Protect Veterans from Financial Fraud Act of 2019

S.679-HAVEN Act;S.785John Scott Hannon Veterans Mental Health;HR2942-HEALTH Act; HR3813-Brian Tally VA Medical;HR3530-Housing for Blind Vets; HR 3640-Vets Ed; HR 3608-Underserved Vets; HR4165-Vet Newborn Care; HR2645-HOPE; HR4137-TEAM Caregiver Act; S.2216-Financial Fraud; HR592-Agent Orange;S.2966, Rural Vet Travel; HR6466,IDES;S.3575,school closures;S.3587, websites for disabled; S.646, MOH & POW burial; S.6322, Student coronavirus Response;HR6168,DIC;HR6157,GI Bill; S3408, Medical foster homes; HR5867, Vet suicide; HR 5697, Vets ACCESS Act; HR 5701, Caregiver; HR5724, SAVE Act; HR 4625, GI Bill;HR4824, Vets Back to Work; HR 4613, VA Transparency; HR 4085, Student Vet Empowerment;HR4370, Oxygen Therapy; HR 4477, Vets Service; HR 4154, Leave no Vets Behind; HR 4451, Care for vet with illness; HR 4503, VA workplace integrity; HR 4817, VA Opioid;HR 5009, Vet ed transfer; S.2950, Vet Burn Pit; HR 5028, Protect vet benefits; HR 5027, Vet mental Health; HR5030, Vet suicide. HR 7111, Retraining vets; S. 3888, Vets healthcare COVID-19; HR 7105 homeless vets; S. 3871, rural vets funeral; S. 3885, burn pit; HR 8105, Education Recognition; HR 8108, Mental Illness; HR 8033, Suicide Prevention; Infertility Treatment, HR8034; S 4334, Brando Act; S. 4365, Disability Examinations; HR 7811, VA Home Loan; HR 7441, VA Hiring Military Personnel;

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

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE, U.S. Coast Guard (USCG), Veterans Affairs, Dept of (VA)

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Pharmacy issues, prescription drug supply chain issues, drug shortages, prescription drug abuse and diversion; support for legislation to preserve patient access to oral oncolytics dispensed by community-based cancer clinics (H.R. 1316); DIR (H.R. 1038), advocacy related to ending retroactive direct and indirect renumeration fees levied on pharmacists; Provider status (H.R. 592), advocacy related to recognizing and reimbursing pharmacists for providing appropriate medical services; H.R. 6688, The Analyzing and Leveraging Existing Rx Transactions (ALERT) Act. H.R. 6880 - The Buy American Medical Supplies Act, Lower Drug Costs Now Act of 2019

Client expense: $230,000 · Firm income: Not reported

Pharmacy issues, prescription drug supply chain issues, drug shortages, prescription drug abuse and diversion; support for legislation to preserve patient access to oral oncolytics dispensed by community-based cancer clinics (H.R. 1316); DIR (H.R. 1038), advocacy related to ending retroactive direct and indirect renumeration fees levied on pharmacists; Provider status (H.R. 592), advocacy related to recognizing and reimbursing pharmacists for providing appropriate medical services; H.R. 6688, The Analyzing and Leveraging Existing Rx Transactions (ALERT) Act.

