. H.R. 3255, Telecommunications Opportunities for Workers Engaging in Real Infrastructure Deployment Act of 2019. H.R. 3022, To provide for the carriage of certain broadcast stations, and for other purposes. H.R. 1220, Truth-in-Billing, Remedies, and User Empowerment over Fees Act of 2019. S. 510, Truth-in-Billing, Remedies, and User Empowerment over Fees Act of 2019. Issues relating to carriage of television broadcast signals. Issues relating to broadcast spectrum auctions. Issues relating to the ATSC 3.0 next generation television standard Department of Justices view of the broadcast television marketplace

Client expense: $2,960,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues relating to white spaces. Issues relating to broadcast spectrum auctions. Issues relating to the Federal Communications Commission's rules governing broadcast ownership. H.R. 1367 Children and Media Research Advancement Act, all provisions. H.R. 1282, Data Accountability and Trust Act, all provisions. S. 583, Digital Accountability and Transparency to Advance Privacy Act, provisions relating to use of consumer data. Issues relating to emergency communications. Issues relating to FCC oversight. Issues relating to changes to Daylight Saving Time. H.R. 264, Financial Services and General Government Appropriations Act, 2019, provisions relating to FCC Appropriations. S. 189, Social Media Privacy Protection and Consumer Rights Act of 2019, provisions relating to use of consumer data. H.R. 1789, To eliminate the discount for UHF television stations for purposes of the limitation on the aggregate national audience reach of television broadcast stations in which a party may have a cognizable interest, all provisions. Issues relating to broadcast use within the c-band. Issues relating to children's television programming. S. 670, A bill to make daylight savings time permanent, and for other purposes, all provisions. H.R. 1556, Sunshine Protection Act of 2019, all provisions. H.R. 1601, To allow States to elect to observe daylight savings time for the duration of the year, and for other purposes, all provisions. H.R. 1848, To amend the Communications Act of 1934 to direct the Federal Communications Commission to carry out a grant program to make grants for the establishment or expansion of job training programs for communications tower service, construction, and maintenance, all provisions. H.R. 1555, Transparency for Cable Consumers Act, all provisions. H.R. 583, PIRATE Act, all provisions. Pirate Radio, Issues relating to pirate radio stations. S. 1655, A bill to provide for the carriage of certain television broadcast stations, and for other purposes. S. 1228, Preventing Illegal Radio Abuse Through Enforcement Act. H.R. 3255, Telecommunications Opportunities for Workers Engaging in Real Infrastructure Deployment Act of 2019. H.R. 3022, To provide for the carriage of certain broadcast stations, and for other purposes. H.R. 1220, Truth-in-Billing, Remedies, and User Empowerment over Fees Act of 2019. S. 510, Truth-in-Billing, Remedies, and User Empowerment over Fees Act of 2019. Issues relating to carriage of television broadcast signals. Issues relating to broadcast spectrum auctions.

Client expense: $2,960,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Letter urging the Centers for Medicare & Medicaid Services (CMS)to consider alternative payment solutions for Chimeric Antigen Receptor T-cell (CAR T) therapy; Joint letter urging Congress to delay the start of the Medicaid disproportionate share hospital (DSH) cuts, which are scheduled to begin in fiscal year (FY) 2020; Comments to CMS on exploring ways continually to improve the Medicaid managed care program to ensure access to high-quality care for the Medicaid population; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019.

Client expense: $4,870,000 · Firm income: Not reported

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

H.R. 2328, Community Health Investment, Modernization, and Excellence Act of 2019 H.R. 3022, Patient Access Protection Act Issue: Support repeal or a delay in the implementation of the Medicaid disproportionate share hospital (DSH) cuts Issue: ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. S. 585, States Achieve Medicaid Expansion (SAME) Act of 2019 Issue: Support legislation to allow states that expanded Medicaid after 2014 to receive the same full federal matching funds as states that previously expanded Medicaid under the Affordable Care Act H.R. 1226 / S. 317, Advancing Care for Exceptional (ACE) Kids Act of 2019 Issue: Support legislation to improve health care for children with complex medical conditions on Medicaid H.R. 1763 / S. 348, Resident Shortage Physician Reduction Act of 2019 Issue: Support additional Medicare funding for graduate medical education H.R. 3414 / H.R. 2439, Opioid Workforce Act Issue: Support additional funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments S. 289, Rural Physician Workforce Production Act of 2019 Issue: Oppose legislation redesigning Medicare GME payment formulas Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. H.R.1358, Advancing Medical Resident Training in Community Hospitals Act of 2019 H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act Issue: Support Medicare Graduate Medical Education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts Issue: Oppose overly burdensome Medicaid GME transparency language. Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Educate Congress on role of academic medicine as it relates to price transparency initiatives Issue: Support aligning 42 CFR Part 2 regulations with the Health Insurance Portability and Accountability Act (HIPAA) for the purposes of treatment, payment, and healthcare operations. Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs HHS Rebate Rule Medicare Part D benefit re-design Issue: Support policies to reduce prescription drug prices

Client expense: $1,045,000 · Firm income: Not reported

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

H.R. 1309/S. 851, the Workplace Violence Prevention for Health Care and Social Service Workers Act, Entirety H.R.1597, National Nurse Act, Entirety H.R.986, Protecting Americans with Preexisting Conditions Act of 2019, Entirety H.R.987, Strengthening Health Care and Lowering Prescription Drug Costs Act, Entirety H.R. 2075/S.1013, the School-Based Health Centers Reauthorization Act of 2019, Entirety H.R.1109, the Mental Health Services for Students Act of 2019, Entirety S.1895, Lower Health Care Cost Act, Entirety H.R.3022, Patient Access Protection Act, Entirety H.R.1386, Expand Navigators' Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019, Entirety S.1773, Territories Health Equity Act, Entirety S.1770, Resilience Investment, Support, and Expansion from Trauma Act or the RISE from Trauma Act, Entirety S.1357, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, Entirety S.1365, Comprehensive Addiction Resources Emergency Act of 2019, Entirety Monitor H.R.1597, National Nurse Act, Entirety

Client expense: $390,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid Long term care/home and community based services, including workforce issues Medicare HR 3022 HR 1597 HR 1309 HR 1046

Client expense: Not reported · Firm income: $131,822

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) 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

Government targets: HOUSE OF REPRESENTATIVES, SENATE