Opioid Workforce Act of 2019

H.R. 8840, Medicare Sequester COVID Moratorium Act, all provisions H.R. 8702, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions S. 5007, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions H.R. 7154, Outpatient Therapy Modernization and Stabilization Act, all provisions H.R. 3107, Improving Seniors Timely Access to Care Act of 2019, all provisions S. 5044, Improving Seniors Timely Access to Care Act of 2020y, all provisions H.R. 8727, Telehealth Modernization Act, all provisions S. 4375, Telehealth Modernization Act, all provisions H.R. 7663, Protecting Access to Post-COVID-19 Telehealth Act of 2020, all provisions H.R. 7391, Protect Telehealth Access Act of 2020, all provisions H.R. 1301, Mental Health Telemedicine Expansion Act, all provisions H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019, all provisions H.R. 5201, Telemental Health Expansion Act of 2020, provisions relating to 1834(m) of the Social Security Act; geographic and originating sites H.R. 7233, Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, all provisions H.R. 5172, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions S. 3067, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions H.R. 3414, Opioid Workforce Act of 2019, all provisions H.R. 7791, Value in Health Care Act of 2020, provisions relating to qualifying APM physician thresholds H.R. 6837, Medicare Accelerated and Advance Payments Improvement Act of 2020, all provisions S. 3750, Medicare Accelerated and Advance Payments Improvement Act, all provisions H.R. 8505, To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes, all provisions H.R. 884, Medicare Mental Health Access Act, all provisions H.R. 945, Mental Health Access Improvement Act of 2019, all provisions H.R. 6744, Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2020, all provisions H.R. 4004, Social Determinants Accelerator Act of 2019, all provisions H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions S. 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, provisions related to PBM and prescription drug price transparency H.R. 19, Lower Costs, More Cures Act of 2019, provisions related to PBM and prescription drug price transparency H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2020, all provisions H.R. 6090, Physician Shortage GME Cap Flex Act of 2020, all provisions H.R. 6142, Black Maternal Health Momnibus Act of 2020, all provisions Medicare program: P.L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) implementation/Accountable Care Organizations/APM thresholds Medicare program: Patient Protection and Affordable Care Act (PPACA)/Prior authorization provider and patient burdens/patient electronic access to health information Medicare program: P.L. 113-93 Protecting Access to Medicare Act (PAMA)/Imaging appropriate use criteria/Radiation Oncology APM Medicare program: FY 2021 Inpatient Rehab Facility Prospective Payment System (IRF PPS)/scope of practice issues Medicare program: CY 2021 physician fee schedule/E&M services/Budget neutrality/Part B/Sequester Medicare program: Alternative payment models (APMs) Medicare program: Merit-based Incentive Payment System (MIPS)/cost/quality/interoperability/hardship exemption Medicare program: Regulatory relief/Advanced APMs, prior authorization, and utilization management Medicare program: Shared Savings Program Medicare program: Quality Payment Program/prior authorization/electronic funds transfer Medicare program: Surprise medical billing Medicare program: Medicare-For-All Medicare program: Electronic Health Records (EHR) Certification Medicare program: 21st Century Cures Act Medicare program: Quality payment program/physician burdens Medicare program: National Coverage determination/validated home blood pressure monitors Medicare program: Health IT/physician burden Medicare program: Drug pricing Medicare program: Most favored nation drug pricing Medicare program: Provider compliance/regulatory relief Medicare program: Provider Enrollment, Chain and Ownership (PECOS) enrollment/revalidation Medicare and Medicaid programs: 21st Century Cures Act/health data and privacy Medicaid program: CMS proposed regulation Medicaid Program Medicaid program: FMAP increases Medicaid program: Interoperability

Client expense: $3,870,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA), White House Office

Support HR 1763/ S 348, Resident Physician Shortage Reduction Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose HR 506,Hospital Competition Act of 2019, a bill to amend title XVIII of the Social Security Act to increase hospital competition; Statement submitted to the House Judiciary on the hearing "Diagnosing the Problem: Exploring the Effects of Consolidation and Anticompetitive Conduct in Health Care Markets"; Support HR 965/ S340, Creating and Restoring Equal Access to Equivalent Samples Act of 2019 or the CREATES Act of 2019, a bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products; Support HR 986/ S466 Protecting Americans with Preexisting Conditions Act of 2019, a bill provide that certain guidance related to waivers for State innovation under the Patient Protection and Affordable Care Act shall have no force or effect; Support HR 987 Strengthening Health Care and Lowering Prescription Drug Costs Act, a bill to amend the Patient Protection and Affordable Care Act to provide for Federal Exchange outreach and educational activities; Support HR 938 Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act of 2019 or the BLOCKING Act of 2019, a bill to amend the Federal Food, Drug, and Cosmetic Act, with respect to eligibility for approval of a subsequent generic drug, to remove the barrier to that approval posed by the 180-day exclusivity period afforded to a first generic applicant that has not yet received final approval, and for other purposes; Support HR 1010, a bill to provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect; Support HR 1499 Protecting Consumer Access to Generic Drugs Act of 2019, a bill to prohibit brand name drug manufacturers from compensating generic drug manufacturers to delay the entry of a generic drug into the market, and to prohibit biological product manufacturers from compensating biosimilar and interchangeable product manufacturers to delay entry of biosimilar and interchangeable products, and for other purposes; Support HR 1425 State Health Care Premium Reduction Act, a bill to amend the Patient Protection and Affordable Care Act to provide for a Improve Health Insurance Affordability Fund to provide for certain reinsurance payments to lower premiums in the individual health insurance market; Support HR 1386/ S 1905 Expand Navigators Resources for Outreach, Learning, and Longevity Act of 2019 or the ENROLL Act of 2019,a bill to amend the Patient Protection and Affordable Care Act to provide for additional requirements with respect to the navigator program, and for other purposes; Support HR 1520 Purple Book Continuity Act of 2019, a bill to amend the Public Health Service Act to provide for the publication of a list of licensed biological products, and for other purposes; Support HR 1503 Orange Book Transparency Act of 2019A bill that would increase transparency for the patent status of both approved biological products and approved drugs; Support HR 2439/ HR 3414 Opioid Workforce Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis; Submitted statement to the House Committee on Ways and Means Overcoming Racial Disparities and Social Determinants in the Maternal Mortality Crisis sharing information regarding hospitals and health systems efforts to address maternal morbidity and mortality, as we seek ways to improve outcomes and reduce health inequities for expectant and new mothers, and give their children the best possible start in life; Submitted oral and written testimony to the House Committee on Ways and Means Subcommittee on Health Hearing on Protecting Patients from Surprise Medical Bills. Protecting patients from surprise medical bills is a top priority and we have adopted a set of guiding principles to use as we evaluate legislative proposals: Define surprise bills, Protect the patient financially, Ensure patient access to emergency care, Preserve the role of private negotiation, Remove the patient from health plan/provider negotiations, Educate patients about their health care coverage, Ensure patients have access to comprehensive provider networks and accurate network information, and Support state laws that work; Letters submitted to the Energy & Commerce Committee in response to the request for comments on their surprise billing discussion draft. Concerned with the Committees draft legislations approach to determining reimbursement for out-of-network providers. Once the patient is protected from surprise bills, providers and insurers should then be permitted to negotiate payment rates for services provided. We strongly oppose approaches that would impose arbitrary rates on providers. We look forward to continuing to work with the Committee on solutions to stop surprise medical bills; Letter sent to the HELP Committee in response to the Lower Health Care Costs Act of 2019 discussion draft about our concerns about several of the proposals that would allow the government to intrude into private commercial contracts between providers and insurers. For example, several of the provisions could undermine value-based purchasing arrangements aimed directly at improving the quality of care while reducing costs. We strongly urge the Committee to remove these provisions; Submitted oral and written testimony to the House Committee on Energy and Commerce, Subcommittee on Health Hearing on No More Surprises: Protecting Patients from Surprise Medical Bills asking that the Committee preserve the ability of providers and insurers to negotiate private contracts and not establish a fixed payment amount for out-of-network services; Oppose HR 1309 Workplace Violence Prevention for Health Care and Social Service Workers Act, a bill to direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan, and for other purposes; Concerns about S.1531, Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 or the STOP Surprise Medical Bills Act of 2019, to amend the Public Health Service Act to provide protections for health insurance consumers from surprise billing; Concerns about S. 1895 Lower Health Care Costs Act Letter addressed concerns about the legislative provision that sets a benchmark rate in statute for the out-of-network payments, as well as provisions that seek to change privately negotiated contracting arrangements between hospitals and insurance companies; Support HR 3425, Advancing Medical Resident Training in Community Hospitals Act of 2019, to amend title XVIII of the Social Security Act to establish rules for payment for graduate medical education (GME) costs for hospitals that establish a new medical residency training program after hosting resident rotators for short durations; Expressed concerns regarding the provisions that reduce reimbursements to providers and hospitals that administer drugs the Prescription Drug Pricing Reduction Act (PDPRA) of 2019: including about Section 107, Medicare Part B Rebate by Manufacturers for Drugs or Biologicals with Prices Increasing Faster than Inflation, Section 110, Establishment of Maximum Add-on Payment for Drugs, Biologicals, and Biosimilars, this provision would establish $1,000 as the maximum add-on amount that a provider can be paid for a separately payable drug, biological or biosimilar, Section 111, Treatment of Drug Administration Services Furnished by an Off-Campus Outpatient Department of a Provider, the site neutral payment reduction would cut aggregate hospital payments; Support S. 2091, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement Act, this legislation would increase the total number of employment-based visas from 140,000 to 270,000 and ensure that critical health care workers needed in the U.S. have access to employment-based visas by carving out health care workers in designated shortage occupations from the limit; Support S 350, The Competitive Health Insurance Reform Act of 2019, a bill to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; Submitted statement to Subcommittee on Health of the Committee on Energy and Commerce for the hearing on Improving Maternal Health: Legislation to Advance Prevention Efforts and Access to Care; Concerns with S. 386 and HR 1044, Fairness for High-Skilled Immigrants Act of 2019, this bill increases the per-country cap on family-based immigrant visas from 7% of the total number of such visas available that year to 15%, and eliminates the 7% cap for employment-based immigrant visas. It also removes an offset that reduced the number of visas for individuals from China; Support H.R. 4538, Closing Loopholes for Orphan Drugs Act, a bill to amend title III of the Public Health Service Act to limit the orphan drug exclusion under the drug discount program under section 340B of such title; Discussions of provisions we support and those we recommend be changes in a draft bill called the Mitigating Existing Drug Shortages (MEDS) Act; Discussions in support of the allowing states to designate hospitals as necessary providers for purposes of waiving the critical access hospital mileage requirements; Provided comments to W&M on legislation to expand Health Profession Opportunity Grants; Support S. 2723, The Mitigating Emergency Drug Shortages (MEDS) Act, a bill to amend Sec. 506C of the Federal Food, Drug, and Cosmetic Act which strengthens requirements for drug manufacturers to disclose the root causes and expected duration of shortages, extends reporting requirements to active pharmaceutical ingredients manufacturers, requires manufacturers have contingency plans to ensure ongoing supply, develops recommendations to incentivize manufacturers to enter the market for drugs in shortage and examines the national security risks of shortages; Discuss DEA reductions in annual quotas for opioid products used by hospitals for sedation and pain management; Meeting with the Office of the Assistant Secretary of Preparedness and Response (ASPR) to discuss developments in the hospital preparedness program, the pilot projects for the Regional Disaster Healthcare System and other issues; Rural access to health care, including identifying core services needed in rural communities, outlining approaches and considerations for delivering those services, and examining access and quality in the rural context; ONCs proposed rule to implement the 21st Century Cures provision on information blocking; Supported members serving on the HHS Quality Summit panel, which was convened by the Deputy Secretary to gather input regarding how to improve and energize quality and safety improvement activities across health care system; Discussion with HHS on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussion with HHS about the work of Aligning for Health to address social determinants of health; Support S 2902, Strengthening Our Rural Health Workforce Act of 2019, a bill to enhance the rural health workforce; Meetings and correspondence with staff members of Senate Financing Committee on a proposal to support rural health care access (REH, re-opening necessary provider CAH, infrastructure funding); Letter to Ways & Means committee Rural and Underserved Communities Health Task Force in response to RFI on factors that contribute to health outcomes in these areas, examples of successful models and lessons from the field that address access and outcomes, and considerations for the unique circumstances of rural and underserved communities; Letter to Energy and Commerce Members regarding health information technology priorities; Letter of Support to Senate Appropriations on funding for the Centers for Disease Control and Prevention and the National Institutes of Health to study gun violence; Support S.2741 and H.R. 4932,Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, a bill to amend title XVIII of the Social Security Act to expand access to telehealth services, and for other purposes; Support S 2603, Resolving Extended Limbo for Immigrant Employees and Families (RELIEF) Act, a bill to amend the Immigration and Nationality Act to end the immigrant visa backlog, and for other purposes; Support HR 4995, Maternal Health Quality Improvement Act of 2019, a bill to amend the Public Health Service Act to improve obstetric care and maternal health outcomes, and for other purposes; Concerns with HR 5800,Ban Surprise Billing Act, a bill to address surprise medical bills that relies on a median in-network rate to resolve out-of-network payments and allows for an independent dispute resolution process to determine the final payment. Concerned with the Committee's legislative approach to determining reimbursement for out-of-network providers. Oppose approaches that would impose arbitrary rates on providers, which could have significant consequences far beyond the scope of surprise medical bills. It is the insurers' responsibility to maintain comprehensive provider networks, and a default payment rate would remove incentives for health plans to contract with providers or to offer fair terms; Support HR 5826, Consumer Protections Against Surprise Medical Bills Act, a bill that prohibits providers from balance billing patients for emergency services or medical care the patient reasonably could have expected to be in-network, and from charging patients more than the in-network cost-sharing amount. Rather than rely on a benchmark payment rate to determine out-of-network reimbursement, the legislation provides a period for health plans and providers to negotiate out-of-network reimbursement, followed by a mediated dispute resolution process if necessary; Letter urging HHS to take regulatory actions to help hospitals and health systems prepare and respond to COVID-19; Letter requesting $100 billion to prepare and respond to COVID-19; Letter urging the Department of Labor to accurately define health care provider when promulgating regulations implementing key sections of the Families First Coronavirus Response Act; Letter sent to the President asking for the use of the Defense Production Act to increase the production of medical supplies and equipment; Letter to HHS regarding $100 billion emergency fund, asking HHS and CMS to directly and expediently distribute to rural and urban hospitals and health systems funds from the Public Health and Social Services Emergency Fund that were designated for providers in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act increased funding by $100 billion in order to reimburse eligible health care providers for health care-related expenses or lost revenues that are attributable to COVID-19. In the letter, we urged HHS and CMS to immediately distribute funding to all hospital types in the US - with additional funding going to COVID-19 hotspots; Letter urging Congress to modernize the Stafford Act as part of its next COVID-19 legislative package to allow all hospitals to recoup financial losses from this pandemic and future disasters; Letter to the Federal Reserve System, the Federal Deposit Insurance Corporation and the Office of the Comptroller of the Currency requesting they, as primary federal regulators for insured depository institutions, take prompt action to assist health care providers on the front line of the COVID-19 pandemic should the need to do so arise; Letter to the Secretary of the Treasury and the Federal Reserve Chair of the Board of Governors urging a supplement to the New Main Street Loan Facility term sheet with prompt guidance to ensure that access to this critically-necessary loan facility will be attainable for hospitals without delay; Letter was sent to the SBA urging it to ensure that small- and mid-size public hospitals, including those that have both nonprofit and public designations, are allowed to apply for and receive loans under the newly-authorized SBA Paycheck Protection Program; Letter in response to FEMAs request for input on establishing a voluntary agreement, under the Defense Production Act, of key private sector stakeholders relevant to responding to COVID-19, urging that such an agreement account for the full breadth of COVID-19 medical supply and equipment needs; Support H.R. 6474/S.3838 Healthcare Broadband Expansion During COVID-19 Act, a bill that would provide an additional $2 billion in funding for the FCC Rural Health Care program and increase the subsidy for health care providers from 65 to 85 percent. This legislation also simplifies the program to allow for more efficient application processes and disbursement of much needed funding; Support HR 6654 Emergency COVID-19 Telehealth Response Act, a bill that would codify an expanded list of providers to deliver and bill for telehealth services during the PHE; Support HR 7233Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, a bill that would require the Department of Health and Human Services and the Government Accountability Office (GAO) to conduct studies to provide information about the expanded use of telehealth during the COVID-19 pandemic; Letter to Senate HELP Committee in response to request for feedback on preparing for next pandemic; Discussion about telehealth waivers and flexibilities with HHS; Discussion about CARES provider relief fund distributions with HHS; Oppose HR 6559/ S 3677 COVID-19 Every Worker Protection Act of 2020, a bill to require the Occupational Safety and Health Administration to promulgate an emergency temporary standard to protect employees from occupational exposure to SARS-CoV-2, and for other purposes; Joint letter with ANA urging Congress to act quickly to get needed resources into the health care system, so that hospitals, nurses and physicians responding to COVID-19 are able to continue to provide treatments, front-line health care personnel are able to provide care and patients are able access health care services; Statement to Committee on Ways and Means for the hearing on The Disproportionate Impact of COVID-19 on Communities of Color urging Congress to employ the resources of the National Institute on Minority Health and Health Disparities - which is congressionally-mandated to coordinate the research of the other National Institutes of Healths centers and institutes related to minority health - to research and develop approaches to specifically address the COVID-19 needs of minority populations; Advocate with Congress for full forgiveness of COVID-19 related accelerated payments received by hospitals; Support S 3781Pharmaceutical Accountability, Responsibility, and Transparency (PART) Act, a bill to increase reporting of, help mitigate potential shortages related to, and promote, accountability and transparency for pharmaceuticals and medical devices; Support S 3780 Help Onshore Manufacturing Efficiencies (HOME) for Drugs and Devices Act, a bill to encourage domestic advanced manufacturing of critical drugs and devices in order to address economic, health, and security concerns, combat shortages of critical drugs and devices, and promote increased domestic diversification of, and independence from foreign reliance on, pharmaceutical and medical device supply chains; Support S.3763 Pandemic Responder Service Award Act, a bill to establish the Pandemic Responder Service Award program to express our gratitude to front-line health care workers; Support HR 6788/ S 3599 Healthcare Workforce Resilience Act, a bill to enhance our Nations nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas; Urged support for joint House and Senate letter to the Administration asking for flexibility for hospitals with respect to J-1 and H-1B visa programs; Letter to Senate Finance Committee to address the important issue of maternal health and the opportunity to provide suggestions regarding how to improve maternal health in this country; Support the Temporary Reciprocity to Ensure Access to Treatment Act, a bill that allows for the temporary reciprocity for treatment by medical professionals licensed in one state to patients in other states; Letter urging the Senate to include in the next COVID-19 relief bill provisions to strengthen the federal response for racial and ethnic minority and marginalized communities, which are disproportionately affected by the pandemic;Letter asking Congress to allocate as part of the next COVID-19 relief package at least an additional $100 billion to the emergency relief fund to provide direct funding to front line health care personnel and providers to continue to respond to this pandemic; Letter sent to HHS urging them to direct HRSA to take action to stop three drug manufacturers from limiting the distribution of 340B drugs to 340B covered entities. These drug manufacturers have taken separate actions to either limit the distribution of 340B drugs or require 340B covered entities provide claims level data for investigatory purposes if that 340B covered entity uses a contract pharmacy arrangement; Letter to the Congressional Leadership asking them to not to include in the next COVID-19 relief package any surprise medical billing legislation - such as a reimbursement rate set in statute - that would further destabilize hospitals finances during the pandemic; Support S 4507, Getting Early Treatment and Comprehensive Assessments Reduces Emergencies Act of 2020 or the GET CARE Act of 2020, a bill to amend the Public Health Service Act to provide for a national campaign to raise awareness of the importance of seeking preventive health services and the utilization of such services; Comment letter addressing concerns on the proposed rule from the Departments of the Treasury, Labor and Health and Human Services that would allow certain grandfathered health plans to increase patient cost-sharing beyond current limits, without losing their grandfathered status; Letter urging the Administration to work with the AHA and Congress to create a future for telehealth that allows not only clinicians, but also hospitals and health systems, to code and bill for virtual services. We further urge CMS and HHS to continue to provide hospitals with the flexibility for annual beneficiary consent to telehealth treatment to be obtained at the same time, and not necessarily before, services are furnished; Support HR 8061,Community Immunity During COVID-19 Act of 2020, a bill that would provide funding to state and local health departments to work with community providers and organizations to increase immunization rates for Advisory Committee on Immunization Practices (ACIP)-recommended vaccines during the COVID-19 public health emergency; Letter again expressing concern with recent actions taken by several major drug manufacturers to limit the distribution of certain 340B drugs to our hospital members. While we understand that the HRSA is further investigating these actions, we urge swift and decisive action to halt these pernicious tactics so as to prevent other manufacturers from following suit; Comment letter outlining our concerns about the ability of hospital systems to distribute provider relief funds among the parent and subsidiaries. HHS published certain FAQs that place problematic restrictions on the use of CARES Act provider relief fund dollars. Specifically, the FAQs restrict the ability of a hospital system to allocate the funds throughout its system where COVID-19 related expenses and lost revenues are occurring; Submitted comments in response to HRSAs RFI on Health Professional Shortage Area (HPSA) scoring. HPSA scores are important for rural hospitals and clinics ability to recruit physicians and other clinicians, namely from the National Health Service Corps (NHSC) program. Letter asking HHS to reinstate the COVID-19 Provider Relief Fund reporting requirements; Support S 4349, Dr. Lorna Breen Health Care Provider Protection Act, a bill to address behavioral health and well-being among health care professionals; Support S. 3595Ensuring Understanding of COVID-19 to Protect Public Health Act, a bill that directs the NIH to conduct a longitudinal study on mild, moderate, and severe cases of COVID-19 on a diverse patient population.