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

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

H.R. 95, the Homeless Veteran Families Act H.R. 96 H.R. 100, the Veteran Overmedication and Suicide Prevention Act of 2019 H.R. 299, the Blue Water Navy Vietnam Veterans Act of 2019 H.R. 444, the Reduce Unemployment for Veterans of All Ages Act of 2019 H.R. 445, the Help Hire Our Heroes Act H.R. 464 H.R. 485, the Veterans Reimbursement for Emergency Ambulance Services Act H.R. 561, the Preparing Business Opportunities for Veterans Act of 2019 H.R. 566, the Agent Orange Exposure Fairness Act H.R. 592, the Protect Veterans from Financial Fraud Act H.R. 663/S. 191, the Burn Pits Accountability Act H.R. 697 H.R. 712, the VA Medicinal Cannabis Research Act of 2019 H.R. 840, the Veterans Access to Child Care Act H.R. 1163/S. 902, the VA Hiring Enhancement Act H.R. 1271, the Veterans-Specific Education for Tomorrows Health Professionals Act of 2019 (VET HP Act) H.R. 1381/S. 554, the Burn Pit Registry Enhancement Act H.R. 1527, the Long Term Care Veterans Choice Act H.R. 1702, the Free Veterans from Fees Act H.R. 1718/S. 791, the GI Education Benefits Fairness Act H.R. 1721, the Veterans Healthcare Improvement Act H.R. 1722, the Build a Better VA Act H.R. 1749, the PFC Joseph P. Dwyer Peer Support Act H.R. 1750, the Supporting Veteran Families in Need Act H.R. 1911, the SFC Brian Woods Gold Star and Military Survivors Act H.R. 1963, the Expanding Care for Veterans Act H.R. 2045/S. 1003, the Veterans Education, Transition, and Opportunity Prioritization Plan Act of 2019 H.R. 2094/S. 1034, the CHAMPVA Childrens Care Protection Act of 2019 H.R. 2109, the Boosting Rates of American Veteran Employment (BRAVE) Act H.R. 2221/S. 1283, the Fry Scholarship Improvement Act of 2019 H.R. 2223, the Helping Homeless Veterans Act of 2019 H.R. 2224, the Homeless Veterans with Children Reintegration Act H.R. 2225 H.R. 2227/S. 1118, the Gold Star Spouses and Spouses of Injured Servicemembers Leasing Relief Expansion Act of 2019 H.R. 2333, the Support for Suicide Prevention Coordinators Act H.R. 2340, the Fostering Intergovernmental Health Transparency in Veterans Suicides Act H.R. 2398, the Veterans HOUSE Act H.R. 2435, the Accelerating Veterans Recovery Outdoors Act H.R. 2557, the Get Veterans a Doctor Now Act H.R. 2555, the Never Forgotten Korean War POW Act H.R. 2628, the VET CARE Act of 2019 H.R. 2645, the Newborn Care Improvement Act of 2019 H.R. 2681 H.R. 2716, the Protecting Gold Star Children Act of 2019 H.R. 2736, the Veterans Estate Transfer to Survivors Act H.R. 2752, the VA Newborn Emergency Treatment Act H.R. 2791, the Department of Veterans Affairs Tribal Advisory Committee Act of 2019 H.R. 2798, the Building Supportive Networks for Women Veterans Act H.R. 2803/S. 1461, the Access to Infertility Treatment and Care Act. H.R. 2816, the Vietnam-Era Veterans Hepatitis C Testing Enhancement Act of 2019 H.R. 2846, the Improving Veterans Access to Congressional Services Act H.R. 2866, the VA Community Infrastructure Act H.R. 2924, the Housing for Women Veterans Act H.R. 2934, the GI Bill Access to Career Credentials Act H.R. 2942/S. 3182, the HEALTH Act H.R. 2972 H.R. 2982, the Women Veterans Health Care Accountability Act H.R. 3010, the Honoring All Veterans Act H.R. 3036, the Breaking Barriers for Women Veterans Act H.R. 3083, the AIR Acceleration Act H.R. 3112, the For Profit Fraud Act H.R. 3221/S. 1047, the Dependency and Indemnity Compensation Improvement Act of 2019 H.R. 3224, the Deborah Sampson Act H.R. 3228, the VA Mission Telehealth Clarification Act H.R. 3350, the VA Emergency Transportation Act H.R. 3495, the IMPROVE Act H.R. 3504, the Ryan Kules Specially Adaptive Housing Improvement Act of 2019 H.R. 3535, the GI Bill Work Study Improvement Act of 2019 H.R. 3582 H.R. 3598, the FREED Vets Act H.R. 3636, the Caring for Our Women Veterans Act H.R. 3798, the Equal Access to Contraception for Veterans Act H.R. 3867, the Violence Against Women Veterans Act H.R. 4096, the Improving Oversight of Women Veterans' Care Act of 2019 H.R. 4138, the State Veterans Home Inspection Simplification Act H.R. 4154, the Leave No Veteran Behind Act H.R. 4182, the Women Veterans Support Act H.R. 4281, the ACCESS to Contraception Expansion for Veterans Act H.R. 4305, the Puppies Assisting Wounded Servicemembers (PAWS) for Veterans Therapy Act. H.R. 4334, the Improving Oversight of Women Veterans Care Act H.R. 4451, the Support Our Services to Veterans Caregivers Act H.R. 4526, the Brian Tally VA Employment Transparency Act H.R. 4554 H.R. 4588, the Modernizing VAs Records Management Program Act H.R. 4589 H.R. 4681, the National World War II Memorial Commemorative Coin Act H.R. 4748, the Justice for ALS Veterans Act of 2019 H.R. 4908, the Native American Veteran Parity in Access to Care Today Act H.R. 4920, the Department of Veterans Affairs Contracting Preference Consistency Act H.R. 4949, the VA Hospitals Establishing Leadership Performance Act H.R. 4985, the Veterans Residential Care Choice Act H.R. 5019, the Veterans Legal Support Act of 2019 H.R. 5030, the VA Suicide Prevention Services Accountability Act H.R. 5045, the Veteran Employment and Child Care Access Act H.R. 5048, the Fairness for Local Veteran Cemeteries Act H.R. 5245, the SHIELD for Veterans Act H.R. 5447 H.R. 5487, the Veterans Cemetery Grants Improvement Act H.R. 5610, the Fair Care for Vietnam Veterans Act H.R. 5639, the Chuck Osier Burial Benefits Act H.R. 5682, the Care for Veterans Act of 2020 H.R. 5697, the Veterans ACCESS Act of 2020 H.R. 5739, the Blast Exposure Protection Act H.R. 5750, the Streamlining GI Bill Processing Act of 2020 H.R. 5761, the Advancing Uniform Transportation Opportunities for Veterans (AUTO) Act H.R. 5766, the VET TEC Expansion Act H.R. 5724, the Same-Day Accountability for Veterans Enhancement Act H.R. 5781 H.R. 5867, the STOP Veteran Suicide and Substance Abuse Act H.R. 6013, the Veteran Families Financial Support Act H.R. 6039 H.R. 6060, the Veterans Burial Benefit Correction Act H.R. 6073 H.R. 6082, the Forgotten Vietnam Veterans Act H.R. 6092, the Veterans Prostate Cancer Treatment and Research Act H.R. 6141, the Protecting Moms Who Served Act H.R. 6157, the Transparency for Student Veterans Act H.R. 6168, the Veterans Compensation Cost-of-Living Adjustment Act of 2020 H.R. 6262, the Disabled Veterans Education Relief Act H.R. 6322, the Student Veteran Coronavirus Response Act of 2020 H.R. 6412 H.R. 6493, the Veterans Benefits Fairness and Transparency Act H.R. 6571, TEAM Veteran Caregivers Act H.R. 6589, the Department of Veterans Affairs Chief Financial Officer Authority and Collaboration Act of 2020 H.R. 6590 H.R. 6720, the Student Loan Forgiveness for Front-line Health Workers Act H.R. 6800, the Health and Economic Recovery Omnibus Emergency Solutions Act or the HEROES Act H.R. 6845, the No Coronavirus Copays for Veterans Act H.R.6933, the Caring for our Survivors Act of 2020 H.R. 6990, the Homeless Veterans CREDIT Act H.R. 7105, the DELIVER Act H.R. 7111/S. 3899, the Veterans Economic Recovery Act of 2020 H.R. 7163, the VA FOIA Reform Act of 2020 H.R. 7176, the Health Care Fairness for Military Families Act of 2020 H.R. 7287 H.R. 7443, the Veterans Claim Transparency Act of 2020 H.R. 7445 H.R. 7451 H.R. 7469, the Modernizing Veterans' Healthcare Eligibility Act H.R. 7504, the VA Clinical TEAM Culture Act of 2020 H.R. 7541, the VA Zero Suicide Demonstration Project Act H.R. 7727, the Burial Equity for Guards and Reserves Act of 2020 H.R. 7747, the VA Solid Start Reporting Act H.R. 7785 H.R. 7795, the Veterans Benefits Fairness and Transparency Act of 2020 H.R. 7879, the VA Telehealth Expansion Act H.R. 7888, the REACH VET Reporting Act H.R. 7926, the Ensuring Veterans Access Act H.R. 7964, the Peer Support for Veteran Families Act H.R. 8005, the Veterans Access to Online Treatment Act H.R. 8033, the Access to Suicide Prevention Coordinators Act H.R.8034, the Veterans Infertility Treatment Act of 2020 H.R. 8068, the American Indian and Alaska Native Veterans Mental Health Act H.R. 8084, the Lethal Means Safety Training Act H.R. 8107, the VA Emergency Department Safety Planning Act H.R. 8108, the VA Serious Mental Illness Act H.R. 8130, the VA Peer Specialists Act H.R. 8144, the VA Mental Health Staffing Improvement Act H.R. 8145, the VA Mental Health Counseling Act H.R. 8147, the TREAT Act H.R. 8148, the VA Data Analytics and Technology Assistance Act H.R. 8149, the VA Precision Medicine Act H.R. 8172, the VA Research Technology Act H.R. 8173, the VA High Altitude and Suicide Research Act H.R. 8212, the VA Expanded Care Hours (ECHO) Act H.R. 8237, the Protecting the Employment Rights of Servicemembers Act H.R. 8247, the Veterans COMPACT Act of 2020 H.R. 8257, the Transparency for Wounded Warriors Act H.R. 8261, the Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2020 H.R. 8483 H. Res. 107, the SFC Sean Cooley and SPC Christopher Horton Congressional Gold Star Family Fellowship Program Act H. Res. 698 H. Res. 729 H. Con. Res. 10 H.J. Res. 94 House Draft Bill, to amend title 38, United States Code, to direct the Secretary of Veterans Affairs to establish a list of drugs that require an increased level of informed consent House Draft Bill, the ANS for Veterans ACCESS Act House Draft Bill, the Ensuring Veterans Smooth Transition Act House Draft Bill, the VA Research Technology Act House Draft Bill, the Veterans Burn Pits Exposure Recognition Act of 2020 House Draft Bill, the Improving VA Accountability to Prevent Sexual Harassment Act of 2020 House Draft Bill, Find our Valor Act House Draft Bill, TAP Modernization House Draft Bill, Expand caregiver benefits House Draft Bill, Modify the Interagency Program Office House Draft Bill, Hear our Heroes Act House Draft Bill, Relief for Defrauded Students Act of 2019 House Draft Bill, Criminal penalties for individuals acting as agents or attorneys for VA claims House Draft Bill, to establish in the Department of Veterans Affairs the Office of Womens Health House Draft Bill, Grants for VSOs for ADA Compliance House Draft Bill, the Blast Exposure Protection Act of 2019 House Draft Bill, the Protecting Moms Who Served Act House Draft Bill, Oath of Exit Act House Draft Bill, to amend title 38, USC to improve the Edith Nourse Rogers STEM scholarship program House Draft Bill, Class Evaluation Act House Draft Bill, to provide for an extended time frame for certain students to find employment following completion of VA high technology education program and for other purposes House Draft Bill, to provide for the eligibility of members of the Armed Forces on terminal leave for the VA high technology education program House Draft Bill, to increase the frequency of benefits under the VAs automobile assistance program House Draft Bill, to authorize VA to provide or assist in providing a second vehicle adapted for operation by disabled individuals to certain eligible persons. House Draft Bill, to reduce the loan fees paid by certain veterans who have been affected by major disasters and are obtaining new loan guarantees, insured, or made by VA House Draft Bill, to provide for the treatment by VA of for-profit educational institutions converted to non-profit educational institutions House Draft Bill, Veteran Transition Technology Act House Draft Bill, Native VetSuccess on Tribal Colleges and Universities Pilot Program House Draft Bill, direct VA to conduct consumer testing to improve the VAs internet website that provides individuals with postsecondary education information House Draft Bill, to clarify the location of an educational institution conducting programs of education exclusively by distance learning for purposes of the VA approval process House Draft Bill, to make certain improvements to educational assistance administered by VA and to the Transition Assistance Program and Skillbridge program of the Department of Defense House Draft Bill, Reducing Veteran Homelessness Act of 2020 House Draft Bill, Authorize VA to enter into a memorandum of understanding with the Secretary of Health and Human Services to coordinate case management services for veterans receiving housing vouchers under Tribal HUD-VASH program House Draft Bill, to authorize VA to reimburse a recipient of a certain grant, made by the Secretary relating to homeless veterans, the fee to use the homeless management information system House Draft Bill, to make a technical correction to clarify that colleges and universities located outside the United States may participate in the VA Yellow Ribbon Program House Draft Bill, to rename VAs Vocational Rehabilitation Program as the Vocational Readiness and Employment Program House Draft Bill, VA Vocational Rehabilitation and Employment program reform House Draft Bill, VA Spinal Cord Injury and Disorders nurse specialty pay House Draft Bill, regarding technical qualifications for licensed hearing aid specialists and appointment of such specialists House Draft Bill, to increase rates of VAs Aid and Attendance by 25 percent during the COVID-19 emergency House Draft Bill, to suspend the time limitation for the use of certain educational assistance by veterans, servicemembers, and their dependents House Draft Bill, to toll certain deadlines relating to claims for VA benefits during the emergency period resulting from the COVID-19 pandemic House Draft Bill, to improve VAs travel mileage rates House Draft Bill, the VA Community Care Act House Draft Bill, the VA Clinical TEAM Culture Act S. 123, the Ensuring Quality Care for our Veterans Act S. 179/H.R. 712, the VA Medicinal Cannabis Research Act of 2019 S. 221, the VA Provider Accountability Act S. 318, the VA Newborn Emergency Treatment Act S. 319, the Women Veterans and Families Health Services Act of 2019 S. 322, the Agent Orange Exposure Fairness Act S. 408, the Veterans Disability Compensation Automatic COLA Act of 2019 S. 450, the Veterans Improved Access and Care Act of 2019 S. 524, the Department of Veterans Affairs Tribal Advisory Committee Act of 2019 S. 598, the BRAVE Act of 2019 S. 679, the Honoring American Veterans in Extreme Need Act (HAVEN) of 2019 S. 760, the Support for Veterans in Effective Apprenticeships Act of 2019 S. 785, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act and amendments S. 850, the Highly Rural Veteran Transportation Program Extension Act S. 1003, the Veterans' Education, Transition, and Opportunity Prioritization Plan Act of 2019 S. 1101, the Better Examiner Standards and Transparency for Veterans Act of 2019 S. 1316, the Wounded Warrior Research Enhancement Act S. 1563, the Janey Ensminger Act of 2019 S. 1934, the Parity in Veterans Health Care Rights Act S. 2022, the Paul Benne Specially Adaptive Housing Improvement Act of 2019 S. 2027 S. 2049 S. 2061, the Veterans Housing Opportunities and Unemployment Support Extension Act of 2019 S. 2216, the Transparency and Effective Accountability Measures (TEAM) for Veteran Caregivers Act S. 2336, the Department of Veterans Affairs Information Technology Reform Act of 2019 S. 2594, the Veterans Preference Parity Act S. 2822, the Post-9/11 Veteran Suicide Prevention Counseling Act S. 2864, the Sergeant Daniel Somers Veterans Network of Support Act of 2019 S. 2944, the Better and Robust Screening Today (BRST) Act S. 2950, the Veterans Burn Pits Exposure Recognition Act of 2019 S. 2966, the Rural Veterans Travel Enhancement Act of 2019 S. 3020, the Veteran Support and Outreach Act S. 2864, the Sergeant Daniel Somers Veterans Network of Support S. 3084 S. 3089 the BUILD for Veterans Act of 2019 S. 3091, the Justice for ALS Veterans Act S. 3110, the Identifying Barriers and Best Practices Study Act of 2019 S. 3224, the VA Research Approval Efficiency Act of 2020 S. 3393 S. 3587, the Department of Veterans Affairs Website Accessibility Act of 2019 S. 3761, the Veterans Claim Transparency Act of 2020 S. 3788, the Veterans Cemetery Grants Improvement Act of 2020 S. 3854, the Leasing Relief for Dependents of Fallen Heroes and Injured Servicemembers Act S. 3899, the Veterans Economic Recovery Act of 2020 S. 3925 S. 4002, the Servicemember Student Loan Affordability Act S. 4149 S. 4393, the TEAM Act of 2020 S. 4412, the Veterans Benefits Fairness and Transparency Act of 2020 S. 4511, the Veteran Benefits Enhancement and Expansion Act of 2020 S. 4545, the VA Zero Suicide Demonstration Project Act of 2020 S. 4572, the Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2020 S. 4594, the Caring for the Survivors and Families of Veterans Act of 2020 Senate Draft Bill, the Veterans Educational Assistance Transparency and Accountability Improvement Act of 2020 Senate Draft Bill, VA Provider Accountability Act Senate Draft Bill, extending the authority of VA to continue to pay educational assistance or subsistence allowances to eligible persons when educational institutions are temporarily closed, and for other purposes Senate Draft Bill, the Enhancing Veterans Access to Legal Services Act of 2019 or the EVALS Act of 2019 Senate Draft Bill, the Protection and Advocacy for Veterans Act Senate Draft Bill, to improve the ability of veterans to access and submit VA disability benefit questionnaire forms Senate Draft Bill, the Veterans Exposure to Toxic Substances Act of 2020 Senate Draft Bill, the Vets Benefits Fair Transparency Act Implementation of P.L. 113-146, the Veterans Access, Choice, and Accountability Act Implementation of P.L. 115-55, the Veterans Appeals Improvement and Modernization Act of 2017 Implementation of P.L. 115-48, the Harry W. Colmery Veterans Educational Assistance Act of 2017 Implementation of P.L. 115-182, the VA MISSION Act of 2018 Implementation of P.L. 115-41, the Department of Veterans Affairs Accountability & Whistleblower Protection Act Implementation of P.L. 116-123, the Blue Water Navy Vietnam Veterans Act of 2019 Implementation of P.L. 116-154, the Ryan Kules and Paul Benne Specially Adaptive Housing Improvement Act of 2019 Discussions on women veterans health care Discussions regarding reducing veterans and servicemembers suicide rates Discussions regarding improved access to IVF Discussions of improved access to VA long-term services and supports, including caregiver supports Discussions regarding the Transition Assistance Program Discussed collection of veterans demographic information to research potential benefits and services disparities Discussions regarding delay in implementation of the AIR Act provisions of P.L. 115-182 Discussions regarding improving access to adaptive automobiles for catastrophically disabled veterans