Client expense: $4,460,000 · 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

Q4 Lobbying Report (October 1 - December 31) Health Issues Healthcare and COVID-19 measures included in the Consolidated Appropriations Act of 2020 (H.R. 133) Public Health and Social Services Emergency Fund (coronavirus relief packages H.R. 1300; H.R. 7010, H.R. 6800) Regulatory relief in light of coronavirus (all coronavirus relief packages - H.R. 133; 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; inpatient prospective payment system proposed rule; Transparency in Coverage Proposed Rule) Surprise medical billing (H.R. 133; H.R. 5826; H.R. 3630; S. 1531) Liability relief (all coronavirus relief packages - H.R. 133; H.R. 6800; S. 1624; S. 4775) 340B Drug Pricing Program Medicare/Medicaid Public Health Emergency designation Medicaid Fiscal Accountability Regulation Rural hospital policies Graduate Medical Education (GME) funding (H.R. 133; 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. 133; H.R. 3022) Medicare sequestration relief (H.R. 133) Federal Medical Assistance Percentage increase (H.R. 133) Telehealth flexibilities and payment (all coronavirus relief packages - H.R. 133; H.R. 6800, S. 1624, S. 4775, physician fee schedule proposed rule) Post-acute care flexibilities (coronavirus relief packages - H.R. 133; H.R. 6800; S. 1624, S. 4775) Site neutral payment policy OPPS, IPPS and physician fee schedule rules Budget FY 2021 Appropriations bills Submitted Comments CMS-10752; Submissions of 1135 Waiver Request Automated Process; Notice, Federal Register (Vol. 85, No. 204) October 21, 2020 CMS-1734-P; Medicare Program; CY 2021 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicaid Promoting Interoperability Program Requirements for Eligible Professionals; Quality Payment Program; Coverage of Opioid Use Disorder Services Furnished by Opioid Treatment Programs; Medicare Enrollment of Opioid Treatment Programs; Electronic Prescribing for Controlled Substances for a Covered Part D Drug Under a Prescription Drug Plan or an MA-PD Plan; Payment for Office/Outpatient Evaluation and Management Services; Hospital IQR Program; Establish New Code Categories; and Medicare Diabetes Prevention Program (MDPP) Expanded Model Emergency Policy Proposed Rule, Federal Register (Vol. 85, No.159), August 17, 2020 CMS-1736-P; Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; New Categories for Hospital Outpatient Department Prior Authorization Process; Clinical Laboratory Fee Schedule: Laboratory Date of Service Policy; Overall Hospital Quality Star Rating Methodology; and Physician Owned Hospitals; Proposed Rule, Federal Register (Vol. 85, No.156), August 12, 2020

Client expense: $290,000 · 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)

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: Educate Congress on the negative impact of the proposed Medicaid Fiscal Accountability Regulation (MFAR) and urge the administration to withdraw or delay the proposal 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. 1343, Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act Issue: Support expansion of Medicaid and CHIP coverage for postpartum women from current 90 days to 1 year. 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. 1763 / S. 348, Resident Physician Shortage 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 Medicare funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs 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. 8892, Rural-Urban Physician Workforce Act of 2020 Issue: Support improvements to Rural Training Track programs. 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. 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. 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. H.R. 5432, Medical Education for a Diverse America Act Issue: Ensure that time medical residents spend in unconscious bias training is counted toward the determination of FTE for Medicare GME Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure 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) S. 1343, Maximizing Outcomes for Moms through Medicaid Improvement and Enhancements of Services (MOMMIES) Act H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2020 Issue: Support expansion of Medicaid coverage for postpartum women. H.R. 8702 Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020 Issue: Support relief for providers from pending evaluation and management cuts included in the CY 2021 Physician Fee Schedule (PSF) rule. H.R. 8840 Medicare Sequester COVID Moratorium Act Issue: Support extension of Medicare sequester. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support making permanent the CMS policy allowing teaching physicians to provide supervision via real-time, interactive audio/video technology to meet resident supervision requirements. Issue: Support making permanent the interim final rule that allows hospitals that unknowingly trigger their Medicare GME caps and per resident amounts to not have that happen and instead retain the ability to build a new resident cap / PRA so long as the cap / PRA is not above a minimum amount. Issue: Support CMS introducing new regulations to make permanent the interim final rule that ensures teaching hospitals that increased their number of inpatient beds to accommodate the surge in patients during the public health emergency to not have their Indirect Medical Education (IME) payments reduced by CMS. Issue: Oppose CMS hospital price transparency rule. Issue: Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Oppose Hospital co-location draft guidance. Issue: Oppose finalizing proposed rule for Medicare Coverage of Innovative Technology (MCIT) and definition of reasonable and necessary. Issue: Oppose enforcement of linking Medicare Conditions of Participation (CoP) compliance with requiring that hospitals report 38 COVID-19 related measures. Issue: Support continuation of the 3-Day Skilled Nursing Facility (SNF) Stay waiver after the conclusion of the COVID-19 public health emergency. Issue: Oppose finalizing prior authorization policy in CY 2020 for certain HOPD services and in CY 2021 to include new service categories. Issue: Oppose efforts to remove five exclusion criteria that would allow over 270 new procedures to be performed in ASC settings in CY 2021. Issue: Oppose the elimination of the Inpatient Only List over a three-year period Issue: Oppose policy of incorporating revenue distinctions into the Medicare Shared Savings Program.

Client expense: $1,035,000 · 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), Federal Emergency Management Agency (FEMA), 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), Office of the Vice President of the United States, SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

H.R. 1763: Resident Physician Shortage Reduction Act, entire bill. H.R. 3235: Access to Genetic Counselor Services Act, entire bill. H.R. 3414: Opioid Workforce Act of 2019, entire bill. H.R. 1897 and S. 916: Mothers and Offspring Mortality and Morbidity Awareness (MOMMA's) Act, entire bill. Issues related to GME, including for specialized fields such as oncofertility.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending 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 H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" S. 2543, "the Prescription Drug Pricing Reduction Act" H.R. 3235, "Access to Genetic Counseling Act" H.R. 925, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROS Act 2.0) H.R. 133, "Consolidated Appropriations Act, 2021" - provisions related to increasing the number of Medicare-funded residency positions, to Medicare, Medicaid, and COVID response Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical Education Medicare bad debt payments Medicaid waivers Medicaid Expansion Issues Medicaid Disproportionate Share Hospital Payments Medicare Disproportionate Share Hospital Payments Legislation related to chronic care treatment Medicaid supplemental payments to hospitals Medicare site neutral payments for hospitals outpatient departments Legislation related to healthcare disparities Medicaid State Flexibility Medicaid 1115 & 1332 Waivers Upper Payment Limit payments State Financing of Medicaid Medicare Part B Cuts-OPPS proposed rule to 340B covered entities Hospital Price Transparency National Quality Forum Funding Medicaid & CHIP Coverage Medicaid Funding for Certified Community Behavioral Health Centers Medicaid Funding for Community-Based long-term care H.R.2328 - REACH Act H.R.3414 - Opioid Workforce Act of 2019 S.1699 - Prescription Drug Cost Reduction Act H.R.3 - Lower Drug Costs Now Act of 2019 S.348 - Resident Physician Shortage Reduction Act of 2019 H.R.1763 - Resident Physician Shortage Reduction Act of 2019 S.2648 - The Rural ACO Improvement Act H.R.4496 - Helping Medicaid Offer Maternity Services Act of 2019 S.2741 - Creating Opportunities Now for Necessary and Efficient Care Technologies for Health Act of 2019 Medicaid Fiscal Accountability Regulation H.R 748, Coronavirus Aid, Relief, and Economic Security (CARES) Act H.R. 6201, Families First Coronavirus Response Act H.R. 6074, Coronavirus Preparedness and Response Supplemental Appropriations Act H.R. 6379, Take Responsibility for Workers and Families Act H.R. 3, Elijah Cummings Lower Drug Costs Now Act H.R. 19, Lower Costs, More Cures Act S. 2543, Drug Pricing Reduction Act Social Determinants for Moms Act (H.R. 6132) IMPACT to Save Moms Act (H.R. 6137) Moms MATTER Act (H.R. 6143) Perinatal Workforce Act (H.R. 6164) Black Maternal Health Momnibus Act (S. 3424) Data to Save Moms Act (H.R. 6165) Social determinants of health HEROES Act Coronavirus Medicaid Response Act Federal Medical Assistance Percentage Telehealth Medicare Accelerated and Advance Payment Program H.R. 7663 - Protecting Access to Post-COVID-19 Telehealth Act of 2020 H.R.7791 - Value in Health Care Act of 2020 HR 4996, Helping MOMS Act Medicare Sequester COVID Moratorium Act (H.R. 8840) Utilizing National Data, Effectively Reforming Standards and Tools, to Address Negative Determinates of Health Act (S. 1323) Supporting Best Practices for Healthy Moms Act (H.R. 8958/S.4949) Consolidated Appropriations Act, 2021 (H.R. 133) Medicare physician payment

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

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

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending 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 H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" H.R. 3235, "Access to Genetic Counseling Act"

Client expense: $398,118 · Firm income: Not reported

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

H.R. 1109/ S. 1122, the Mental Health Services for Students Act S. 1782, the Improving Mental Health Access for Students Act H.R. 7293 / S. 2492, the Suicide Training and awareness nationally delivered for universal prevention act (STAND UP Act) H.R. 2431 / S. 2550, the Mental Health Professionals Workforce Shortage Loan Repayment Act of 2019 H.R. 3414/ S. 2892, the Opioid Workforce Act of 2019 Efforts related to safety of children going back to school during COVID-19.

Client expense: $238,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), 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), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of the Vice President of the United States, SENATE, Veterans Affairs, Dept of (VA), White House Office

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; Nursing and Allied Health Education payments; H.R. 133) Delay of Medicaid Disproportionate Share Hospital payment cuts (H.R. 133) Medicare sequestration (H.R. 133) Federal Medical Assistance Percentage increase (H.R. 133) Telehealth payment (all coronavirus relief packages - H.R. 6074, H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800, HEALS Act, S. 4775, H.R. 133; physician fee schedule rule) Medicare hospital accelerated payment program (H.R. 8337, 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, H.R. 133) 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) Waiver for Temporary Nurse Aides (H.R. 8874)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 8840, Medicare Sequester COVID Moratorium Act, all provisions H.R. 8702, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions S. 5007, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions H.R. 7154, Outpatient Therapy Modernization and Stabilization Act, all provisions H.R. 3107, Improving Seniors Timely Access to Care Act of 2019, all provisions S. 5044, Improving Seniors Timely Access to Care Act of 2020y, all provisions H.R. 8727, Telehealth Modernization Act, all provisions S. 4375, Telehealth Modernization Act, all provisions H.R. 7663, Protecting Access to Post-COVID-19 Telehealth Act of 2020, all provisions H.R. 7391, Protect Telehealth Access Act of 2020, all provisions H.R. 1301, Mental Health Telemedicine Expansion Act, all provisions H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019, all provisions H.R. 5201, Telemental Health Expansion Act of 2020, provisions relating to 1834(m) of the Social Security Act; geographic and originating sites H.R. 7233, Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, all provisions H.R. 5172, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions S. 3067, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions H.R. 3414, Opioid Workforce Act of 2019, all provisions H.R. 7791, Value in Health Care Act of 2020, provisions relating to qualifying APM physician thresholds H.R. 6837, Medicare Accelerated and Advance Payments Improvement Act of 2020, all provisions S. 3750, Medicare Accelerated and Advance Payments Improvement Act, all provisions H.R. 8505, To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes, all provisions H.R. 884, Medicare Mental Health Access Act, all provisions H.R. 945, Mental Health Access Improvement Act of 2019, all provisions H.R. 6744, Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2020, all provisions H.R. 4004, Social Determinants Accelerator Act of 2019, all provisions H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions S. 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, provisions related to PBM and prescription drug price transparency H.R. 19, Lower Costs, More Cures Act of 2019, provisions related to PBM and prescription drug price transparency H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2020, all provisions H.R. 6090, Physician Shortage GME Cap Flex Act of 2020, all provisions H.R. 6142, Black Maternal Health Momnibus Act of 2020, all provisions Medicare program: P.L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) implementation/Accountable Care Organizations/APM thresholds Medicare program: Patient Protection and Affordable Care Act (PPACA)/Prior authorization provider and patient burdens/patient electronic access to health information Medicare program: P.L. 113-93 Protecting Access to Medicare Act (PAMA)/Imaging appropriate use criteria/Radiation Oncology APM Medicare program: FY 2021 Inpatient Rehab Facility Prospective Payment System (IRF PPS)/scope of practice issues Medicare program: CY 2021 physician fee schedule/E&M services/Budget neutrality/Part B/Sequester Medicare program: Alternative payment models (APMs) Medicare program: Merit-based Incentive Payment System (MIPS)/cost/quality/interoperability/hardship exemption Medicare program: Regulatory relief/Advanced APMs, prior authorization, and utilization management Medicare program: Shared Savings Program Medicare program: Quality Payment Program/prior authorization/electronic funds transfer Medicare program: Surprise medical billing Medicare program: Medicare-For-All Medicare program: Electronic Health Records (EHR) Certification Medicare program: 21st Century Cures Act Medicare program: Quality payment program/physician burdens Medicare program: National Coverage determination/validated home blood pressure monitors Medicare program: Health IT/physician burden Medicare program: Drug pricing Medicare program: Most favored nation drug pricing Medicare program: Provider compliance/regulatory relief Medicare program: Provider Enrollment, Chain and Ownership (PECOS) enrollment/revalidation Medicare and Medicaid programs: 21st Century Cures Act/health data and privacy Medicaid program: CMS proposed regulation Medicaid Program Medicaid program: FMAP increases Medicaid program: Interoperability

Client expense: $4,170,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA), White House Office

FDA regulation of Laboratory-Developed Tests (LDTs); H.R.3414/S.2892, Opioid Workforce Act of 2019.