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. Pilot test 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, to take effect in 2020, 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. 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; Advocated with regard to a complaint filed with the Department of Homeland Security Office of the Inspector General (OIG) on September 14, 2020 concerning Lack of Medical Care, Unsafe Work Practices, and Absence of Adequate Protection Against COVID-19 for Detained Immigrants and Employees Alike at the Irwin County Detention Center. The concerns raised in the complaint, if substantiated, would represent an alarming violation of patient autonomy and ethical standards governing informed consent, appropriate access to health care and appropriate protection against COVID-19, causing great harm. The College urged an immediate internal investigation followed by swift and decisive corrective action as warranted should the complaint be substantiated. 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. Health IT and Telehealth: Urged that physicians be able to easily access accurate and reliable COVID-19 testing results from the various testing sites and labs. These results must contain the appropriate flags for review and should be received in standard formats, ideally within physicians existing health IT systems. The current eCase reporting to public health agencies process is time-consuming and duplicative, and EHR functionality to do eCase reporting varies widely across vendors and state public health departments. HHS should take a leadership role in making sure these programs and health IT standards projects are adopted and implemented consistently across the country. Ensure federally qualified health centers and rural health clinics can furnish telehealth services after the public health emergency.

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. Pilot test 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, to take effect in 2020, 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. 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; Advocated with regard to a complaint filed with the Department of Homeland Security Office of the Inspector General (OIG) on September 14, 2020 concerning Lack of Medical Care, Unsafe Work Practices, and Absence of Adequate Protection Against COVID-19 for Detained Immigrants and Employees Alike at the Irwin County Detention Center. The concerns raised in the complaint, if substantiated, would represent an alarming violation of patient autonomy and ethical standards governing informed consent, appropriate access to health care and appropriate protection against COVID-19, causing great harm. The College urged an immediate internal investigation followed by swift and decisive corrective action as warranted should the complaint be substantiated. 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. Health IT and Telehealth: Urged that physicians be able to easily access accurate and reliable COVID-19 testing results from the various testing sites and labs. These results must contain the appropriate flags for review and should be received in standard formats, ideally within physicians existing health IT systems. The current eCase reporting to public health agencies process is time-consuming and duplicative, and EHR functionality to do eCase reporting varies widely across vendors and state public health departments. HHS should take a leadership role in making sure these programs and health IT standards projects are adopted and implemented consistently across the country. Ensure federally qualified health centers and rural health clinics can furnish telehealth services after the public health emergency.

S.679-HAVEN Act;S.785John Scott Hannon Veterans Mental Health;HR2942-HEALTH Act; HR3813-Brian Tally VA Medical;HR3530-Housing for Blind Vets; HR 3640-Vets Ed; HR 3608-Underserved Vets; HR4165-Vet Newborn Care; HR2645-HOPE; HR4137-TEAM Caregiver Act; S.2216-Financial Fraud; HR592-Agent Orange;S.2966, Rural Vet Travel; HR6466,IDES;S.3575,school closures;S.3587, websites for disabled; S.646, MOH & POW burial; S.6322, Student coronavirus Response;HR6168,DIC;HR6157,GI Bill; S3408, Medical foster homes; HR5867, Vet suicide; HR 5697, Vets ACCESS Act; HR 5701, Caregiver; HR5724, SAVE Act; HR 4625, GI Bill;HR4824, Vets Back to Work; HR 4613, VA Transparency; HR 4085, Student Vet Empowerment;HR4370, Oxygen Therapy; HR 4477, Vets Service; HR 4154, Leave no Vets Behind; HR 4451, Care for vet with illness; HR 4503, VA workplace integrity; HR 4817, VA Opioid;HR 5009, Vet ed transfer; S.2950, Vet Burn Pit; HR 5028, Protect vet benefits; HR 5027, Vet mental Health; HR5030, Vet suicide. HR 7111, Retraining vets; S. 3888, Vets healthcare COVID-19; HR 7105 homeless vets; S. 3871, rural vets funeral; S. 3885, burn pit; HR 8105, Education Recognition; HR 8108, Mental Illness; HR 8033, Suicide Prevention; Infertility Treatment, HR8034; S 4334, Brando Act; S. 4365, Disability Examinations; HR 7811, VA Home Loan; HR 7441, VA Hiring Military Personnel;

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

Pharmacy issues, prescription drug supply chain issues, drug shortages, prescription drug abuse and diversion; support for legislation to preserve patient access to oral oncolytics dispensed by community-based cancer clinics (H.R. 1316); DIR (H.R. 1038), advocacy related to ending retroactive direct and indirect renumeration fees levied on pharmacists; Provider status (H.R. 592), advocacy related to recognizing and reimbursing pharmacists for providing appropriate medical services; H.R. 6688, The Analyzing and Leveraging Existing Rx Transactions (ALERT) Act.