Client expense: Not reported · Firm income: $20,000

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

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

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Support direct funding for health care providers treating COVID-19 patients, including funding through the Hospital Preparedness Program. Support funding and efforts to ensure health care providers have access to essential materials, such as PPE, for COVID-19 response and readiness. Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Advocate for direct Federal funding for state and local governments during the COVID-19 crisis. Discuss the distribution methodology for the Public Health and Social Services Emergency Fund with Congressional staff. Discuss issues related to Medicare accelerated payments with Congressional staff. Discuss legislative priorities with Congressional staff: a delay of cuts to Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), funding for hospital infrastructure (support), the Affordable Care Act (support), and liver allocation reforms (support). Discuss the need to reform the United States' liver allocation system with Congressional staff/members. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 348/H.R. 1763) and the Opioid Workforce Act (H.R. 3414/S. 2439). Discuss technical assistance regarding the Opioid Workforce Act (H.R. 3414/S. 2439) with committee staff. Discuss the Prescription Drug Pricing Reduction Act of 2019 (S. 2543) with Congressional staff. Support surprise billing legislation reform and work with committee and Congressional staff on a range of issues. Discussed several bills including: Protecting People from Surprise Medical Bills Act (H.R. 3502), Lower Health Care Costs Act (S. 1895), No Surprises Act (H.R. 3630) and Consumer Protections Against Surprise Medical Bills Act of 2020 (H.R. 5826). Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Discuss provisions in the CARES Act (H.R. 748) related to health care provider liability and immunity with Congressional staff. Discuss Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with congressional staff. Discuss drug shortages related to the COVID-19 crisis with Congressional and Administration staff. Discuss the HEROES Act (H.R. 6800) and other COVID-19 phase four response legislation with Congressional staff. Discuss disbursements from the Public Health and Social Services Emergency Fund with Congressional staff. Discuss Medicare Advance Payment forgiveness with Congressional staff. Discuss supply chain issues, including PPE and ventilators, with Congressional staff. Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss increased Federal Medical Assistance Percentages (support) and increased funding for state and local governments (support) with Congressional staff.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discuss proposed appropriations language related to OPTN/UNOS liver allocation reforms with Congressional staff. Support the inclusion of funding for hospital infrastructure and workforce programs in appropriations legislation. Support for the inclusion of provisions to delay the Medicaid DSH cuts in appropriations legislation. Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Support direct funding for health care providers treating COVID-19 patients, including funding through the Hospital Preparedness Program. Support funding and efforts to ensure health care providers have access to essential materials, such as PPE, for COVID-19 response and readiness. Advocate for direct Federal funding for state and local governments during the COVID-19 crisis. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 348/H.R. 1763) and the Opioid Workforce Act (H.R. 3414/S. 2439) and its inclusion in appropriations legislative.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS and Congressional staff. Advocate for continued Federal funding for New York States DSRIP program. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), and the Affordable Care Act (support). Oppose several provisions in the White House's FY 2021 budget blueprint including cuts and changes to GME funding, site-neutral policies, changes to Medicare UCP and bad debt, Medicare post-acute care payments, wage index adjustments, and other Medicaid cuts. Educate Congressional staff and lawmakers on Medicare for All. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 348/H.R. 1763) and the Opioid Workforce Act (H.R. 3414/S. 2439). Discuss technical assistance regarding the Opioid Workforce Act (H.R. 3414/S. 2439) with committee staff. Discuss the Prescription Drug Pricing Reduction Act of 2019 (S. 2543) with Congressional staff and committee staff. Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House and Congressional staff. Discuss the HEROES Act (H.R. 6800) and other COVID-19 phase four response legislation with lawmakers, Congressional staff, HHS and the White House. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 7292 (support). Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss increased Federal Medical Assistance Percentages (support) and increased funding for state and local governments (support) with Congressional staff. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS.

Client expense: $550,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), President of the U.S., SENATE, Small Business Administration (SBA), Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

Oppose several provisions in the White House's FY 2021 budget blueprint including cuts and changes to GME funding, site-neutral policies, changes to Medicare UCP and bad debt, Medicare post-acute care payments, wage index adjustments, and other Medicaid cuts. Support for the Medical liability provisions in the budget. Discuss proposed appropriations language related to OPTN/UNOS liver allocation reforms with Congressional staff and lawmakers. Support the inclusion of funding for hospital infrastructure and workforce programs in appropriations legislation. Support for the inclusion of provisions to delay the Medicaid DSH cuts in appropriations legislation. Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (n) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for federal childcare benefits for members of the health care workforce. Support direct funding for health care providers treating COVID-19 patients, including funding through the Hospital Preparedness Program. Support funding and efforts to ensure health care providers have access to essential materials, such as PPE, for COVID-19 response and readiness. Advocate for direct Federal funding for state and local governments during the COVID-19 crisis. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 348/H.R. 1763) and the Opioid Workforce Act (H.R. 3414/S. 2439), and its inclusion in appropriations legislative.

Client expense: $550,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), President of the U.S., SENATE, Small Business Administration (SBA), Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for federal childcare benefits for members of the health care workforce. Advocate for increasing borrowing limits on SBA loans and ensuring health care providers are eligible. Support direct funding for health care providers treating COVID-19 patients, including funding through the Hospital Preparedness Program. Support funding and efforts to ensure health care providers have access to essential materials, such as PPE, for COVID-19 response and readiness. Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Advocate for direct Federal funding for state and local governments during the COVID-19 crisis. Discuss the distribution methodology for the Public Health and Social Services Emergency Fund with the White House, HHS, CMS and Congressional staff. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS and Congressional staff. Advocate for continued Federal funding for New York States DSRIP program. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts to Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), funding for hospital infrastructure (support), the Affordable Care Act (support), and liver allocation reforms (support). Discuss the need to reform the United States' liver allocation system with Congressional staff/members, HHS, HRSA, UNOS and OPTN. Oppose several provisions in the White House's FY 2021 budget blueprint including cuts and changes to GME funding, site-neutral policies, changes to Medicare UCP and bad debt, Medicare post-acute care payments, wage index adjustments, and other Medicaid cuts. Support for the Medical liability provisions in the budget. Educate Congressional staff and lawmakers on Medicare for All. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 348/H.R. 1763) and the Opioid Workforce Act (H.R. 3414/S. 2439). Discuss technical assistance regarding the Opioid Workforce Act (H.R. 3414/S. 2439) with committee staff. Discuss the Prescription Drug Pricing Reduction Act of 2019 (S. 2543) with Congressional staff and committee staff. Support surprise billing legislation reform and work with committee and Congressional staff on a range of issues. Discussed several bills including: Protecting People from Surprise Medical Bills Act (H.R. 3502), Lower Health Care Costs Act (S. 1895), No Surprises Act (H.R. 3630) and Consumer Protections Against Surprise Medical Bills Act of 2020 (H.R. 5826). Discussed the inclusion of surprise billing legislation in COVID-19 response legislation. Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues Discuss provisions in the CARES Act (H.R. 748) related to health care provider liability and immunity with Congressional and committee staff. Attend cybersecurity briefing related to foreign threats with FBI. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House and Congressional staff. Discuss drug shortages related to the COVID-19 crisis with Congressional and Administration staff. Coordinate with ASPR, the Department of Defense, FEMA and the FDA on COVID-19 response efforts. Discuss the HEROES Act (H.R. 6800) and other COVID-19 phase four response legislation with lawmakers, Congressional staff, HHS and the White House. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss hospital infrastructure spending with Congressional staff, including in the Invest in America Act (H.R. 2). Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 7292 (support). Discuss supply chain issues, including PPE and ventilators, with Congressional staff, HHS and White House. Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss increased Federal Medical Assistance Percentages (support) and increased funding for state and local governments (support) with Congressional staff. Discuss surprise billing legislation with White House staff. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS.

Client expense: $550,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), President of the U.S., SENATE, Small Business Administration (SBA), Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

Public Health Emergency designation Medicaid Fiscal Accountability Regulation Rural hospital policies Graduate Medical Education (GME) funding (H.R. 133; 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. 133; H.R. 3022) Medicare sequestration relief (H.R. 133) Federal Medical Assistance Percentage increase (H.R. 133) Telehealth flexibilities and payment (all coronavirus relief packages - H.R. 133; H.R. 6800, S. 1624, S. 4775, physician fee schedule proposed rule) Post-acute care flexibilities (coronavirus relief packages - H.R. 133; H.R. 6800; S. 1624, S. 4775) Site neutral payment policy OPPS, IPPS and physician fee schedule rules

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

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

Medicare-Graduate Medical Education HRSA THCGME Program Resident Physician Shortage Reduction Act of 2019 (H.R. 1763/S. 348) Rural Physician Workforce Production Act of 2019 (S. 289) Training the Next Generation of Primary Care Doctors Act of 2019 (H.R. 2815/S. 1191) Opioid Workforce Act of 2019 (H.R. 3414/S. 2892) Advancing Medical Resident Training in Community Hospitals Act of 2019 (H.R. 3425) Supporting Graduate Medical Education at Community Hospitals Act of 2019 (H.R. 3753/S. 2116) PPE to Address COVID-19 Pandemic Community Health Center Fund in COVID stimulus COVID-19 impact on health professions education COVID-19 impact on osteopathic medical education Coronavirus Health Care Worker Wellness Act (H.R. 7255) Restoring Rural Residencies Act of 2019 (S. 1240) Community and Public Health Programs Extension Act (S.192) Public health and public health infrastructure support in COVID-19 stimulus Title VII and Title VIII program support in COVID-19 stimulus Ensuring Understanding of COVID-19 to Protect Public Health Act (S. 3595/H.R. 6701) Dr. Lorna Breen Health Care Provider Protection Act (H.R. 8094/S. 4349) Addressing COVID-19 Health Disparities Act (H.R.8067) Debt and economic relief for frontline workers Federal funding for rural hospitals and physician practices impacted by COVID-19 Funding for federal research agencies to prevent and respond to pandemic-related disruptions to federally-funded research

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Affordable Care Act (P.L. 111-148, P.L. 111-152): Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Advocated against a December 2018 ruling by a federal judge in Texas that the entire Affordable Care Act (ACA) is unconstitutional. Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Medicare Payments to Physicians: Urged that Congress provide incentives to physicians who transform their practices into Advanced Alternative Payment Models and continue to provide stability for physicians in the MIPS program. Specifically, Congress should extend the five percent Qualified Alternative Payment Model participant bonus beyond the 2022 performance year, replace the zero percent baseline payment updates under Medicare with positive updates. Urged congressional committees with jurisdiction over Medicare to exercise their oversight authority and urge CMS to expedite approval of more Advanced APMS, particularly those that work for small and specialty practices and to simplify the scoring structure and reporting requirements under the Merit-Based Incentive Payment System (MIPS) in order to fulfill Congress intent of a more streamlined program that reduces burdens on physicians; Supported S.2648, the Rural ACO Improvement Act, amends title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program (MSSP) to ensure that all ACOs have an equal opportunity to share in savings regardless of their geographic location; Provided recommendations to CMS on the Merit-based Incentive Payment System Value Pathway (MVP), which aims to reduce reporting burden and complexity within MIPS while improving the accuracy and effectiveness of performance measurement. The College noted specifically that a robust, multi-year transition period will be critical to the success of the MVP, that it does not support making the MVP mandatory, that CMS should continue to support numerous reporting mechanisms, including qualified registries and clinical data registries, which have been instrumental in developing specialty-specific performance measures, among other things. Urged support for H.R. 8505, a bill to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule; Urged that any legislation to hold some Medicare physician payment codes harmless from budget neutrality do so for just one year and to allow evaluation and management increases, along with GPC1X codes to go into effect. Administrative Tasks on Physicians and Patients: Congress should accelerate its efforts to reduce administrative burdens on clinicians and patients, including: streamlining the prior authorization process, better integrating clinical data into clinicians electronic health records (EHRs), and working with CMS in their effort to overhaul clinical documentation guidelines; Urged Congress to cosponsor and pass the Safe Step Act (H.R. 2279), to require health insurers to provide an exceptions process for any medication step therapy protocol based on clinical decision-making, medical necessity, and other patient needs. Prescription Drug Costs: The College advocated for greater transparency in drug pricing, the elimination of anti-competitive industry practices that create barriers to generics coming to market, the importance of accounting for value in payment and coverage for prescriptions, and providing authority to the federal government to negotiate drug discounts under the Medicare Part D program. Specifically, the College urged Congress to pass the Medicare Prescription Drug Price Negotiation Act of 2019 (H.R. 275/S. 62), which allows the Secretary of Health and Human Services to negotiate covered Part D drug prices on behalf of Medicare beneficiaries, and the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2019, (H.R. 965/S. 340), which would improve patient access to alternative low-cost prescription drugs and biological products by preventing prescription drug manufacturers from misusing the FDAs Risk Evaluation and Mitigation Strategies (REMS) process to make it difficult for competing generics to be brought to the market. Also urged that Congress pass the Reforming Evergreening and Manipulation that Extends Drug Years, REMEDY Act (S. 1209), to aid in the approval of more generic drug applications by the FDA and therefore improve patient access to those medications. Also urged that Congress pass the Prescription Drug STAR Act (H.R. 2113), and the Fair Accountability and Innovative Research (FAIR) Drug Pricing Act (H.R. 2296/S. 1391), to promote greater drug pricing transparency; Expressed appreciation to the House speaker for introduction of H.R. 3, the Lower Drug Costs Now Act, noting encouragement for its provisions to empower the Secretary of Health and Human Services (HHS) to negotiate with drug companies for lower prices and to cap out-of-pocket costs for seniors enrolled in the Medicare Part D program. Commented to the FDA on its prescription drug reimportation proposed rule noting that while the College is generally supportive of drug importation as laid out in the proposed rule as a means to control the cost of prescription drugs, the FDA must guarantee that the design and implementation of the rule includes numerous measures and safeguards to ensure patient safety. By limiting the origin of imported drugs to Canadian-certified and FDA-approved and registered drugs and entities, the College believes the proposed rule meets the required U.S. standards to assure high-quality drugs and patient safety. Any final drug importation system must also be one that is a closed system and has a tightly controlled and documented supply chain to assure authenticity and avoid degradation of the drug. Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2021 for federal programs/initiatives designed to support primary care including Title VII Health Professions grants and the National Health Service Corps (NHSC). Equally important is the need to fund essential health services and medical research by the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH) and public health programs supported by the Centers for Disease Control and Prevention (CDC). Firearms-Related Injury and Death: The College advocated for lawmakers to pass measures to strengthen the criminal background check system, ban assault weapons and high capacity magazines, prevent the unlawful transfer of firearms to those who cannot legally purchase them, and remove restrictions on, and provide dedicated funding for, research by federal agencies on prevention of firearms-related injuries and death. Specifically, the College urged passage of the Bipartisan Background Checks Act of 2019 (H.R. 8), which would strengthen the accuracy and reporting of the National Instant Criminal Background Check System (NICS) as well as expand Brady background checks to cover all firearm sales, including unlicensed firearms sellers currently not required to use background checks, and the Gun Violence Prevention Research Act (H.R. 674/S. 184), which would authorize funding for the Centers for Disease Control and Prevention (CDC) to study firearms safety and gun violence prevention. Also urged Congress to pass the Violence Against Women (VAWA) Reauthorization Act of 2019 (H.R. 1585), to provide protections for domestic violence victims by restricting access to firearms by those deemed a threat to them. Also urged Congress to pass the Assault Weapons Ban of 2019 (S. 66/H.R. 1296), to ban the sale of semi-automatic weapons and high capacity magazines. Immigration: The College advocated against family separation at the U.S. border. Specifically, the College urged support for H.R. 541 - the Keep Families Together Act, which would help ensure that children are not separated from their parents when families unlawfully cross over the border into the United States and would ensure that the Department of Homeland Security would not be able to implement the zero tolerance policy that separated families at the border last summer; urged congressional oversight of family separation policies. Also urged that Congress pass H.R. 6, the Dream and Promise Act of 2019, which would provide a pathway to U.S. citizenship for undocumented children who came to the United States due to the action of their parents, also known as Dreamers. Expressed concern to the U.S. Department of Homeland Security with the recent U.S. Citizenship and Immigration Service (USCIS) policy change to no longer accept or adjudicate non-military deferred action requests including those for individuals with serious medical conditions; Urged USCIS to reverse this decision immediately and resume consideration of deferred action requests for medical reasons; Opposed the proposed rule, U.S. Immigration and Customs Enforcement (ICE) Establishing a Fixed Time Period of Admission and an Extension of Stay Procedure for Nonimmigrant Academic Students, Exchange Visitors, and Representatives of Foreign Information Media. This rule would change the process to extend the period of authorized stay in the United States for certain categories of nonimmigrants by eliminating the long-standing "duration of status and replacing it with a specific end date. The College urged the Department of Homeland Security to exclude physicians in the Department of States (DOS) Exchange Visitor Program in J-1 visa status from this rule change because it will otherwise disrupt the training of thousands of physicians - physicians who already have been thoroughly vetted, already are serving on our nations health care teams, and already are carefully monitored during their time in the U.S. Graduate Medical Education: Urged that Congress support medical education training and debt relief for primary care physicians and other specialties facing shortages by passing the Resident Physician Shortage Reduction Act of 2019 (S. 348, H.R. 1763), to lift the GME caps as needed to permit training an adequate number of primary care physicians, including internal medicine specialists, and physicians in other specialties facing shortages; passing the Resident Education Deferred Interest Act (H.R. 1554), to save physicians in residency programs thousands of dollars in interest on their loans and help incentivize the opening of practices in underserved areas; pass legislation to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; support funding for GME/IME and programs within the Veterans Health Administration that provide graduate medical education to ensure that physicians are adequately trained with the skills needed to treat an aging population. Urged Congress to pass the Opioid Workforce Act of 2019 (H.R. 3414), which would provide Medicare support for an additional 1,000 graduate medical education (GME) positions over five years in hospitals that have, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry, or pain medicine. Urged Congress to pass S. 1203 and H.R. 2441, the What You Can Do For Your Country Act, which would improve and reform the Public Service Loan Forgiveness (PSLF) Program. Vaccines: Urged Congress to pass the Vaccines Act (HR 2862), which would provide federal funding for vaccine hesitancy surveillance at the Centers for Disease Control and Prevention (CDC), and outline a national public messaging campaign informed by this research to help improve vaccination rates; Supported H.R. 592, recognizing the anniversary of the eradication of smallpox and the importance of vaccination in the United States and worldwide; Urged the U.S. Department of Homeland Security (DHS) to reconsider its decision to not vaccinate families in the custody of U.S. Customs and Border Protection (CBP) against influenza (flu). Urged Congress to support payments for vaccines, as finalized by CMS, and set for implementation on Jan. 1, 2021. Surprise Medical Billing: Urged Congress to pass legislation that would protect patients from surprise out-of-network medical bills in both emergency and non-emergency settings that includes the following principles: hold patients harmless from surprise medical bills for out-of-network services, address narrow insurance networks, abandon efforts to establish an in-network median rate for services in these settings and instead opt for an independent dispute resolution process to determine payment. Appropriations: Urged Congress to fund Title VII, Section 747, Primary Care Training and Enhancement (PCTE) at $71 million for fiscal year 2021; Fund the Agency for Health Care Research and Quality (AHRQ) at $460 million for fiscal year 2021; Fund the National Health Service Corps (NHSC) at $830 million for fiscal year 2021; Fund the Title X Family Planning Program at $400 million for fiscal year 2021 and include language to remove barriers to care that interfere with the patient-physician relationship; Fund Research on Prevention of Firearms-related Injuries and Deaths at $50 million for Fiscal Year 2021; Fund the National Institutes of Health (NIH) at $44.7 billion for fiscal year 2021; Fund the Centers for Disease Control and Prevention (CDC) at $8.3 billion for fiscal year 2021; Urged the House and Senate Armed Services Committees to support provisions in any final FY2021 National Defense Authorization Act to prevent cuts to the Military Health Service and the military medical workforce without requiring appropriate congressional oversight and review. Physician Fee Schedule: Commented to CMS and to Congress to fully implement payment increases for all evaluation and management codes, as finalized by CMS, and as scheduled for implementation on Jan. 1, 2021. Reduce the documentation burden for E/M services by allowing choice of medical decision making or time, and work to develop additional clarity and guidance on acceptable documentation to operationalize these important proposals; examination room desktop computers should be counted as a direct medical equipment cost; care management should be promoted by increasing the values of services like Transitional Care Management (TCM) and Chronic Care Management and implementing Principle Care Management (PCM) codes; require additional survey and review for any requests to increase non-outpatient E/M or other services; work with the physician community prior to finalizing any policy affecting eligibility to participate in the Medicare program; Urged congressional committees of jurisdiction to support: Higher physician work relative value units (RVUs) for new and established office visit codes, leading to increased payments for them, Reduced documentation requirements for office visit codes, which enables physicians to select and document for each visit based on medical decision-making or total time, Expanded and improved payment for care management services. Urged Congress to support waiving budget neutrality, applicable to the calendar year 2021 physician fee schedule. COVID-19: Urged congressional appropriators to provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the virus that is commensurate with the public health emergency that the virus represents. Urged the administration to explore regulatory and other actions that would make COVID-19 testing free-of-charge to patients covered by both public and private insurance plans, including ACA-compliant plans offered through the insurance exchanges, and to waive co-pays and deductibles for patients seeing physicians for symptoms that may be indicative of COVID-19 or who are hospitalized for treatment. Urged CMS to utilize a national disaster recovery program that would pay doctors 110% of Medicare rates for caring for uninsured patients who have been infected with SARS-CoV-2. Expressed support to Congress and the administration for the Families First Coronavirus Response Act, H.R. 6201, and other stimulus reforms related to COVID-19 including: Emergency paid leave benefits, paid sick days for public health emergencies, coverage of testing for COVID-19, waiving of cost sharing under Medicare, Medicare Advantage, Medicaid, and CHIP, increasing the federal FMAP under Medicaid, providing reimbursement for CPT codes 99441 - 99443, which are telephone evaluation and management services, expediting entrance of international medical graduates who are citizens of other nations (non-US IMGs) into the country and ensuring that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic, funding for physician practices under the Public Health and Social Service Emergency Fund (PHSSEF), providing tax relief, grants, and loans to small and medium size practices impacted by COVID-19, increasing funding for personal protective equipment (PPE), ensuring Medicaid pay parity with Medicare for primary care services; Urged HHS and Congress to make a targeted allocation out of the Provider Relief Fund (PRF) to support primary care physicians and their practices, sufficient to keep their doors open, by offsetting lost revenue from the COVID-19 pandemic, similar to the targeted allocation for rural hospitals; Urged support for the Student Loan Forgiveness for Frontline Health Workers Act, H.R. 6720, introduced May 5, 2020 by Representative Carolyn B. Maloney (D-NY) which would eliminate graduate school debt for healthcare workers, including physicians and medical students, who are providing direct patient care in response to the COVID-19 pandemic; Urged support for H.R. 7059, the Coronavirus Provider Protection Act, which extend liability protections to those who provide care in good faith during the COVID-19 public health emergency (plus a reasonable time, such as 60 days, after the emergency declaration ends), and not in situations of gross negligence or willful misconduct. The College also urged that pay parity between telephone claims and in-person visits and between all telehealth and in-person visits be maintained after the PHE is lifted. This extension-either continued by CMS or mandated by Congress-should last at least through the end of 2021, or until such a time when effective vaccines and treatments are widely available, with an option to extend it even further, or consider making permanent, based on the experience and learnings of patients and physicians who are utilizing these visits. Urged Congress to support a targeted allocation from the Provider Relief Fund specifically for primary care services. Priorities for New Administration: Urged the incoming Biden Administration to identify and appoint physicians to health care leadership positions within your Administration. Implement approval, distribution, and funding of a safe and effective COVID-19 vaccine based on recommendations from the Advisory Committee on Immunization Practices (ACIP). Provide support to physicians and other frontline health care workers, including ensuring access and distribution of personal protective equipment (PPE) to health care workers. Fund COVID-19 testing and contact tracing efforts. Reverse regulations that allow the sale of extended short-term, limited duration plans, association health plans. Take action to defend the Affordable Care Act from any litigation, including California v. Texas, that would undermine coverage and patient protections. Expand premium tax credits and cost-sharing reductions. Establish a federal public option to inject competition into the health insurance marketplace. Expand Medicaid eligibility and oppose expansion waivers that limit benefits and apply high cost sharing. Permanently increase payment for Medicaid primary care services to the level of Medicare. Restore the Deferred Action for Childhood Arrivals, consistent with a recent ruling from a federal judge, and identify executive actions that can be taken to ensure that it is not vulnerable to being eliminated in the future. Pursue executive actions to preserve the principles of patient autonomy regarding reproductive decision-making rights. Reverse the Title X gag rule and restore funding to family planning clinics. Establish universal access to at least six weeks of paid family and medical leave that is flexible to accommodate care for a diverse array of family structures, including updating the Family Medical and Leave Act to include grandparents or in-laws. Re-introduce and pass the George Floyd Act and other legislation focused on eliminating racism and police violence. Rejoin the Paris Agreement.