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

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

H.R. 95, the Homeless Veteran Families Act H.R. 96 H.R. 100, the Veteran Overmedication and Suicide Prevention Act of 2019 H.R. 299, the Blue Water Navy Vietnam Veterans Act of 2019 H.R. 444, the Reduce Unemployment for Veterans of All Ages Act of 2019 H.R. 445, the Help Hire Our Heroes Act H.R. 464 H.R. 485, the Veterans Reimbursement for Emergency Ambulance Services Act H.R. 561, the Preparing Business Opportunities for Veterans Act of 2019 H.R. 566, the Agent Orange Exposure Fairness Act H.R. 592, the Protect Veterans from Financial Fraud Act H.R. 663/S. 191, the Burn Pits Accountability Act H.R. 712, the VA Medicinal Cannabis Research Act of 2019 H.R. 840, the Veterans Access to Child Care Act H.R. 1163/S. 902, the VA Hiring Enhancement Act H.R. 1271, the Veterans-Specific Education for Tomorrows Health Professionals Act of 2019 (VET HP Act) H.R. 1381/S. 554, the Burn Pit Registry Enhancement Act H.R. 1527, the Long Term Care Veterans Choice Act H.R. 1718/S. 791, the GI Education Benefits Fairness Act H.R. 1721, the Veterans Healthcare Improvement Act H.R. 1722, the Build a Better VA Act H.R. 1749, the PFC Joseph P. Dwyer Peer Support Act H.R. 1750, the Supporting Veteran Families in Need Act H.R. 1911, the SFC Brian Woods Gold Star and Military Survivors Act H.R. 1963, the Expanding Care for Veterans Act H.R. 2045/S. 1003, the Veterans Education, Transition, and Opportunity Prioritization Plan Act of 2019 H.R. 2094/S. 1034, the CHAMPVA Childrens Care Protection Act of 2019 H.R. 2109, the Boosting Rates of American Veteran Employment (BRAVE) Act H.R. 2221/S. 1283, the Fry Scholarship Improvement Act of 2019 H.R. 2223, the Helping Homeless Veterans Act of 2019 H.R. 2224, the Homeless Veterans with Children Reintegration Act H.R. 2225 H.R. 2227/S. 1118, the Gold Star Spouses and Spouses of Injured Servicemembers Leasing Relief Expansion Act of 2019 H.R. 2333, the Support for Suicide Prevention Coordinators Act H.R. 2340, the Fostering Intergovernmental Health Transparency in Veterans Suicides Act H.R. 2398, the Veterans HOUSE Act H.R. 2435, the Accelerating Veterans Recovery Outdoors Act H.R. 2557, the Get Veterans a Doctor Now Act H.R. 2555, the Never Forgotten Korean War POW Act H.R. 2628, the VET CARE Act of 2019 H.R. 2645, the Newborn Care Improvement Act of 2019 H.R. 2681 H.R. 2716, the Protecting Gold Star Children Act of 2019 H.R. 2736, the Veterans Estate Transfer to Survivors Act H.R. 2752, the VA Newborn Emergency Treatment Act H.R. 2791, the Department of Veterans Affairs Tribal Advisory Committee Act of 2019 H.R. 2798, the Building Supportive Networks for Women Veterans Act H.R. 2803/S. 1461, the Access to Infertility Treatment and Care Act. H.R. 2816, the Vietnam-Era Veterans Hepatitis C Testing Enhancement Act of 2019 H.R. 2846, the Improving Veterans Access to Congressional Services Act H.R. 2866, the VA Community Infrastructure Act H.R. 2924, the Housing for Women Veterans Act H.R. 2934, the GI Bill Access to Career Credentials Act H.R. 2942/S. 3182, the HEALTH Act H.R. 2972 H.R. 2982, the Women Veterans Health Care Accountability Act H.R. 3010, the Honoring All Veterans Act H.R. 3036, the Breaking Barriers for Women Veterans Act H.R. 3083, the AIR Acceleration Act H.R. 3112, the For Profit Fraud Act H.R. 3221/S. 1047, the Dependency and Indemnity Compensation Improvement Act of 2019 H.R. 3224, the Deborah Sampson Act H.R. 3228, the VA Mission Telehealth Clarification Act H.R. 3350, the VA Emergency Transportation Act H.R. 3495, the IMPROVE Act H.R. 3504, the Ryan Kules Specially Adaptive Housing Improvement Act of 2019 H.R. 3535, the GI Bill Work Study Improvement Act of 2019 H.R. 3598, the FREED Vets Act H.R. 3636, the Caring for Our Women Veterans Act H.R. 3798, the Equal Access to Contraception for Veterans Act H.R. 3867, the Violence Against Women Veterans Act H.R. 4096, the Improving Oversight of Women Veterans' Care Act of 2019 H.R. 4138, the State Veterans Home Inspection Simplification Act H.R. 4154, the Leave No Veteran Behind Act H.R. 4182, the Women Veterans Support Act H.R. 4281, the ACCESS to Contraception Expansion for Veterans Act H.R. 4305, the Puppies Assisting Wounded Servicemembers (PAWS) for Veterans Therapy Act. H.R. 4334, the Improving Oversight of Women Veterans Care Act H.R. 4451, the Support Our Services to Veterans Caregivers Act H.R. 4526, the Brian Tally VA Employment Transparency Act H.R. 4554 H.R. 4588, the Modernizing VAs Records Management Program Act H.R. 4589 H.R. 4681, the National World War II Memorial Commemorative Coin Act H.R. 4748, the Justice for ALS Veterans Act of 2019 H.R. 4908, the Native American Veteran Parity in Access to Care Today Act H.R. 4920, the Department of Veterans Affairs Contracting Preference Consistency Act H.R. 4949, the VA Hospitals Establishing Leadership Performance Act H.R. 4985, the Veterans Residential Care Choice Act H.R. 5030, the VA Suicide Prevention Services Accountability Act H.R. 5045, the Veteran Employment and Child Care Access Act H.R. 5447, to provide certain veterans with nonarticulating trailers H.R. 5610, the Fair Care for Vietnam Veterans Act H.R. 5682, the Care for Veterans Act of 2020 H.R. 5697, the Veterans ACCESS Act of 2020 H.R. 5739, the Blast Exposure Protection Act H.R. 5750, the Streamlining GI Bill Processing Act of 2020 H.R. 5761, the Advancing Uniform Transportation Opportunities for Veterans (AUTO) Act H.R. 5766, the VET TEC Expansion Act H.R. 5724, the Same-Day Accountability for Veterans Enhancement Act H.R. 5781 H.R. 6013, the Veteran Families Financial Support Act H.R. 6073 H.R. 6092, the Veterans Prostate Cancer Treatment and Research Act H.R. 6157, the Transparency for Student Veterans Act H.R. 6168, the Veterans Compensation Cost-of-Living Adjustment Act of 2020 H.R. 6262, the Disabled Veterans Education Relief Act H.R. 6322, the Student Veteran Coronavirus Response Act of 2020 H.R. 6412 H.R.6493, the Veterans Benefits Fairness and Transparency Act H.R. 6571, TEAM Veteran Caregivers Act H.R. 6590 H.R. 6720, the Student Loan Forgiveness for Front-line Health Workers Act H.R. 6800, the Health and Economic Recovery Omnibus Emergency Solutions Act or the HEROES Act H.R. 6845, the No Coronavirus Copays for Veterans Act H.R.6933, the Caring for our Survivors Act of 2020 H.R. 6990, the Homeless Veterans CREDIT Act H.R. 7111/S. 3899, the Veterans Economic Recovery Act of 2020 H.R. 7176, the Health Care Fairness for Military Families Act of 2020 H.R. 7451 H. Res. 107, the SFC Sean Cooley and SPC Christopher Horton Congressional Gold Star Family Fellowship Program Act H. Res. 698 H. Res. 729 H. Con. Res. 10 House Draft Bill, Find our Valor Act House Draft Bill, TAP Modernization House Draft Bill, Expand caregiver benefits House Draft Bill, Modify the Interagency Program Office House Draft Bill, Hear our Heroes Act House Draft Bill, Relief for Defrauded Students Act of 2019 House Draft Bill, Criminal penalties for individuals acting as agents or attorneys for VA claims House Draft Bill, to establish in the Department of Veterans Affairs the Office of Womens Health House Draft Bill, Grants for VSOs for ADA Compliance House Draft Bill, the Blast Exposure Protection Act of 2019 House Draft Bill, the Protecting Moms Who Served Act House Draft Bill, Oath of Exit Act House Draft Bill, to amend title 38, USC to improve the Edith Nourse Rogers STEM scholarship program House Draft Bill, Class Evaluation Act House Draft Bill, to provide for an extended time frame for certain students to find employment following completion of VA high technology education program and for other purposes House Draft Bill, to provide for the eligibility of members of the Armed Forces on terminal leave for the VA high technology education program House Draft Bill, to increase the frequency of benefits under the VAs automobile assistance program House Draft Bill, to authorize VA to provide or assist in providing a second vehicle adapted for operation by disabled individuals to certain eligible persons. House Draft Bill, to reduce the loan fees paid by certain veterans who have been affected by major disasters and are obtaining new loan guarantees, insured, or made by VA House Draft Bill, to provide for the treatment by VA of for-profit educational institutions converted to non-profit educational institutions House Draft Bill, Veteran Transition Technology Act House Draft Bill, Native VetSuccess on Tribal Colleges and Universities Pilot Program House Draft Bill, direct VA to conduct consumer testing to improve the VAs internet website that provides individuals with postsecondary education information House Draft Bill, to clarify the location of an educational institution conducting programs of education exclusively by distance learning for purposes of the VA approval process House Draft Bill, to make certain improvements to educational assistance administered by VA and to the Transition Assistance Program and Skillbridge program of the Department of Defense House Draft Bill, Reducing Veteran Homelessness Act of 2020 House Draft Bill, Authorize VA to enter into a memorandum of understanding with the Secretary of Health and Human Services to coordinate case management services for veterans receiving housing vouchers under Tribal HUD-VASH program House Draft Bill, to authorize VA to reimburse a recipient of a certain grant, made by the Secretary relating to homeless veterans, the fee to use the homeless management information system House Draft Bill, to make a technical correction to clarify that colleges and universities located outside the United States may participate in the VA Yellow Ribbon Program House Draft Bill, to rename VAs Vocational Rehabilitation Program as the Vocational Readiness and Employment Program House Draft Bill, VA Vocational Rehabilitation and Employment program reform House Draft Bill, VA Spinal Cord Injury and Disorders nurse specialty pay House Draft Bill, regarding technical qualifications for licensed hearing aid specialists and appointment of such specialists House Draft Bill, to increase rates of VAs Aid and Attendance by 25 percent during the COVID-19 emergency House Draft Bill, to suspend the time limitation for the use of certain educational assistance by veterans, servicemembers, and their dependents House Draft Bill, to toll certain deadlines relating to claims for VA benefits during the emergency period resulting from the COVID-19 pandemic House Draft Bill, to improve VAs travel mileage rates House Draft Bill, the VA Community Care Act House Draft Bill, the VA Clinical TEAM Culture Act S. 123, the Ensuring Quality Care for our Veterans Act S. 179/H.R. 712, the VA Medicinal Cannabis Research Act of 2019 S. 221, the VA Provider Accountability Act S. 318, the VA Newborn Emergency Treatment Act S. 319, the Women Veterans and Families Health Services Act of 2019 S. 322, the Agent Orange Exposure Fairness Act S. 408, the Veterans Disability Compensation Automatic COLA Act of 2019 S. 450, the Veterans Improved Access and Care Act of 2019 S. 524, the Department of Veterans Affairs Tribal Advisory Committee Act of 2019 S. 598, the BRAVE Act of 2019 S. 679, the Honoring American Veterans in Extreme Need Act (HAVEN) of 2019 S. 760, the Support for Veterans in Effective Apprenticeships Act of 2019 S. 785, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act and amendments S. 850, the Highly Rural Veteran Transportation Program Extension Act S. 1003, the Veterans' Education, Transition, and Opportunity Prioritization Plan Act of 2019 S. 1101, the Better Examiner Standards and Transparency for Veterans Act of 2019 S. 1316, the Wounded Warrior Research Enhancement Act S. 1563, the Janey Ensminger Act of 2019 S. 1934, the Parity in Veterans Health Care Rights Act S. 2022, the Paul Benne Specially Adaptive Housing Improvement Act of 2019 S. 2027 S. 2049 S. 2061, the Veterans Housing Opportunities and Unemployment Support Extension Act of 2019 S. 2216, the Transparency and Effective Accountability Measures (TEAM) for Veteran Caregivers Act S. 2336, the Department of Veterans Affairs Information Technology Reform Act of 2019 S. 2594, the Veterans Preference Parity Act S. 2822, the Post-9/11 Veteran Suicide Prevention Counseling Act S. 2864, the Sergeant Daniel Somers Veterans Network of Support Act of 2019 S. 2944, the Better and Robust Screening Today (BRST) Act S. 2950, the Veterans Burn Pits Exposure Recognition Act of 2019 S. 2966, the Rural Veterans Travel Enhancement Act of 2019 S. 3020, the Veteran Support and Outreach Act S. 2864, the Sergeant Daniel Somers Veterans Network of Support S. 3084 S. 3089 the BUILD for Veterans Act of 2019 S. 3091, the Justice for ALS Veterans Act S. 3110, the Identifying Barriers and Best Practices Study Act of 2019 S. 3224, the VA Research Approval Efficiency Act of 2020 S. 3393 S. 3761, the Veterans Claim Transparency Act of 2020 S. 3788, the Veterans Cemetery Grants Improvement Act of 2020 S. 3854, the Leasing Relief for Dependents of Fallen Heroes and Injured Servicemembers Act S. 3925 S. 4002, the Servicemember Student Loan Affordability Act S. 4149 Senate Draft Bill, VA Provider Accountability Act Senate Draft Bill, extending the authority of VA to continue to pay educational assistance or subsistence allowances to eligible persons when educational institutions are temporarily closed, and for other purposes Senate Draft Bill, the Enhancing Veterans Access to Legal Services Act of 2019 or the EVALS Act of 2019 Senate Draft Bill, the Protection and Advocacy for Veterans Act Senate Draft Bill, to improve the ability of veterans to access and submit VA disability benefit questionnaire forms Senate Draft Bill, the Veterans Exposure to Toxic Substances Act of 2020 Senate Draft Bill, the Vets Benefits Fair Transparency Act Implementation of P.L. 113-146, the Veterans Access, Choice, and Accountability Act Implementation of P.L. 115-55, the Veterans Appeals Improvement and Modernization Act of 2017 Implementation of P.L. 115-48, the Harry W. Colmery Veterans Educational Assistance Act of 2017 Implementation of P.L. 115-182, the VA MISSION Act of 2018 Implementation of P.L. 115-41, the Department of Veterans Affairs Accountability & Whistleblower Protection Act Implementation of P.L. 116-123, the Blue Water Navy Vietnam Veterans Act of 2019 Discussions on women veterans health care Discussions regarding reducing veterans and servicemembers suicide rates Discussions regarding improved access to IVF Discussions of improved access to VA long-term services and supports, including caregiver supports Discussions regarding the Transition Assistance Program Discussed collection of veterans demographic information to research potential benefits and services disparities Discussions regarding delay in implementation of the AIR Act provisions of P.L. 115-182