Client expense: $241,204 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS)

The Affordable Care Act (P.L. 111-148, P.L. 111-152): Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Advocated against a December 2018 ruling by a federal judge in Texas that the entire Affordable Care Act (ACA) is unconstitutional. Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Medicare Payments to Physicians: Urged that Congress provide incentives to physicians who transform their practices into Advanced Alternative Payment Models and continue to provide stability for physicians in the MIPS program. Specifically, Congress should extend the five percent Qualified Alternative Payment Model participant bonus beyond the 2022 performance year, replace the zero percent baseline payment updates under Medicare with positive updates. Urged congressional committees with jurisdiction over Medicare to exercise their oversight authority and urge CMS to expedite approval of more Advanced APMS, particularly those that work for small and specialty practices and to simplify the scoring structure and reporting requirements under the Merit-Based Incentive Payment System (MIPS) in order to fulfill Congress intent of a more streamlined program that reduces burdens on physicians; Supported S.2648, the Rural ACO Improvement Act, amends title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program (MSSP) to ensure that all ACOs have an equal opportunity to share in savings regardless of their geographic location; Provided recommendations to CMS on the Merit-based Incentive Payment System Value Pathway (MVP), which aims to reduce reporting burden and complexity within MIPS while improving the accuracy and effectiveness of performance measurement. The College noted specifically that a robust, multi-year transition period will be critical to the success of the MVP, that it does not support making the MVP mandatory, that CMS should continue to support numerous reporting mechanisms, including qualified registries and clinical data registries, which have been instrumental in developing specialty-specific performance measures, among other things. Urged support for H.R. 8505, a bill to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule; Urged that any legislation to hold some Medicare physician payment codes harmless from budget neutrality do so for just one year and to allow evaluation and management increases, along with GPC1X codes to go into effect. Administrative Tasks on Physicians and Patients: Congress should accelerate its efforts to reduce administrative burdens on clinicians and patients, including: streamlining the prior authorization process, better integrating clinical data into clinicians electronic health records (EHRs), and working with CMS in their effort to overhaul clinical documentation guidelines; Urged Congress to cosponsor and pass the Safe Step Act (H.R. 2279), to require health insurers to provide an exceptions process for any medication step therapy protocol based on clinical decision-making, medical necessity, and other patient needs. Prescription Drug Costs: The College advocated for greater transparency in drug pricing, the elimination of anti-competitive industry practices that create barriers to generics coming to market, the importance of accounting for value in payment and coverage for prescriptions, and providing authority to the federal government to negotiate drug discounts under the Medicare Part D program. Specifically, the College urged Congress to pass the Medicare Prescription Drug Price Negotiation Act of 2019 (H.R. 275/S. 62), which allows the Secretary of Health and Human Services to negotiate covered Part D drug prices on behalf of Medicare beneficiaries, and the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2019, (H.R. 965/S. 340), which would improve patient access to alternative low-cost prescription drugs and biological products by preventing prescription drug manufacturers from misusing the FDAs Risk Evaluation and Mitigation Strategies (REMS) process to make it difficult for competing generics to be brought to the market. Also urged that Congress pass the Reforming Evergreening and Manipulation that Extends Drug Years, REMEDY Act (S. 1209), to aid in the approval of more generic drug applications by the FDA and therefore improve patient access to those medications. Also urged that Congress pass the Prescription Drug STAR Act (H.R. 2113), and the Fair Accountability and Innovative Research (FAIR) Drug Pricing Act (H.R. 2296/S. 1391), to promote greater drug pricing transparency; Expressed appreciation to the House speaker for introduction of H.R. 3, the Lower Drug Costs Now Act, noting encouragement for its provisions to empower the Secretary of Health and Human Services (HHS) to negotiate with drug companies for lower prices and to cap out-of-pocket costs for seniors enrolled in the Medicare Part D program. Commented to the FDA on its prescription drug reimportation proposed rule noting that while the College is generally supportive of drug importation as laid out in the proposed rule as a means to control the cost of prescription drugs, the FDA must guarantee that the design and implementation of the rule includes numerous measures and safeguards to ensure patient safety. By limiting the origin of imported drugs to Canadian-certified and FDA-approved and registered drugs and entities, the College believes the proposed rule meets the required U.S. standards to assure high-quality drugs and patient safety. Any final drug importation system must also be one that is a closed system and has a tightly controlled and documented supply chain to assure authenticity and avoid degradation of the drug. Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2021 for federal programs/initiatives designed to support primary care including Title VII Health Professions grants and the National Health Service Corps (NHSC). Equally important is the need to fund essential health services and medical research by the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH) and public health programs supported by the Centers for Disease Control and Prevention (CDC). Firearms-Related Injury and Death: The College advocated for lawmakers to pass measures to strengthen the criminal background check system, ban assault weapons and high capacity magazines, prevent the unlawful transfer of firearms to those who cannot legally purchase them, and remove restrictions on, and provide dedicated funding for, research by federal agencies on prevention of firearms-related injuries and death. Specifically, the College urged passage of the Bipartisan Background Checks Act of 2019 (H.R. 8), which would strengthen the accuracy and reporting of the National Instant Criminal Background Check System (NICS) as well as expand Brady background checks to cover all firearm sales, including unlicensed firearms sellers currently not required to use background checks, and the Gun Violence Prevention Research Act (H.R. 674/S. 184), which would authorize funding for the Centers for Disease Control and Prevention (CDC) to study firearms safety and gun violence prevention. Also urged Congress to pass the Violence Against Women (VAWA) Reauthorization Act of 2019 (H.R. 1585), to provide protections for domestic violence victims by restricting access to firearms by those deemed a threat to them. Also urged Congress to pass the Assault Weapons Ban of 2019 (S. 66/H.R. 1296), to ban the sale of semi-automatic weapons and high capacity magazines. Immigration: The College advocated against family separation at the U.S. border. Specifically, the College urged support for H.R. 541 - the Keep Families Together Act, which would help ensure that children are not separated from their parents when families unlawfully cross over the border into the United States and would ensure that the Department of Homeland Security would not be able to implement the zero tolerance policy that separated families at the border last summer; urged congressional oversight of family separation policies. Also urged that Congress pass H.R. 6, the Dream and Promise Act of 2019, which would provide a pathway to U.S. citizenship for undocumented children who came to the United States due to the action of their parents, also known as Dreamers. Expressed concern to the U.S. Department of Homeland Security with the recent U.S. Citizenship and Immigration Service (USCIS) policy change to no longer accept or adjudicate non-military deferred action requests including those for individuals with serious medical conditions; Urged USCIS to reverse this decision immediately and resume consideration of deferred action requests for medical reasons; Opposed the proposed rule, U.S. Immigration and Customs Enforcement (ICE) Establishing a Fixed Time Period of Admission and an Extension of Stay Procedure for Nonimmigrant Academic Students, Exchange Visitors, and Representatives of Foreign Information Media. This rule would change the process to extend the period of authorized stay in the United States for certain categories of nonimmigrants by eliminating the long-standing "duration of status and replacing it with a specific end date. The College urged the Department of Homeland Security to exclude physicians in the Department of States (DOS) Exchange Visitor Program in J-1 visa status from this rule change because it will otherwise disrupt the training of thousands of physicians - physicians who already have been thoroughly vetted, already are serving on our nations health care teams, and already are carefully monitored during their time in the U.S. Graduate Medical Education: Urged that Congress support medical education training and debt relief for primary care physicians and other specialties facing shortages by passing the Resident Physician Shortage Reduction Act of 2019 (S. 348, H.R. 1763), to lift the GME caps as needed to permit training an adequate number of primary care physicians, including internal medicine specialists, and physicians in other specialties facing shortages; passing the Resident Education Deferred Interest Act (H.R. 1554), to save physicians in residency programs thousands of dollars in interest on their loans and help incentivize the opening of practices in underserved areas; pass legislation to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; support funding for GME/IME and programs within the Veterans Health Administration that provide graduate medical education to ensure that physicians are adequately trained with the skills needed to treat an aging population. Urged Congress to pass the Opioid Workforce Act of 2019 (H.R. 3414), which would provide Medicare support for an additional 1,000 graduate medical education (GME) positions over five years in hospitals that have, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry, or pain medicine. Urged Congress to pass S. 1203 and H.R. 2441, the What You Can Do For Your Country Act, which would improve and reform the Public Service Loan Forgiveness (PSLF) Program. Vaccines: Urged Congress to pass the Vaccines Act (HR 2862), which would provide federal funding for vaccine hesitancy surveillance at the Centers for Disease Control and Prevention (CDC), and outline a national public messaging campaign informed by this research to help improve vaccination rates; Supported H.R. 592, recognizing the anniversary of the eradication of smallpox and the importance of vaccination in the United States and worldwide; Urged the U.S. Department of Homeland Security (DHS) to reconsider its decision to not vaccinate families in the custody of U.S. Customs and Border Protection (CBP) against influenza (flu). Urged Congress to support payments for vaccines, as finalized by CMS, and set for implementation on Jan. 1, 2021. Surprise Medical Billing: Urged Congress to pass legislation that would protect patients from surprise out-of-network medical bills in both emergency and non-emergency settings that includes the following principles: hold patients harmless from surprise medical bills for out-of-network services, address narrow insurance networks, abandon efforts to establish an in-network median rate for services in these settings and instead opt for an independent dispute resolution process to determine payment. Appropriations: Urged Congress to fund Title VII, Section 747, Primary Care Training and Enhancement (PCTE) at $71 million for fiscal year 2021; Fund the Agency for Health Care Research and Quality (AHRQ) at $460 million for fiscal year 2021; Fund the National Health Service Corps (NHSC) at $830 million for fiscal year 2021; Fund the Title X Family Planning Program at $400 million for fiscal year 2021 and include language to remove barriers to care that interfere with the patient-physician relationship; Fund Research on Prevention of Firearms-related Injuries and Deaths at $50 million for Fiscal Year 2021; Fund the National Institutes of Health (NIH) at $44.7 billion for fiscal year 2021; Fund the Centers for Disease Control and Prevention (CDC) at $8.3 billion for fiscal year 2021; Urged the House and Senate Armed Services Committees to support provisions in any final FY2021 National Defense Authorization Act to prevent cuts to the Military Health Service and the military medical workforce without requiring appropriate congressional oversight and review. Physician Fee Schedule: Commented to CMS and to Congress to fully implement payment increases for all evaluation and management codes, as finalized by CMS, and as scheduled for implementation on Jan. 1, 2021. Reduce the documentation burden for E/M services by allowing choice of medical decision making or time, and work to develop additional clarity and guidance on acceptable documentation to operationalize these important proposals; examination room desktop computers should be counted as a direct medical equipment cost; care management should be promoted by increasing the values of services like Transitional Care Management (TCM) and Chronic Care Management and implementing Principle Care Management (PCM) codes; require additional survey and review for any requests to increase non-outpatient E/M or other services; work with the physician community prior to finalizing any policy affecting eligibility to participate in the Medicare program; Urged congressional committees of jurisdiction to support: Higher physician work relative value units (RVUs) for new and established office visit codes, leading to increased payments for them, Reduced documentation requirements for office visit codes, which enables physicians to select and document for each visit based on medical decision-making or total time, Expanded and improved payment for care management services. Urged Congress to support waiving budget neutrality, applicable to the calendar year 2021 physician fee schedule. COVID-19: Urged congressional appropriators to provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the virus that is commensurate with the public health emergency that the virus represents. Urged the administration to explore regulatory and other actions that would make COVID-19 testing free-of-charge to patients covered by both public and private insurance plans, including ACA-compliant plans offered through the insurance exchanges, and to waive co-pays and deductibles for patients seeing physicians for symptoms that may be indicative of COVID-19 or who are hospitalized for treatment. Urged CMS to utilize a national disaster recovery program that would pay doctors 110% of Medicare rates for caring for uninsured patients who have been infected with SARS-CoV-2. Expressed support to Congress and the administration for the Families First Coronavirus Response Act, H.R. 6201, and other stimulus reforms related to COVID-19 including: Emergency paid leave benefits, paid sick days for public health emergencies, coverage of testing for COVID-19, waiving of cost sharing under Medicare, Medicare Advantage, Medicaid, and CHIP, increasing the federal FMAP under Medicaid, providing reimbursement for CPT codes 99441 - 99443, which are telephone evaluation and management services, expediting entrance of international medical graduates who are citizens of other nations (non-US IMGs) into the country and ensuring that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic, funding for physician practices under the Public Health and Social Service Emergency Fund (PHSSEF), providing tax relief, grants, and loans to small and medium size practices impacted by COVID-19, increasing funding for personal protective equipment (PPE), ensuring Medicaid pay parity with Medicare for primary care services; Urged HHS and Congress to make a targeted allocation out of the Provider Relief Fund (PRF) to support primary care physicians and their practices, sufficient to keep their doors open, by offsetting lost revenue from the COVID-19 pandemic, similar to the targeted allocation for rural hospitals; Urged support for the Student Loan Forgiveness for Frontline Health Workers Act, H.R. 6720, introduced May 5, 2020 by Representative Carolyn B. Maloney (D-NY) which would eliminate graduate school debt for healthcare workers, including physicians and medical students, who are providing direct patient care in response to the COVID-19 pandemic; Urged support for H.R. 7059, the Coronavirus Provider Protection Act, which extend liability protections to those who provide care in good faith during the COVID-19 public health emergency (plus a reasonable time, such as 60 days, after the emergency declaration ends), and not in situations of gross negligence or willful misconduct. The College also urged that pay parity between telephone claims and in-person visits and between all telehealth and in-person visits be maintained after the PHE is lifted. This extension-either continued by CMS or mandated by Congress-should last at least through the end of 2021, or until such a time when effective vaccines and treatments are widely available, with an option to extend it even further, or consider making permanent, based on the experience and learnings of patients and physicians who are utilizing these visits. Urged Congress to support a targeted allocation from the Provider Relief Fund specifically for primary care services. Priorities for New Administration: Urged the incoming Biden Administration to identify and appoint physicians to health care leadership positions within your Administration. Implement approval, distribution, and funding of a safe and effective COVID-19 vaccine based on recommendations from the Advisory Committee on Immunization Practices (ACIP). Provide support to physicians and other frontline health care workers, including ensuring access and distribution of personal protective equipment (PPE) to health care workers. Fund COVID-19 testing and contact tracing efforts. Reverse regulations that allow the sale of extended short-term, limited duration plans, association health plans. Take action to defend the Affordable Care Act from any litigation, including California v. Texas, that would undermine coverage and patient protections. Expand premium tax credits and cost-sharing reductions. Establish a federal public option to inject competition into the health insurance marketplace. Expand Medicaid eligibility and oppose expansion waivers that limit benefits and apply high cost sharing. Permanently increase payment for Medicaid primary care services to the level of Medicare. Restore the Deferred Action for Childhood Arrivals, consistent with a recent ruling from a federal judge, and identify executive actions that can be taken to ensure that it is not vulnerable to being eliminated in the future. Pursue executive actions to preserve the principles of patient autonomy regarding reproductive decision-making rights. Reverse the Title X gag rule and restore funding to family planning clinics. Establish universal access to at least six weeks of paid family and medical leave that is flexible to accommodate care for a diverse array of family structures, including updating the Family Medical and Leave Act to include grandparents or in-laws. Re-introduce and pass the George Floyd Act and other legislation focused on eliminating racism and police violence. Rejoin the Paris Agreement.