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. Pilot test 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, to take effect in 2020, 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. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically, the College urged Congress to develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expand cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introduce legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care. Urged that Congress pass the Protecting Pre-existing Conditions and Making Health Care More Affordable Act of 2019 (H.R. 1884), which strengthens and expands tax credits; stops skimpy health plans that do not cover essential benefits and that discriminate against people with pre-existing conditions; and provides funding for reinsurance programs. 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; Urged that the E/M documentation requirements in the FY2019 Physician Fee Schedule should be implemented immediately and not coupled with the E/M payment policy reforms planned for 2021. 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. 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). 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. Physician Fee Schedule: Commented to CMS on its 2020 fee schedule final rule to: finalize E/M codes, current Procedural Terminology (CPT) guidelines, and RUC recommended values exactly as implemented by the CPT Editorial Panel and submitted by the RUC; finalize proposals to 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. 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. Health IT and Telehealth: Urged that physicians be able to easily access accurate and reliable COVID-19 testing results from the various testing sites and labs. These results must contain the appropriate flags for review and should be received in standard formats, ideally within physicians existing health IT systems. The current eCase reporting to public health agencies process is time-consuming and duplicative, and EHR functionality to do eCase reporting varies widely across vendors and state public health departments. HHS should take a leadership role in making sure these programs and health IT standards projects are adopted and implemented consistently across the country. Ensure federally qualified health centers and rural health clinics can furnish telehealth services after the public health emergency. Veterans Issues: Urged the Secretary of the VA to amend Directive 1899 as it relates to allowing non-physician healthcare professionals in 32 specialties to operate within the full scope of their license, registration, or certification and rescind the Memorandum as it relates to encouraging all VA medical facilities to allow CRNAs to practice without physician oversight during the national health emergency.