Client expense: $91,236 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS)

Advocated for FY2021 Labor HHS Appropriations bill - appropriations related to strengthening the addiction services workforce, including full funding of the loan repayment program for the substance use disorder treatment workforce authorized in the SUPPORT Act, increase in funding for the mental and substance use disorders training demonstration program authorized in 21st Century Cures Act, funding for preventive medicine residency programs, and $8.8 billion for discretionary Health Resources and Services Administration programs. Supported HR 3414 (and prior versions)/ S. 2892 - Opioid Workforce Act of 2019 - bill increases the number of residency positions eligible for graduate medical education payments under Medicare for hospitals that have addiction or pain management programs, with an aggregate increase of 1,000 positions over a five-year period. Supported HR 3165 and S 1737 - Mental Health Parity Compliance Act - strengthen parity in mental health and substance use disorder benefits. Advocated for its inclusion in the Lower Health Care Costs Act of 2019. Supported S 873 and HR 1879 - Stabilize Medicaid and CHIP Coverage Act which would provide for 12 months of continuous enrollment in Medicaid and CHIP to ensure better access to care and reduce churn. This bill is not specific to mental health, but it would provide significant stability to those patients and providers. Supported H.R.1329 - Medicaid Reentry Act - This bill allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release. Supported HR 4974/S 4640: the MATE Act - to amend the Controlled Substances Act to require physicians and other prescribers of controlled substances to complete training on treating and managing patients with opioid and other substance use disorders (which shall also satisfy certain training required to receive a waiver for dispensing narcotic drugs for maintenance or detoxification treatment),and for other purposes. Supported a conditional endorsement of The Mainstreaming Addiction Treatment Act, which is contingent upon the elimination of DEA regulations on medications in Schedules III-V that are based on the prescribing intent to treat addiction and a requirement that all DEA controlled substance prescribers complete medical education on addiction. Supported the Humane Correctional Health Care Act , H.R. 4141/S. 2305, which would repeal the Medicaid Inmate Exclusion. The exclusion strips health coverage from Medicaid enrollees who are involved in the criminal justice system. Supported H.R. 3925, the Reducing Barriers to Substance Use Treatment Act, introduced by Representatives Paul Tonko (D-NY) and David McKinley (R-VA). The bill would prohibit state Medicaid programs, beginning in October 1, 2020, and ending September 30, 2025, from imposing prior authorizations or other types of utilization control policies or procedures on medications approved to treat OUD, including, with respect to the provision of those medications, counseling services and behavioral therapy. Supported HR 7593/S 4103, the TREATS Act, that would increase the use of telehealth for substance use disorder treatment, and for other purposes Advocated for at least $38.5B in emergency relief funds for mental health disorder and addiction treatment providers as a result of losses suffered due to COVID-19, as well as direct funding from SAMHSA to opioid treatment programs and qualified practice settings Advocated for an increase in the Federal Medical Assistance Percentage for Medicaid as a result of COVID-19 Supported the Improving Medicaid Programs Response to Overdose Victims and Enhancing (IMPROVE) Addiction Care Act which would require state Medicaid programs to use their existing drug utilization review (DUR) programs to increase access to addiction treatment and boost safeguards for those on Medicaid who have experienced a non-fatal, opioid-related overdose. Opposed passage of H.R. 884 / S. 2772, the Medicare Mental Health Access Act, which would change the definition of physician under the Medicare program to include clinical psychologists. Supported the Dr. Lorna Breen Health Care Provider Protection Act (S.4349). The legislation would greatly reduce and prevent suicide and mental and behavioral health conditions among health care professionals. Submitted comments on the Center for Medicare and Medicaid Services (CMS) Value in Opioid Use Disorder Treatment (Value in Treatment) Demonstration design. The 4-year demonstration program was authorized by section 6042 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). Supported additional research funding for NIAAA to study alcohol use related to the impact of COVID-19 Submitted comments on the proposed 2021 Medicare Physician Fee Schedule (MPFS). Comments stressed the importance of the Centers for Medicare and Medicaid Services altering the MPFS to expand access to treatment for as many beneficiaries suffering from substance use disorder (SUD) as possible by introducing new codes for telehealth, expanding the range of eligible disorders for the billing of certain bundled payments, and empowering ED clinicians through the creation of a new code. Submitted its response to the Centers for Medicare and Medicaid Services (CMS) Request for Information (RFI) on Electronic Prescribing of Controlled Substances (EPCS). The RFI solicited feedback from stakeholders about whether CMS should include exceptions to the electronic prescribing of controlled substances and under what circumstances, and whether CMS should impose penalties for noncompliance with this mandate in its rulemaking, and what those penalties should be. Submitted response to CMS supporting EPCS as a way to assure quality and reduce errors and fraud in the transmission of prescriptions from the prescribing health care practitioner to the dispensing pharmacist but recommending CMS consider the financial impact of this requirement on small practices that do not yet have electronic systems in place that allow for EPCS, and extend the waiver timeline as well as provide additional resources or incentives for these practices to adopt such technology. Urged Senate leadership to include $58 million for syringe services programs (SSPs) and other harm reduction service providers in the next COVID relief package. Supported H.R. 7286, the Quit Because of COVID-19 Act. This legislation would ensure that all Medicaid and Childrens Health Insurance Program (CHIP) enrollees have access to the full array of evidence-based tobacco cessation treatments. Supported includsion of S. 348, the Resident Physician Shortage Act, in the next COVID supplemental package Opposed passage of the MORE Act H.R. 3884, which would, among other things, remove cannabis from the list of controlled substances under the CSA. Provided comments on a draft Residential Substance Abuse Treatment (RSAT) bill Provided comments on CARA 2.0 legislation, S. 5000, related to prescriber education and curricula grants Joined coalition letter to FDA urging the Commissioner to commence rulemaking to prohibit menthol as characterizing flavor in cigarettes Discussions regarding draft legislation on Medicaid reimbursement for addition treatment providers and repeal of the IMD exclusion in Medicaid for residential addiction treatment Discussions regarding the EASY MAT Act, HR 2281, CBO score Submitted letter of support for S. 4612, the Methamphetamine Response Act, which would declare methamphetamine an emerging drug threst

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

Advocated for FY2021 Labor HHS Appropriations bill - appropriations related to strengthening the addiction services workforce, including full funding of the loan repayment program for the substance use disorder treatment workforce authorized in the SUPPORT Act, increase in funding for the mental and substance use disorders training demonstration program authorized in 21st Century Cures Act, funding for preventive medicine residency programs, and $8.8 billion for discretionary Health Resources and Services Administration programs. Supported HR 3414 (and prior versions)/ S. 2892 - Opioid Workforce Act of 2019 - bill increases the number of residency positions eligible for graduate medical education payments under Medicare for hospitals that have addiction or pain management programs, with an aggregate increase of 1,000 positions over a five-year period. Supported HR 3165 and S 1737 - Mental Health Parity Compliance Act - strengthen parity in mental health and substance use disorder benefits. Advocated for its inclusion in the Lower Health Care Costs Act of 2019. Supported S 873 and HR 1879 - Stabilize Medicaid and CHIP Coverage Act which would provide for 12 months of continuous enrollment in Medicaid and CHIP to ensure better access to care and reduce churn. This bill is not specific to mental health, but it would provide significant stability to those patients and providers. Supported H.R.1329 - Medicaid Reentry Act - This bill allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release. Supported HR 4974/S 4640: the MATE Act - to amend the Controlled Substances Act to require physicians and other prescribers of controlled substances to complete training on treating and managing patients with opioid and other substance use disorders (which shall also satisfy certain training required to receive a waiver for dispensing narcotic drugs for maintenance or detoxification treatment),and for other purposes. Supported a conditional endorsement of The Mainstreaming Addiction Treatment Act, which is contingent upon the elimination of DEA regulations on medications in Schedules III-V that are based on the prescribing intent to treat addiction and a requirement that all DEA controlled substance prescribers complete medical education on addiction. Supported the Humane Correctional Health Care Act , H.R. 4141/S. 2305, which would repeal the Medicaid Inmate Exclusion. The exclusion strips health coverage from Medicaid enrollees who are involved in the criminal justice system. Supported H.R. 3925, the Reducing Barriers to Substance Use Treatment Act, introduced by Representatives Paul Tonko (D-NY) and David McKinley (R-VA). The bill would prohibit state Medicaid programs, beginning in October 1, 2020, and ending September 30, 2025, from imposing prior authorizations or other types of utilization control policies or procedures on medications approved to treat OUD, including, with respect to the provision of those medications, counseling services and behavioral therapy. Supported HR 7593/S 4103, the TREATS Act, that would increase the use of telehealth for substance use disorder treatment, and for other purposes Advocated for at least $38.5B in emergency relief funds for mental health disorder and addiction treatment providers as a result of losses suffered due to COVID-19, as well as direct funding from SAMHSA to opioid treatment programs and qualified practice settings Advocated for an increase in the Federal Medical Assistance Percentage for Medicaid as a result of COVID-19 Supported the Improving Medicaid Programs Response to Overdose Victims and Enhancing (IMPROVE) Addiction Care Act which would require state Medicaid programs to use their existing drug utilization review (DUR) programs to increase access to addiction treatment and boost safeguards for those on Medicaid who have experienced a non-fatal, opioid-related overdose. Opposed passage of H.R. 884 / S. 2772, the Medicare Mental Health Access Act, which would change the definition of physician under the Medicare program to include clinical psychologists. Supported the Dr. Lorna Breen Health Care Provider Protection Act (S.4349). The legislation would greatly reduce and prevent suicide and mental and behavioral health conditions among health care professionals. Submitted comments on the Center for Medicare and Medicaid Services (CMS) Value in Opioid Use Disorder Treatment (Value in Treatment) Demonstration design. The 4-year demonstration program was authorized by section 6042 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). Supported additional research funding for NIAAA to study alcohol use related to the impact of COVID-19 Submitted comments on the proposed 2021 Medicare Physician Fee Schedule (MPFS). Comments stressed the importance of the Centers for Medicare and Medicaid Services altering the MPFS to expand access to treatment for as many beneficiaries suffering from substance use disorder (SUD) as possible by introducing new codes for telehealth, expanding the range of eligible disorders for the billing of certain bundled payments, and empowering ED clinicians through the creation of a new code. Submitted its response to the Centers for Medicare and Medicaid Services (CMS) Request for Information (RFI) on Electronic Prescribing of Controlled Substances (EPCS). The RFI solicited feedback from stakeholders about whether CMS should include exceptions to the electronic prescribing of controlled substances and under what circumstances, and whether CMS should impose penalties for noncompliance with this mandate in its rulemaking, and what those penalties should be. Submitted response to CMS supporting EPCS as a way to assure quality and reduce errors and fraud in the transmission of prescriptions from the prescribing health care practitioner to the dispensing pharmacist but recommending CMS consider the financial impact of this requirement on small practices that do not yet have electronic systems in place that allow for EPCS, and extend the waiver timeline as well as provide additional resources or incentives for these practices to adopt such technology. Urged Senate leadership to include $58 million for syringe services programs (SSPs) and other harm reduction service providers in the next COVID relief package. Supported H.R. 7286, the Quit Because of COVID-19 Act. This legislation would ensure that all Medicaid and Childrens Health Insurance Program (CHIP) enrollees have access to the full array of evidence-based tobacco cessation treatments. Supported includsion of S. 348, the Resident Physician Shortage Act, in the next COVID supplemental package Opposed passage of the MORE Act H.R. 3884, which would, among other things, remove cannabis from the list of controlled substances under the CSA. Provided comments on a draft Residential Substance Abuse Treatment (RSAT) bill Provided comments on CARA 2.0 legislation, S. 5000, related to prescriber education and curricula grants Joined coalition letter to FDA urging the Commissioner to commence rulemaking to prohibit menthol as characterizing flavor in cigarettes Discussions regarding draft legislation on Medicaid reimbursement for addition treatment providers and repeal of the IMD exclusion in Medicaid for residential addiction treatment Discussions regarding the EASY MAT Act, HR 2281, CBO score Submitted letter of support for S. 4612, the Methamphetamine Response Act, which would declare methamphetamine an emerging drug threst

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

Advocated for FY2021 Labor HHS Appropriations bill - appropriations related to strengthening the addiction services workforce, including full funding of the loan repayment program for the substance use disorder treatment workforce authorized in the SUPPORT Act, increase in funding for the mental and substance use disorders training demonstration program authorized in 21st Century Cures Act, funding for preventive medicine residency programs, and $8.8 billion for discretionary Health Resources and Services Administration programs. Supported HR 3414 (and prior versions)/ S. 2892 - Opioid Workforce Act of 2019 - bill increases the number of residency positions eligible for graduate medical education payments under Medicare for hospitals that have addiction or pain management programs, with an aggregate increase of 1,000 positions over a five-year period. Supported HR 3165 and S 1737 - Mental Health Parity Compliance Act - strengthen parity in mental health and substance use disorder benefits. Advocated for its inclusion in the Lower Health Care Costs Act of 2019. Supported S 873 and HR 1879 - Stabilize Medicaid and CHIP Coverage Act which would provide for 12 months of continuous enrollment in Medicaid and CHIP to ensure better access to care and reduce churn. This bill is not specific to mental health, but it would provide significant stability to those patients and providers. Supported H.R.1329 - Medicaid Reentry Act - This bill allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release. Supported HR 4974/S 4640: the MATE Act - to amend the Controlled Substances Act to require physicians and other prescribers of controlled substances to complete training on treating and managing patients with opioid and other substance use disorders (which shall also satisfy certain training required to receive a waiver for dispensing narcotic drugs for maintenance or detoxification treatment),and for other purposes. Supported a conditional endorsement of The Mainstreaming Addiction Treatment Act, which is contingent upon the elimination of DEA regulations on medications in Schedules III-V that are based on the prescribing intent to treat addiction and a requirement that all DEA controlled substance prescribers complete medical education on addiction. Supported the Humane Correctional Health Care Act , H.R. 4141/S. 2305, which would repeal the Medicaid Inmate Exclusion. The exclusion strips health coverage from Medicaid enrollees who are involved in the criminal justice system. Supported H.R. 3925, the Reducing Barriers to Substance Use Treatment Act, introduced by Representatives Paul Tonko (D-NY) and David McKinley (R-VA). The bill would prohibit state Medicaid programs, beginning in October 1, 2020, and ending September 30, 2025, from imposing prior authorizations or other types of utilization control policies or procedures on medications approved to treat OUD, including, with respect to the provision of those medications, counseling services and behavioral therapy. Supported HR 7593/S 4103, the TREATS Act, that would increase the use of telehealth for substance use disorder treatment, and for other purposes Advocated for at least $38.5B in emergency relief funds for mental health disorder and addiction treatment providers as a result of losses suffered due to COVID-19, as well as direct funding from SAMHSA to opioid treatment programs and qualified practice settings Advocated for an increase in the Federal Medical Assistance Percentage for Medicaid as a result of COVID-19 Supported the Improving Medicaid Programs Response to Overdose Victims and Enhancing (IMPROVE) Addiction Care Act which would require state Medicaid programs to use their existing drug utilization review (DUR) programs to increase access to addiction treatment and boost safeguards for those on Medicaid who have experienced a non-fatal, opioid-related overdose. Opposed passage of H.R. 884 / S. 2772, the Medicare Mental Health Access Act, which would change the definition of physician under the Medicare program to include clinical psychologists. Supported the Dr. Lorna Breen Health Care Provider Protection Act (S.4349). The legislation would greatly reduce and prevent suicide and mental and behavioral health conditions among health care professionals. Submitted comments on the Center for Medicare and Medicaid Services (CMS) Value in Opioid Use Disorder Treatment (Value in Treatment) Demonstration design. The 4-year demonstration program was authorized by section 6042 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). Supported additional research funding for NIAAA to study alcohol use related to the impact of COVID-19 Submitted comments on the proposed 2021 Medicare Physician Fee Schedule (MPFS). Comments stressed the importance of the Centers for Medicare and Medicaid Services altering the MPFS to expand access to treatment for as many beneficiaries suffering from substance use disorder (SUD) as possible by introducing new codes for telehealth, expanding the range of eligible disorders for the billing of certain bundled payments, and empowering ED clinicians through the creation of a new code. Submitted its response to the Centers for Medicare and Medicaid Services (CMS) Request for Information (RFI) on Electronic Prescribing of Controlled Substances (EPCS). The RFI solicited feedback from stakeholders about whether CMS should include exceptions to the electronic prescribing of controlled substances and under what circumstances, and whether CMS should impose penalties for noncompliance with this mandate in its rulemaking, and what those penalties should be. Submitted response to CMS supporting EPCS as a way to assure quality and reduce errors and fraud in the transmission of prescriptions from the prescribing health care practitioner to the dispensing pharmacist but recommending CMS consider the financial impact of this requirement on small practices that do not yet have electronic systems in place that allow for EPCS, and extend the waiver timeline as well as provide additional resources or incentives for these practices to adopt such technology. Urged Senate leadership to include $58 million for syringe services programs (SSPs) and other harm reduction service providers in the next COVID relief package. Supported H.R. 7286, the Quit Because of COVID-19 Act. This legislation would ensure that all Medicaid and Childrens Health Insurance Program (CHIP) enrollees have access to the full array of evidence-based tobacco cessation treatments. Supported includsion of S. 348, the Resident Physician Shortage Act, in the next COVID supplemental package Opposed passage of the MORE Act H.R. 3884, which would, among other things, remove cannabis from the list of controlled substances under the CSA. Provided comments on a draft Residential Substance Abuse Treatment (RSAT) bill Provided comments on CARA 2.0 legislation, S. 5000, related to prescriber education and curricula grants Joined coalition letter to FDA urging the Commissioner to commence rulemaking to prohibit menthol as characterizing flavor in cigarettes Discussions regarding draft legislation on Medicaid reimbursement for addition treatment providers and repeal of the IMD exclusion in Medicaid for residential addiction treatment Discussions regarding the EASY MAT Act, HR 2281, CBO score Submitted letter of support for S. 4612, the Methamphetamine Response Act, which would declare methamphetamine an emerging drug threst

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

Advocated for FY2021 Labor HHS Appropriations bill - appropriations related to strengthening the addiction services workforce, including full funding of the loan repayment program for the substance use disorder treatment workforce authorized in the SUPPORT Act, increase in funding for the mental and substance use disorders training demonstration program authorized in 21st Century Cures Act, funding for preventive medicine residency programs, and $8.8 billion for discretionary Health Resources and Services Administration programs. Supported HR 3414 (and prior versions)/ S. 2892 - Opioid Workforce Act of 2019 - bill increases the number of residency positions eligible for graduate medical education payments under Medicare for hospitals that have addiction or pain management programs, with an aggregate increase of 1,000 positions over a five-year period. Supported HR 3165 and S 1737 - Mental Health Parity Compliance Act - strengthen parity in mental health and substance use disorder benefits. Advocated for its inclusion in the Lower Health Care Costs Act of 2019. Supported S 873 and HR 1879 - Stabilize Medicaid and CHIP Coverage Act which would provide for 12 months of continuous enrollment in Medicaid and CHIP to ensure better access to care and reduce churn. This bill is not specific to mental health, but it would provide significant stability to those patients and providers. Supported H.R.1329 - Medicaid Reentry Act - This bill allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release. Supported HR 4974/S 4640: the MATE Act - to amend the Controlled Substances Act to require physicians and other prescribers of controlled substances to complete training on treating and managing patients with opioid and other substance use disorders (which shall also satisfy certain training required to receive a waiver for dispensing narcotic drugs for maintenance or detoxification treatment),and for other purposes. Supported a conditional endorsement of The Mainstreaming Addiction Treatment Act, which is contingent upon the elimination of DEA regulations on medications in Schedules III-V that are based on the prescribing intent to treat addiction and a requirement that all DEA controlled substance prescribers complete medical education on addiction. Supported the Humane Correctional Health Care Act , H.R. 4141/S. 2305, which would repeal the Medicaid Inmate Exclusion. The exclusion strips health coverage from Medicaid enrollees who are involved in the criminal justice system. Supported H.R. 3925, the Reducing Barriers to Substance Use Treatment Act, introduced by Representatives Paul Tonko (D-NY) and David McKinley (R-VA). The bill would prohibit state Medicaid programs, beginning in October 1, 2020, and ending September 30, 2025, from imposing prior authorizations or other types of utilization control policies or procedures on medications approved to treat OUD, including, with respect to the provision of those medications, counseling services and behavioral therapy. Supported HR 7593/S 4103, the TREATS Act, that would increase the use of telehealth for substance use disorder treatment, and for other purposes Advocated for at least $38.5B in emergency relief funds for mental health disorder and addiction treatment providers as a result of losses suffered due to COVID-19, as well as direct funding from SAMHSA to opioid treatment programs and qualified practice settings Advocated for an increase in the Federal Medical Assistance Percentage for Medicaid as a result of COVID-19 Supported the Improving Medicaid Programs Response to Overdose Victims and Enhancing (IMPROVE) Addiction Care Act which would require state Medicaid programs to use their existing drug utilization review (DUR) programs to increase access to addiction treatment and boost safeguards for those on Medicaid who have experienced a non-fatal, opioid-related overdose. Opposed passage of H.R. 884 / S. 2772, the Medicare Mental Health Access Act, which would change the definition of physician under the Medicare program to include clinical psychologists. Supported the Dr. Lorna Breen Health Care Provider Protection Act (S.4349). The legislation would greatly reduce and prevent suicide and mental and behavioral health conditions among health care professionals. Submitted comments on the Center for Medicare and Medicaid Services (CMS) Value in Opioid Use Disorder Treatment (Value in Treatment) Demonstration design. The 4-year demonstration program was authorized by section 6042 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). Supported additional research funding for NIAAA to study alcohol use related to the impact of COVID-19 Submitted comments on the proposed 2021 Medicare Physician Fee Schedule (MPFS). Comments stressed the importance of the Centers for Medicare and Medicaid Services altering the MPFS to expand access to treatment for as many beneficiaries suffering from substance use disorder (SUD) as possible by introducing new codes for telehealth, expanding the range of eligible disorders for the billing of certain bundled payments, and empowering ED clinicians through the creation of a new code. Submitted its response to the Centers for Medicare and Medicaid Services (CMS) Request for Information (RFI) on Electronic Prescribing of Controlled Substances (EPCS). The RFI solicited feedback from stakeholders about whether CMS should include exceptions to the electronic prescribing of controlled substances and under what circumstances, and whether CMS should impose penalties for noncompliance with this mandate in its rulemaking, and what those penalties should be. Submitted response to CMS supporting EPCS as a way to assure quality and reduce errors and fraud in the transmission of prescriptions from the prescribing health care practitioner to the dispensing pharmacist but recommending CMS consider the financial impact of this requirement on small practices that do not yet have electronic systems in place that allow for EPCS, and extend the waiver timeline as well as provide additional resources or incentives for these practices to adopt such technology. Urged Senate leadership to include $58 million for syringe services programs (SSPs) and other harm reduction service providers in the next COVID relief package. Supported H.R. 7286, the Quit Because of COVID-19 Act. This legislation would ensure that all Medicaid and Childrens Health Insurance Program (CHIP) enrollees have access to the full array of evidence-based tobacco cessation treatments. Supported includsion of S. 348, the Resident Physician Shortage Act, in the next COVID supplemental package Opposed passage of the MORE Act H.R. 3884, which would, among other things, remove cannabis from the list of controlled substances under the CSA. Provided comments on a draft Residential Substance Abuse Treatment (RSAT) bill Provided comments on CARA 2.0 legislation, S. 5000, related to prescriber education and curricula grants Joined coalition letter to FDA urging the Commissioner to commence rulemaking to prohibit menthol as characterizing flavor in cigarettes Discussions regarding draft legislation on Medicaid reimbursement for addition treatment providers and repeal of the IMD exclusion in Medicaid for residential addiction treatment Discussions regarding the EASY MAT Act, HR 2281, CBO score Submitted letter of support for S. 4612, the Methamphetamine Response Act, which would declare methamphetamine an emerging drug threst

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

Advocated for FY2021 Labor HHS Appropriations bill - appropriations related to strengthening the addiction services workforce, including full funding of the loan repayment program for the substance use disorder treatment workforce authorized in the SUPPORT Act, increase in funding for the mental and substance use disorders training demonstration program authorized in 21st Century Cures Act, funding for preventive medicine residency programs, and $8.8 billion for discretionary Health Resources and Services Administration programs. Supported HR 3414 (and prior versions)/ S. 2892 - Opioid Workforce Act of 2019 - bill increases the number of residency positions eligible for graduate medical education payments under Medicare for hospitals that have addiction or pain management programs, with an aggregate increase of 1,000 positions over a five-year period. Supported HR 3165 and S 1737 - Mental Health Parity Compliance Act - strengthen parity in mental health and substance use disorder benefits. Advocated for its inclusion in the Lower Health Care Costs Act of 2019. Supported S 873 and HR 1879 - Stabilize Medicaid and CHIP Coverage Act which would provide for 12 months of continuous enrollment in Medicaid and CHIP to ensure better access to care and reduce churn. This bill is not specific to mental health, but it would provide significant stability to those patients and providers. Supported H.R.1329 - Medicaid Reentry Act - This bill allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release. Supported HR 4974/S 4640: the MATE Act - to amend the Controlled Substances Act to require physicians and other prescribers of controlled substances to complete training on treating and managing patients with opioid and other substance use disorders (which shall also satisfy certain training required to receive a waiver for dispensing narcotic drugs for maintenance or detoxification treatment),and for other purposes. Supported a conditional endorsement of The Mainstreaming Addiction Treatment Act, which is contingent upon the elimination of DEA regulations on medications in Schedules III-V that are based on the prescribing intent to treat addiction and a requirement that all DEA controlled substance prescribers complete medical education on addiction. Supported the Humane Correctional Health Care Act , H.R. 4141/S. 2305, which would repeal the Medicaid Inmate Exclusion. The exclusion strips health coverage from Medicaid enrollees who are involved in the criminal justice system. Supported H.R. 3925, the Reducing Barriers to Substance Use Treatment Act, introduced by Representatives Paul Tonko (D-NY) and David McKinley (R-VA). The bill would prohibit state Medicaid programs, beginning in October 1, 2020, and ending September 30, 2025, from imposing prior authorizations or other types of utilization control policies or procedures on medications approved to treat OUD, including, with respect to the provision of those medications, counseling services and behavioral therapy. Supported HR 7593/S 4103, the TREATS Act, that would increase the use of telehealth for substance use disorder treatment, and for other purposes Advocated for at least $38.5B in emergency relief funds for mental health disorder and addiction treatment providers as a result of losses suffered due to COVID-19, as well as direct funding from SAMHSA to opioid treatment programs and qualified practice settings Advocated for an increase in the Federal Medical Assistance Percentage for Medicaid as a result of COVID-19 Supported the Improving Medicaid Programs Response to Overdose Victims and Enhancing (IMPROVE) Addiction Care Act which would require state Medicaid programs to use their existing drug utilization review (DUR) programs to increase access to addiction treatment and boost safeguards for those on Medicaid who have experienced a non-fatal, opioid-related overdose. Opposed passage of H.R. 884 / S. 2772, the Medicare Mental Health Access Act, which would change the definition of physician under the Medicare program to include clinical psychologists. Supported the Dr. Lorna Breen Health Care Provider Protection Act (S.4349). The legislation would greatly reduce and prevent suicide and mental and behavioral health conditions among health care professionals. Submitted comments on the Center for Medicare and Medicaid Services (CMS) Value in Opioid Use Disorder Treatment (Value in Treatment) Demonstration design. The 4-year demonstration program was authorized by section 6042 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). Supported additional research funding for NIAAA to study alcohol use related to the impact of COVID-19 Submitted comments on the proposed 2021 Medicare Physician Fee Schedule (MPFS). Comments stressed the importance of the Centers for Medicare and Medicaid Services altering the MPFS to expand access to treatment for as many beneficiaries suffering from substance use disorder (SUD) as possible by introducing new codes for telehealth, expanding the range of eligible disorders for the billing of certain bundled payments, and empowering ED clinicians through the creation of a new code. Submitted its response to the Centers for Medicare and Medicaid Services (CMS) Request for Information (RFI) on Electronic Prescribing of Controlled Substances (EPCS). The RFI solicited feedback from stakeholders about whether CMS should include exceptions to the electronic prescribing of controlled substances and under what circumstances, and whether CMS should impose penalties for noncompliance with this mandate in its rulemaking, and what those penalties should be. Submitted response to CMS supporting EPCS as a way to assure quality and reduce errors and fraud in the transmission of prescriptions from the prescribing health care practitioner to the dispensing pharmacist but recommending CMS consider the financial impact of this requirement on small practices that do not yet have electronic systems in place that allow for EPCS, and extend the waiver timeline as well as provide additional resources or incentives for these practices to adopt such technology. Urged Senate leadership to include $58 million for syringe services programs (SSPs) and other harm reduction service providers in the next COVID relief package. Supported H.R. 7286, the Quit Because of COVID-19 Act. This legislation would ensure that all Medicaid and Childrens Health Insurance Program (CHIP) enrollees have access to the full array of evidence-based tobacco cessation treatments. Supported includsion of S. 348, the Resident Physician Shortage Act, in the next COVID supplemental package Opposed passage of the MORE Act H.R. 3884, which would, among other things, remove cannabis from the list of controlled substances under the CSA. Provided comments on a draft Residential Substance Abuse Treatment (RSAT) bill Provided comments on CARA 2.0 legislation, S. 5000, related to prescriber education and curricula grants Joined coalition letter to FDA urging the Commissioner to commence rulemaking to prohibit menthol as characterizing flavor in cigarettes Discussions regarding draft legislation on Medicaid reimbursement for addition treatment providers and repeal of the IMD exclusion in Medicaid for residential addiction treatment Discussions regarding the EASY MAT Act, HR 2281, CBO score Submitted letter of support for S. 4612, the Methamphetamine Response Act, which would declare methamphetamine an emerging drug threst

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

Advocated for FY2021 Labor HHS Appropriations bill - appropriations related to strengthening the addiction services workforce, including full funding of the loan repayment program for the substance use disorder treatment workforce authorized in the SUPPORT Act, increase in funding for the mental and substance use disorders training demonstration program authorized in 21st Century Cures Act, funding for preventive medicine residency programs, and $8.8 billion for discretionary Health Resources and Services Administration programs. Supported HR 3414 (and prior versions)/ S. 2892 - Opioid Workforce Act of 2019 - bill increases the number of residency positions eligible for graduate medical education payments under Medicare for hospitals that have addiction or pain management programs, with an aggregate increase of 1,000 positions over a five-year period. Supported HR 3165 and S 1737 - Mental Health Parity Compliance Act - strengthen parity in mental health and substance use disorder benefits. Advocated for its inclusion in the Lower Health Care Costs Act of 2019. Supported S 873 and HR 1879 - Stabilize Medicaid and CHIP Coverage Act which would provide for 12 months of continuous enrollment in Medicaid and CHIP to ensure better access to care and reduce churn. This bill is not specific to mental health, but it would provide significant stability to those patients and providers. Supported H.R.1329 - Medicaid Reentry Act - This bill allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release. Supported HR 4974/S 4640: the MATE Act - to amend the Controlled Substances Act to require physicians and other prescribers of controlled substances to complete training on treating and managing patients with opioid and other substance use disorders (which shall also satisfy certain training required to receive a waiver for dispensing narcotic drugs for maintenance or detoxification treatment),and for other purposes. Supported a conditional endorsement of The Mainstreaming Addiction Treatment Act, which is contingent upon the elimination of DEA regulations on medications in Schedules III-V that are based on the prescribing intent to treat addiction and a requirement that all DEA controlled substance prescribers complete medical education on addiction. Supported the Humane Correctional Health Care Act , H.R. 4141/S. 2305, which would repeal the Medicaid Inmate Exclusion. The exclusion strips health coverage from Medicaid enrollees who are involved in the criminal justice system. Supported H.R. 3925, the Reducing Barriers to Substance Use Treatment Act, introduced by Representatives Paul Tonko (D-NY) and David McKinley (R-VA). The bill would prohibit state Medicaid programs, beginning in October 1, 2020, and ending September 30, 2025, from imposing prior authorizations or other types of utilization control policies or procedures on medications approved to treat OUD, including, with respect to the provision of those medications, counseling services and behavioral therapy. Supported HR 7593/S 4103, the TREATS Act, that would increase the use of telehealth for substance use disorder treatment, and for other purposes Advocated for at least $38.5B in emergency relief funds for mental health disorder and addiction treatment providers as a result of losses suffered due to COVID-19, as well as direct funding from SAMHSA to opioid treatment programs and qualified practice settings Advocated for an increase in the Federal Medical Assistance Percentage for Medicaid as a result of COVID-19 Supported the Improving Medicaid Programs Response to Overdose Victims and Enhancing (IMPROVE) Addiction Care Act which would require state Medicaid programs to use their existing drug utilization review (DUR) programs to increase access to addiction treatment and boost safeguards for those on Medicaid who have experienced a non-fatal, opioid-related overdose. Opposed passage of H.R. 884 / S. 2772, the Medicare Mental Health Access Act, which would change the definition of physician under the Medicare program to include clinical psychologists. Supported the Dr. Lorna Breen Health Care Provider Protection Act (S.4349). The legislation would greatly reduce and prevent suicide and mental and behavioral health conditions among health care professionals. Submitted comments on the Center for Medicare and Medicaid Services (CMS) Value in Opioid Use Disorder Treatment (Value in Treatment) Demonstration design. The 4-year demonstration program was authorized by section 6042 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). Supported additional research funding for NIAAA to study alcohol use related to the impact of COVID-19 Submitted comments on the proposed 2021 Medicare Physician Fee Schedule (MPFS). Comments stressed the importance of the Centers for Medicare and Medicaid Services altering the MPFS to expand access to treatment for as many beneficiaries suffering from substance use disorder (SUD) as possible by introducing new codes for telehealth, expanding the range of eligible disorders for the billing of certain bundled payments, and empowering ED clinicians through the creation of a new code. Submitted its response to the Centers for Medicare and Medicaid Services (CMS) Request for Information (RFI) on Electronic Prescribing of Controlled Substances (EPCS). The RFI solicited feedback from stakeholders about whether CMS should include exceptions to the electronic prescribing of controlled substances and under what circumstances, and whether CMS should impose penalties for noncompliance with this mandate in its rulemaking, and what those penalties should be. Submitted response to CMS supporting EPCS as a way to assure quality and reduce errors and fraud in the transmission of prescriptions from the prescribing health care practitioner to the dispensing pharmacist but recommending CMS consider the financial impact of this requirement on small practices that do not yet have electronic systems in place that allow for EPCS, and extend the waiver timeline as well as provide additional resources or incentives for these practices to adopt such technology. Urged Senate leadership to include $58 million for syringe services programs (SSPs) and other harm reduction service providers in the next COVID relief package. Supported H.R. 7286, the Quit Because of COVID-19 Act. This legislation would ensure that all Medicaid and Childrens Health Insurance Program (CHIP) enrollees have access to the full array of evidence-based tobacco cessation treatments. Supported includsion of S. 348, the Resident Physician Shortage Act, in the next COVID supplemental package Opposed passage of the MORE Act H.R. 3884, which would, among other things, remove cannabis from the list of controlled substances under the CSA. Provided comments on a draft Residential Substance Abuse Treatment (RSAT) bill Provided comments on CARA 2.0 legislation, S. 5000, related to prescriber education and curricula grants Joined coalition letter to FDA urging the Commissioner to commence rulemaking to prohibit menthol as characterizing flavor in cigarettes Discussions regarding draft legislation on Medicaid reimbursement for addition treatment providers and repeal of the IMD exclusion in Medicaid for residential addiction treatment Discussions regarding the EASY MAT Act, HR 2281, CBO score Submitted letter of support for S. 4612, the Methamphetamine Response Act, which would declare methamphetamine an emerging drug threst

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

Medicare, Medicaid, private insurance and other health care policies that impact patient access to hospital and physician care, including the "Resident Physician Shortage Reduction Act of 2019 (S. 348, H.R. 1763)", the "Lower Health Care Costs Act (S. 1895)", the "Opioid Workforce Act (H.R. 3414, S. 2892)", the "Ban Surprise Bill Act (H.R. 5800)", the "Consumer Protections Against Surprise Medical Bills Act (H.R. 5826)", the "Coronavirus Preparedness and Response Supplemental (H.R. 6074)", the "Families First Coronavirus Response Act (H.R. 6201)", the "Coronavirus Aid, Relief and Economic Security Act (H.R. 748)", the "Health and Economic Recovery Omnibus Emergency Solutions Act (H.R. 6800 and H.R 8406)", the "Paycheck Protection Program and Health Care Enhancement Act (H.R. 266)", the "Medicare Accelerated and Advance Payment Improvement Act (S. 3750, H.R. 6837)", the "Continuing Appropriations Act, 2021 and Other Extensions Act (H.R. 8337)", the "American Workers, Families and Employer Assistance Act (S.4318)", the "States Achieve Medicaid Expansion Act of 2019 (S.585)", the "Further Continuing Appropriations Act, 2021 and Other Extensions Act (H.R. 8900)", the Further Additional Continuing Appropriations Act, 2021 (H.J. Res. 107)", the "Extension of Continuing Appropriations Act, 2021 (H.J.Res 110)", the Consolidated Appropriations Act, 2021 (H.R. 133)", the "Medical Education for a Diverse America Act (H.R. 5432)", the "Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 (H.R. 8702, S. 5007)", and H.R. 8505 related to Medicare physician payment.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Resident Physcian Shortage Reduction Act Organ (liver) Transplant Allocation Site-Neutral Provider Reimbursement Graduate Medical Education (GME) HR 3414 - Opioid Workforce Act Surprise billing HR 133 Consolidated Appropriations Act 2021-Hospital Funding Issues

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

H.R. 1766/S.800- College Transparency Act; all provisions H.R. 7386/S.3611 - Faster Access to Federal Student Aid (FAFSA) Act of 2018 ; all provisions H.R. 4674 - The College Affordability Act; all provisionsS. 342/H.R. 2562 - Advancing International and Foreign Language Education Act; all provisions H.R. 3414- Opioid Workforce Act; all provisions H.R. 1804- Student-Athlete Equity Act; all provisions H.R. 5784 - the Supporting Minority STEM Student to Career ActAll Provisions

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

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

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: Educate Congress on the negative impact of the proposed Medicaid Fiscal Accountability Regulation (MFAR) and urge the administration to withdraw or delay the proposal 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. 1343, Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act Issue: Support expansion of Medicaid and CHIP coverage for postpartum women from current 90 days to 1 year. H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2020 Issue: Support expansion of Medicaid coverage for postpartum women. 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. 1763, S. 348, Resident Physician Shortage 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 Medicare 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. H.R. 5432, Medical Education for a Diverse America Act Issue: Ensure that time medical residents spend in unconscious bias training is counted toward the determination of FTE for Medicare GME Issue: Educate Congress on role of academic medicine as it relates to price disclosure 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) Issue: Support nominees for MedPAC

Client expense: $1,095,000 · 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), Federal Emergency Management Agency (FEMA), 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), Office of the Vice President of the United States, SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending 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 H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" S. 2543, "the Prescription Drug Pricing Reduction Act" H.R. 3235, "Access to Genetic Counseling Act" H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare Senate Health, Economic Assistance, Liability Protections and Schools (HEALS) Act H.R. 925, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROS Act 2.0) Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

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

Government targets: HOUSE OF REPRESENTATIVES, 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

Support HR 1763/ S 348, Resident Physician Shortage Reduction Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose HR 506,Hospital Competition Act of 2019, a bill to amend title XVIII of the Social Security Act to increase hospital competition; Statement submitted to the House Judiciary on the hearing "Diagnosing the Problem: Exploring the Effects of Consolidation and Anticompetitive Conduct in Health Care Markets";Letter of support for the Senate Workgroups efforts to ensure consumer protections by addressing surprise medical bills and comments on the development of legislation to protect patients from surprise medical bills; Letter urging Congress and the Administration to take further action to help reduce input and administrative costs, as well as maximize the number of insured patients; Support HR 965/ S340, Creating and Restoring Equal Access to Equivalent Samples Act of 2019 or the CREATES Act of 2019, a bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products; Support HR 986/ S466 Protecting Americans with Preexisting Conditions Act of 2019, a bill provide that certain guidance related to waivers for State innovation under the Patient Protection and Affordable Care Act shall have no force or effect; Support HR 987 Strengthening Health Care and Lowering Prescription Drug Costs Act, a bill to amend the Patient Protection and Affordable Care Act to provide for Federal Exchange outreach and educational activities; Support HR 938 Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act of 2019 or the BLOCKING Act of 2019, a bill to amend the Federal Food, Drug, and Cosmetic Act, with respect to eligibility for approval of a subsequent generic drug, to remove the barrier to that approval posed by the 180-day exclusivity period afforded to a first generic applicant that has not yet received final approval, and for other purposes; Support HR 1010, a bill to provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect; Support HR 1499 Protecting Consumer Access to Generic Drugs Act of 2019, a bill to prohibit brand name drug manufacturers from compensating generic drug manufacturers to delay the entry of a generic drug into the market, and to prohibit biological product manufacturers from compensating biosimilar and interchangeable product manufacturers to delay entry of biosimilar and interchangeable products, and for other purposes; Support HR 1425 State Health Care Premium Reduction Act, a bill to amend the Patient Protection and Affordable Care Act to provide for a Improve Health Insurance Affordability Fund to provide for certain reinsurance payments to lower premiums in the individual health insurance market; Support HR 1386/ S 1905 Expand Navigators Resources for Outreach, Learning, and Longevity Act of 2019 or the ENROLL Act of 2019,a bill to amend the Patient Protection and Affordable Care Act to provide for additional requirements with respect to the navigator program, and for other purposes; Support HR 1520 Purple Book Continuity Act of 2019, a bill to amend the Public Health Service Act to provide for the publication of a list of licensed biological products, and for other purposes; Support HR 1503 Orange Book Transparency Act of 2019A bill that would increase transparency for the patent status of both approved biological products and approved drugs; Support HR 2439/ HR 3414 Opioid Workforce Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis; Submitted statement to the House Committee on Ways and Means Overcoming Racial Disparities and Social Determinants in the Maternal Mortality Crisis sharing information regarding hospitals and health systems efforts to address maternal morbidity and mortality, as we seek ways to improve outcomes and reduce health inequities for expectant and new mothers, and give their children the best possible start in life; Submitted oral and written testimony to the House Committee on Ways and Means Subcommittee on Health Hearing on Protecting Patients from Surprise Medical Bills. Protecting patients from surprise medical bills is a top priority and we have adopted a set of guiding principles to use as we evaluate legislative proposals: Define surprise bills, Protect the patient financially, Ensure patient access to emergency care, Preserve the role of private negotiation, Remove the patient from health plan/provider negotiations, Educate patients about their health care coverage, Ensure patients have access to comprehensive provider networks and accurate network information, and Support state laws that work; Letters submitted to the Energy & Commerce Committee in response to the request for comments on their surprise billing discussion draft. Concerned with the Committees draft legislations approach to determining reimbursement for out-of-network providers. Once the patient is protected from surprise bills, providers and insurers should then be permitted to negotiate payment rates for services provided. We strongly oppose approaches that would impose arbitrary rates on providers. We look forward to continuing to work with the Committee on solutions to stop surprise medical bills; Letter sent to the HELP Committee in response to the Lower Health Care Costs Act of 2019 discussion draft about our concerns about several of the proposals that would allow the government to intrude into private commercial contracts between providers and insurers. For example, several of the provisions could undermine value-based purchasing arrangements aimed directly at improving the quality of care while reducing costs. We strongly urge the Committee to remove these provisions; Submitted oral and written testimony to the House Committee on Energy and Commerce, Subcommittee on Health Hearing on No More Surprises: Protecting Patients from Surprise Medical Bills asking that the Committee preserve the ability of providers and insurers to negotiate private contracts and not establish a fixed payment amount for out-of-network services; Oppose HR 1309 Workplace Violence Prevention for Health Care and Social Service Workers Act, a bill to direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan, and for other purposes; Concerns about S.1531, Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 or the STOP Surprise Medical Bills Act of 2019, to amend the Public Health Service Act to provide protections for health insurance consumers from surprise billing; Concerns about S. 1895 Lower Health Care Costs Act Letter addressed concerns about the legislative provision that sets a benchmark rate in statute for the out-of-network payments, as well as provisions that seek to change privately negotiated contracting arrangements between hospitals and insurance companies; Support HR 3425, Advancing Medical Resident Training in Community Hospitals Act of 2019, to amend title XVIII of the Social Security Act to establish rules for payment for graduate medical education (GME) costs for hospitals that establish a new medical residency training program after hosting resident rotators for short durations; Expressed concerns regarding the provisions that reduce reimbursements to providers and hospitals that administer drugs the Prescription Drug Pricing Reduction Act (PDPRA) of 2019: including about Section 107, Medicare Part B Rebate by Manufacturers for Drugs or Biologicals with Prices Increasing Faster than Inflation, Section 110, Establishment of Maximum Add-on Payment for Drugs, Biologicals, and Biosimilars, this provision would establish $1,000 as the maximum add-on amount that a provider can be paid for a separately payable drug, biological or biosimilar, Section 111, Treatment of Drug Administration Services Furnished by an Off-Campus Outpatient Department of a Provider, the site neutral payment reduction would cut aggregate hospital payments; Support S. 2091, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement Act, this legislation would increase the total number of employment-based visas from 140,000 to 270,000 and ensure that critical health care workers needed in the U.S. have access to employment-based visas by carving out health care workers in designated shortage occupations from the limit; Support S 350, The Competitive Health Insurance Reform Act of 2019, a bill to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; Submitted statement to Subcommittee on Health of the Committee on Energy and Commerce for the hearing on Improving Maternal Health: Legislation to Advance Prevention Efforts and Access to Care; Concerns with S. 386 and HR 1044, Fairness for High-Skilled Immigrants Act of 2019, this bill increases the per-country cap on family-based immigrant visas from 7% of the total number of such visas available that year to 15%, and eliminates the 7% cap for employment-based immigrant visas. It also removes an offset that reduced the number of visas for individuals from China; Support H.R. 4538, Closing Loopholes for Orphan Drugs Act, a bill to amend title III of the Public Health Service Act to limit the orphan drug exclusion under the drug discount program under section 340B of such title; Discussions of provisions we support and those we recommend be changes in a draft bill called the Mitigating Existing Drug Shortages (MEDS) Act; Discussions in support of the allowing states to designate hospitals as necessary providers for purposes of waiving the critical access hospital mileage requirements; Provided comments to W&M on legislation to expand Health Profession Opportunity Grants; Support S. 2723, The Mitigating Emergency Drug Shortages (MEDS) Act, a bill to amend Sec. 506C of the Federal Food, Drug, and Cosmetic Act which strengthens requirements for drug manufacturers to disclose the root causes and expected duration of shortages, extends reporting requirements to active pharmaceutical ingredients manufacturers, requires manufacturers have contingency plans to ensure ongoing supply, develops recommendations to incentivize manufacturers to enter the market for drugs in shortage and examines the national security risks of shortages; Discuss DEA reductions in annual quotas for opioid products used by hospitals for sedation and pain management; Meeting with the Office of the Assistant Secretary of Preparedness and Response (ASPR) to discuss developments in the hospital preparedness program, the pilot projects for the Regional Disaster Healthcare System and other issues; Rural access to health care, including identifying core services needed in rural communities, outlining approaches and considerations for delivering those services, and examining access and quality in the rural context; ONCs proposed rule to implement the 21st Century Cures provision on information blocking; Supported members serving on the HHS Quality Summit panel, which was convened by the Deputy Secretary to gather input regarding how to improve and energize quality and safety improvement activities across health care system; Discussion with HHS on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussion with HHS about the work of Aligning for Health to address social determinants of health; Support S 2902, Strengthening Our Rural Health Workforce Act of 2019, a bill to enhance the rural health workforce; Meetings and correspondence with staff members of Senate Financing Committee on a proposal to support rural health care access (REH, re-opening necessary provider CAH, infrastructure funding); Letter to Ways & Means committee Rural and Underserved Communities Health Task Force in response to RFI on factors that contribute to health outcomes in these areas, examples of successful models and lessons from the field that address access and outcomes, and considerations for the unique circumstances of rural and underserved communities; Letter to Energy and Commerce Members regarding health information technology priorities; Letter of Support to Senate Appropriations on funding for the Centers for Disease Control and Prevention and the National Institutes of Health to study gun violence; Support S.2741 and H.R. 4932,Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, a bill to amend title XVIII of the Social Security Act to expand access to telehealth services, and for other purposes; Support S 2603, Resolving Extended Limbo for Immigrant Employees and Families (RELIEF) Act, a bill to amend the Immigration and Nationality Act to end the immigrant visa backlog, and for other purposes; Support HR 4995, Maternal Health Quality Improvement Act of 2019, a bill to amend the Public Health Service Act to improve obstetric care and maternal health outcomes, and for other purposes; Concerns with HR 5800,Ban Surprise Billing Act, a bill to address surprise medical bills that relies on a median in-network rate to resolve out-of-network payments and allows for an independent dispute resolution process to determine the final payment. Concerned with the Committee's legislative approach to determining reimbursement for out-of-network providers. Oppose approaches that would impose arbitrary rates on providers, which could have significant consequences far beyond the scope of surprise medical bills. It is the insurers' responsibility to maintain comprehensive provider networks, and a default payment rate would remove incentives for health plans to contract with providers or to offer fair terms; Support HR 5826, Consumer Protections Against Surprise Medical Bills Act, a bill that prohibits providers from balance billing patients for emergency services or medical care the patient reasonably could have expected to be in-network, and from charging patients more than the in-network cost-sharing amount. Rather than rely on a benchmark payment rate to determine out-of-network reimbursement, the legislation provides a period for health plans and providers to negotiate out-of-network reimbursement, followed by a mediated dispute resolution process if necessary; Letter urging HHS to take regulatory actions to help hospitals and health systems prepare and respond to COVID-19; Letter requesting $100 billion to prepare and respond to COVID-19; Letter urging the Department of Labor to accurately define health care provider when promulgating regulations implementing key sections of the Families First Coronavirus Response Act; Letter sent to the President asking for the use of the Defense Production Act to increase the production of medical supplies and equipment; Letter to HHS regarding $100 billion emergency fund, asking HHS and CMS to directly and expediently distribute to rural and urban hospitals and health systems funds from the Public Health and Social Services Emergency Fund that were designated for providers in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act increased funding by $100 billion in order to reimburse eligible health care providers for health care-related expenses or lost revenues that are attributable to COVID-19. In the letter, we urged HHS and CMS to immediately distribute funding to all hospital types in the US - with additional funding going to COVID-19 hotspots; Letter urging Congress to modernize the Stafford Act as part of its next COVID-19 legislative package to allow all hospitals to recoup financial losses from this pandemic and future disasters; Letter to the Federal Reserve System, the Federal Deposit Insurance Corporation and the Office of the Comptroller of the Currency requesting they, as primary federal regulators for insured depository institutions, take prompt action to assist health care providers on the front line of the COVID-19 pandemic should the need to do so arise; Letter to the Secretary of the Treasury and the Federal Reserve Chair of the Board of Governors urging a supplement to the New Main Street Loan Facility term sheet with prompt guidance to ensure that access to this critically-necessary loan facility will be attainable for hospitals without delay; Letter was sent to the SBA urging it to ensure that small- and mid-size public hospitals, including those that have both nonprofit and public designations, are allowed to apply for and receive loans under the newly-authorized SBA Paycheck Protection Program; Letter in response to FEMAs request for input on establishing a voluntary agreement, under the Defense Production Act, of key private sector stakeholders relevant to responding to COVID-19, urging that such an agreement account for the full breadth of COVID-19 medical supply and equipment needs; Support H.R. 6474/S.3838 Healthcare Broadband Expansion During COVID-19 Act, a bill that would provide an additional $2 billion in funding for the FCC Rural Health Care program and increase the subsidy for health care providers from 65 to 85 percent. This legislation also simplifies the program to allow for more efficient application processes and disbursement of much needed funding; Support HR 6654 Emergency COVID-19 Telehealth Response Act, a bill that would codify an expanded list of providers to deliver and bill for telehealth services during the PHE; Support HR 7233Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, a bill that would require the Department of Health and Human Services and the Government Accountability Office (GAO) to conduct studies to provide information about the expanded use of telehealth during the COVID-19 pandemic; Letter to Senate HELP Committee in response to request for feedback on preparing for next pandemic; Discussion about telehealth waivers and flexibilities with HHS; Discussion about CARES provider relief fund distributions with HHS; Oppose HR 6559/ S 3677 COVID-19 Every Worker Protection Act of 2020, a bill to require the Occupational Safety and Health Administration to promulgate an emergency temporary standard to protect employees from occupational exposure to SARS-CoV-2, and for other purposes; Joint letter with ANA urging Congress to act quickly to get needed resources into the health care system, so that hospitals, nurses and physicians responding to COVID-19 are able to continue to provide treatments, front-line health care personnel are able to provide care and patients are able access health care services; Statement to Committee on Ways and Means for the hearing on The Disproportionate Impact of COVID-19 on Communities of Color urging Congress to employ the resources of the National Institute on Minority Health and Health Disparities - which is congressionally-mandated to coordinate the research of the other National Institutes of Healths centers and institutes related to minority health - to research and develop approaches to specifically address the COVID-19 needs of minority populations; Advocate with Congress for full forgiveness of COVID-19 related accelerated payments received by hospitals; Support S 3781Pharmaceutical Accountability, Responsibility, and Transparency (PART) Act, a bill to increase reporting of, help mitigate potential shortages related to, and promote, accountability and transparency for pharmaceuticals and medical devices; Support S 3780 Help Onshore Manufacturing Efficiencies (HOME) for Drugs and Devices Act, a bill to encourage domestic advanced manufacturing of critical drugs and devices in order to address economic, health, and security concerns, combat shortages of critical drugs and devices, and promote increased domestic diversification of, and independence from foreign reliance on, pharmaceutical and medical device supply chains; Support S.3763 Pandemic Responder Service Award Act, a bill to establish the Pandemic Responder Service Award program to express our gratitude to front-line health care workers; Support HR 6788/ S 3599 Healthcare Workforce Resilience Act, a bill to enhance our Nations nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas; Urged support for joint House and Senate letter to the Administration asking for flexibility for hospitals with respect to J-1 and H-1B visa programs; Letter to Senate Finance Committee to address the important issue of maternal health and the opportunity to provide suggestions regarding how to improve maternal health in this country; Support the Temporary Reciprocity to Ensure Access to Treatment Act, a bill that allows for the temporary reciprocity for treatment by medical professionals licensed in one state to patients in other states; Letter urging the Senate to include in the next COVID-19 relief bill provisions to strengthen the federal response for racial and ethnic minority and marginalized communities, which are disproportionately affected by the pandemic;Letter asking Congress to allocate as part of the next COVID-19 relief package at least an additional $100 billion to the emergency relief fund to provide direct funding to front line health care personnel and providers to continue to respond to this pandemic; Letter sent to HHS urging them to direct HRSA to take action to stop three drug manufacturers from limiting the distribution of 340B drugs to 340B covered entities. These drug manufacturers have taken separate actions to either limit the distribution of 340B drugs or require 340B covered entities provide claims level data for investigatory purposes if that 340B covered entity uses a contract pharmacy arrangement; Letter to the Congressional Leadership asking them to not to include in the next COVID-19 relief package any surprise medical billing legislation - such as a reimbursement rate set in statute - that would further destabilize hospitals finances during the pandemic; Support S 4507, Getting Early Treatment and Comprehensive Assessments Reduces Emergencies Act of 2020 or the GET CARE Act of 2020, a bill to amend the Public Health Service Act to provide for a national campaign to raise awareness of the importance of seeking preventive health services and the utilization of such services; Comment letter addressing concerns on the proposed rule from the Departments of the Treasury, Labor and Health and Human Services that would allow certain grandfathered health plans to increase patient cost-sharing beyond current limits, without losing their grandfathered status; Letter urging the Administration to work with the AHA and Congress to create a future for telehealth that allows not only clinicians, but also hospitals and health systems, to code and bill for virtual services. We further urge CMS and HHS to continue to provide hospitals with the flexibility for annual beneficiary consent to telehealth treatment to be obtained at the same time, and not necessarily before, services are furnished; Support HR 8061,Community Immunity During COVID-19 Act of 2020, a bill that would provide funding to state and local health departments to work with community providers and organizations to increase immunization rates for Advisory Committee on Immunization Practices (ACIP)-recommended vaccines during the COVID-19 public health emergency; Letter again expressing concern with recent actions taken by several major drug manufacturers to limit the distribution of certain 340B drugs to our hospital members. While we understand that the HRSA is further investigating these actions, we urge swift and decisive action to halt these pernicious tactics so as to prevent other manufacturers from following suit; Comment letter outlining our concerns about the ability of hospital systems to distribute provider relief funds among the parent and subsidiaries. HHS published certain FAQs that place problematic restrictions on the use of CARES Act provider relief fund dollars. Specifically, the FAQs restrict the ability of a hospital system to allocate the funds throughout its system where COVID-19 related expenses and lost revenues are occurring; Submitted comments in response to HRSAs RFI on Health Professional Shortage Area (HPSA) scoring. HPSA scores are important for rural hospitals and clinics ability to recruit physicians and other clinicians, namely from the National Health Service Corps (NHSC) program. Letter asking HHS to reinstate the COVID-19 Provider Relief Fund reporting requirements.

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

FDA regulation of Laboratory-Developed Tests (LDTs); H.R.3414/S.2892, Opioid Workforce Act of 2019.

Client expense: Not reported · Firm income: $20,000

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

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

Medicare-Graduate Medical Education HRSA THCGME Program Resident Physician Shortage Reduction Act of 2019 (H.R. 1763/S. 348) Rural Physician Workforce Production Act of 2019 (S. 289) Training the Next Generation of Primary Care Doctors Act of 2019 (H.R. 2815/S. 1191) Opioid Workforce Act of 2019 (H.R. 3414/S. 2892) Advancing Medical Resident Training in Community Hospitals Act of 2019 (H.R. 3425) Supporting Graduate Medical Education at Community Hospitals Act of 2019 (H.R. 3753/S. 2116) PPE to Address COVID-19 Pandemic Community Health Center Fund in COVID stimulus COVID-19 impact on health professions education COVID-19 impact on osteopathic medical education Coronavirus Health Care Worker Wellness Act (H.R. 7255) Restoring Rural Residencies Act of 2019 (S. 1240) Community and Public Health Programs Extension Act (S.192) Public health and public health infrastructure support in COVID-19 stimulus Title VII and Title VIII program support in COVID-19 stimulus Ensuring Understanding of COVID-19 to Protect Public Health Act (S. 3595/H.R. 6701) Indian Health Service Health Professions Tax Fairness Act (H.R. 6448/S. 2871) Building a Health Care Workforce for the Future Act (H.R. 7470) Dr. Lorna Breen Health Care Provider Protection Act (H.R. 8094/S. 4349) Addressing COVID-19 Health Disparities Act (H.R.8067) Debt and economic relief for frontline workers Federal funding for rural hospitals and physician practices impacted by COVID-19 Funding for federal research agencies to prevent and respond to pandemic-related disruptions to federally-funded research

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

opposition to DSH cuts, support increase to NIH funding and CHGME/GME funding, obtain repeal of the repeal of the imputed rural floor and work for legislative fix on impact of imputed rural floor. oppose cuts to 340B drug pricing program. support opioid workforce act of 2019 s2892/HR3414. support emergency hospital funding for covid19 related expenses and criteria for funding hospital including stimulus 1, stimulus 2, stimulus 3 and stimulus 4 legislation. Oppose new guidance on reporting on provider relief funds.

Client expense: Not reported · Firm income: Not reported

Government targets: 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)

H.R. 5201, Telemental Health Expansion Act of 2019, provisions relating to 1834(m) of the Social Security Act; geographic and originating sites H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019, all provisions H.R. 7391, Protect Telehealth Access Act of 2020, all provisions H.R. 7233, KEEP Telehealth Options Act of 2020, all provisions H.R. 7663, Protecting Access to Post-COVID-19 Telehealth Act of 2020, all provisions S. 4375, Telehealth Modernization Act, all provisions H.R. 1301, Mental Health Telemedicine Expansion Act, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 19, Lower Costs, More Cures Act of 2019, all provisions H.R. 3414, Opioid Workforce Act of 2019, all provisions H.R. 7791, Value in Health Care Act of 2020, all provisions H.R. 3107, Improving Seniors' Timely Access to Care Act of 2019, all provisions H.R. 6379, Take Responsibility for Workers and Families Act, provisions related to Medicare and Medicaid H.R. 6837, Medicare Accelerated and Advance Payments Improvement Act of 2020, all provisions S. 3750, Medicare Accelerated and Advance Payments Improvement Act of 2020, all provisions H.R. 7154, Outpatient Therapy Modernization and Stabilization Act, all provisions H.R. 6585, Equitable Data Collection and Disclosure on COVID-19 Act, all provisions H.R. 884, Medicare Mental Health Access Act, all provisions S. 2772, Medicare Mental Health Access Act, all provisions H.R. 945, Mental Health Access Improvement Act of 2019, all provisions H.R. 1763, Resident Physician Shortage Reduction Act of 2019, all provisions H.R. 6774, Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2020, all provisions H.R. 4004, Social Determinants Accelerator Act of 2019, all provisions H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2020, all provisions H.R. 6090, Physician Shortage GME Cap Flex Act of 2020, all provisions H.R. 913, CLINICAL TREATMENT Act, all provisions H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions S, 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions Medicare program: P.L. 113-93 Protecting Access to Medicare Act (PAMA), provisions relating to imaging appropriate use criteria Medicare program: Sequester exemption Medicare program: Laboratory developed tests for COVID-19/coverage Medicare program: Medicare for All Medicare program: CY 2021 Medicare Physician Fee Schedule/E&M/Budget Neutrality Medicare program: Inpatient Rehab Facility/Prospective Payment System (IRF/PPS)/Scope issues Medicare program: Public Health Emergency/Scope and licensure waivers sunset Medicare program: Medicare Advanced Payment Program improvements Medicare program: Regulatory Relief/Advanced Alternative Payment Models (APMs)/Prior authorization and utilization management Medicare program: Merit-based Incentive Payment System (MIPS)/Quality/cost/improvement activity/interoperability Medicare program: Program integrity Medicare program: Interoperability and data blocking Medicare program: Quality Payment Program/physician burdens Medicare program: Health IT physician burdens Medicare program: Open Payments Medicare program: PECOS Enrollment/Revalidation Medicare program: Graduate Medical Education/cap flexibility Medicare program: Diabetes Prevention Program Medicare program: MACRA/Alternative Payment Model (APM) bonus payments Medicare program: MACRA/radiation oncology payments Medicare program: Accelerated and Advance Payment Program/physician relief Medicare and Medicaid programs: Medicare Provider Relief Fund extension Medicare and Medicaid programs: 21st Century Cures Act/health data and privacy Medicare and Medicaid program: Electronic health record (EHR) certification Medicare and Medicaid programs: P.L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) Medicare and Medicaid programs: Accountable Care Organizations Medicare and Medicaid programs: Telehealth waivers Medicare and Medicaid programs: Qualifying APM Physician Thresholds Medicare and Medicaid programs: Opioid use disorder Medicare and Medicaid programs: Validated home blood pressure monitors/coverage Medicaid program: Federal Medical Assistance Percentages (FMAP) increases Medicaid program: Georgia's Section 1332 waiver

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Institutes of Health (NIH), Office of Natl Drug Control Policy (NDCP), President of the U.S., SENATE, State, Dept of (DOS), U.S. Immigration & Customs Enforcement (ICE), Veterans Affairs, Dept of (VA), White House Office

H.R. 1763: Resident Physician Shortage Reduction Act, entire bill. H.R. 3235: Access to Genetic Counselor Services Act, entire bill. H.R. 3414: Opioid Workforce Act of 2019, entire bill. H.R. 1897 and S. 916: Mothers and Offspring Mortality and Morbidity Awareness (MOMMA's) Act, entire bill. Issues related to GME, including for specialized fields such as oncofertility.

Client expense: $98,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1766/S.800- College Transparency Act; all provisions H.R. 7386/S.3611 - Faster Access to Federal Student Aid (FAFSA) Act of 2018 ; all provisions H.R. 4674 - The College Affordability Act; all provisionsS. 342/H.R. 2562 - Advancing International and Foreign Language Education Act; all provisions H.R. 3414- Opioid Workforce Act; all provisions H.R. 1804- Student-Athlete Equity Act; all provisions H.R. 5784 - the Supporting Minority STEM Student to Career ActAll Provisions

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

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

Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical Education Medicare bad debt payments Medicaid waivers Medicaid Expansion Issues Medicaid Disproportionate Share Hospital Payments Medicare Disproportionate Share Hospital Payments Legislation related to chronic care treatment Medicaid supplemental payments to hospitals Medicare site neutral payments for hospitals outpatient departments Legislation related to healthcare disparities Medicaid State Flexibility Medicaid 1115 & 1332 Waivers Upper Payment Limit payments State Financing of Medicaid Medicare Part B Cuts-OPPS proposed rule to 340B covered entities Hospital Price Transparency National Quality Forum Funding Medicaid & CHIP Coverage Medicaid Funding for Certified Community Behavioral Health Centers Medicaid Funding for Community-Based long-term care H.R.2328 - REACH Act H.R.3414 - Opioid Workforce Act of 2019 S.1699 - Prescription Drug Cost Reduction Act H.R.3 - Lower Drug Costs Now Act of 2019 S.348 - Resident Physician Shortage Reduction Act of 2019 H.R.1763 - Resident Physician Shortage Reduction Act of 2019 S.2648 - The Rural ACO Improvement Act H.R.4496 - Helping Medicaid Offer Maternity Services Act of 2019 S.2741 - Creating Opportunities Now for Necessary and Efficient Care Technologies for Health Act of 2019 Medicaid Fiscal Accountability Regulation H.R 748, Coronavirus Aid, Relief, and Economic Security (CARES) Act H.R. 6201, Families First Coronavirus Response Act H.R. 6074, Coronavirus Preparedness and Response Supplemental Appropriations Act H.R. 6379, Take Responsibility for Workers and Families Act H.R. 3, Elijah Cummings Lower Drug Costs Now Act H.R. 19, Lower Costs, More Cures Act S. 2543, Drug Pricing Reduction Act Social Determinants for Moms Act (H.R. 6132) IMPACT to Save Moms Act (H.R. 6137) Moms MATTER Act (H.R. 6143) Perinatal Workforce Act (H.R. 6164) Black Maternal Health Momnibus Act (S. 3424) Data to Save Moms Act (H.R. 6165) Social determinants of health HEROES Act Coronavirus Medicaid Response Act Federal Medical Assistance Percentage Telehealth Medicare Accelerated and Advance Payment Program H.R. 7663 - Protecting Access to Post-COVID-19 Telehealth Act of 2020 H.R.7791 - Value in Health Care Act of 2020 HR 4996, Helping MOMS Act

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

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