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. Pilot test 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, to take effect in 2020, 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. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically, the College urged Congress to develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expand cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introduce legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care. Urged that Congress pass the Protecting Pre-existing Conditions and Making Health Care More Affordable Act of 2019 (H.R. 1884), which strengthens and expands tax credits; stops skimpy health plans that do not cover essential benefits and that discriminate against people with pre-existing conditions; and provides funding for reinsurance programs. 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; Urged that the E/M documentation requirements in the FY2019 Physician Fee Schedule should be implemented immediately and not coupled with the E/M payment policy reforms planned for 2021. 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. 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). 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. Physician Fee Schedule: Commented to CMS on its 2020 fee schedule final rule to: finalize E/M codes, current Procedural Terminology (CPT) guidelines, and RUC recommended values exactly as implemented by the CPT Editorial Panel and submitted by the RUC; finalize proposals to 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. 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. Health IT and Telehealth: Urged that physicians be able to easily access accurate and reliable COVID-19 testing results from the various testing sites and labs. These results must contain the appropriate flags for review and should be received in standard formats, ideally within physicians existing health IT systems. The current eCase reporting to public health agencies process is time-consuming and duplicative, and EHR functionality to do eCase reporting varies widely across vendors and state public health departments. HHS should take a leadership role in making sure these programs and health IT standards projects are adopted and implemented consistently across the country. Ensure federally qualified health centers and rural health clinics can furnish telehealth services after the public health emergency. Veterans Issues: Urged the Secretary of the VA to amend Directive 1899 as it relates to allowing non-physician healthcare professionals in 32 specialties to operate within the full scope of their license, registration, or certification and rescind the Memorandum as it relates to encouraging all VA medical facilities to allow CRNAs to practice without physician oversight during the national health emergency.

S.679-HAVEN Act;S.785John Scott Hannon Veterans Mental Health;HR2942-HEALTH Act; HR3813-Brian Tally VA Medical;HR3530-Housing for Blind Vets; HR 3640-Vets Ed; HR 3608-Underserved Vets; HR4165-Vet Newborn Care; HR2645-HOPE; HR4137-TEAM Caregiver Act; S.2216-Financial Fraud; HR592-Agent Orange;S.2966, Rural Vet Travel; HR6466,IDES;S.3575,school closures;S.3587, websites for disabled; S.646, MOH & POW burial; S.6322, Student coronavirus Response;HR6168,DIC;HR6157,GI Bill; S3408, Medical foster homes; HR5867, Vet suicide; HR 5697, Vets ACCESS Act; HR 5701, Caregiver; HR5724, SAVE Act; HR 4625, GI Bill;HR4824, Vets Back to Work; HR 4613, VA Transparency; HR 4085, Student Vet Empowerment;HR4370, Oxygen Therapy; HR 4477, Vets Service; HR 4154, Leave no Vets Behind; HR 4451, Care for vet with illness; HR 4503, VA workplace integrity; HR 4817, VA Opioid;HR 5009, Vet ed transfer; S.2950, Vet Burn Pit; HR 5028, Protect vet benefits; HR 5027, Vet mental Health; HR5030, Vet suicide. HR 7111, Retraining vets; S. 3888, Vets healthcare COVID-19; HR 7105 homeless vets; S. 3871, rural vets funeral; S. 3885, burn pit;

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

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S.679-HAVEN Act;S.785John Scott Hannon Veterans Mental Health;HR2942-HEALTH Act; HR3813-Brian Tally VA Medical;HR3530-Housing for Blind Vets; HR 3640-Vets Ed; HR 3608-Underserved Vets; HR4165-Vet Newborn Care; HR2645-HOPE; HR4137-TEAM Caregiver Act; S.2216-Financial Fraud; HR592-Agent Orange;S.2966, Rural Vet Travel; HR6466,IDES;S.3575,school closures;S.3587, websites for disabled; S.646, MOH & POW burial; S.6322, Student coronavirus Response;HR6168,DIC;HR6157,GI Bill; S3408, Medical foster homes; HR5867, Vet suicide; HR 5697, Vets ACCESS Act; HR 5701, Caregiver; HR5724, SAVE Act; HR 4625, GI Bill;HR4824, Vets Back to Work; HR 4613, VA Transparency; HR 4085, Student Vet Empowerment;HR4370, Oxygen Therapy; HR 4477, Vets Service; HR 4154, Leave no Vets Behind; HR 4451, Care for vet with illness; HR 4503, VA workplace integrity; HR 4817, VA Opioid;HR 5009, Vet ed transfer; S.2950, Vet Burn Pit; HR 5028, Protect vet benefits; HR 5027, Vet mental Health; HR5030, Vet suicide.

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

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE

Pharmacy issues, prescription drug supply chain issues, drug shortages, prescription drug abuse and diversion; support for legislation to preserve patient access to oral oncolytics dispensed by community-based cancer clinics (H.R. 1316); DIR (H.R. 1038), advocacy related to ending retroactive direct and indirect renumeration fees levied on pharmacists; Provider status (H.R. 592), advocacy related to recognizing and reimbursing pharmacists for providing appropriate medical services; H.R. 6688, The Analyzing and Leveraging Existing Rx Transactions (ALERT) Act.

Client expense: $515,000 · Firm income: Not reported

H.R. 95, the Homeless Veteran Families Act H.R. 96 H.R. 100, the Veteran Overmedication and Suicide Prevention Act of 2019 H.R. 299, the Blue Water Navy Vietnam Veterans Act of 2019 H.R. 444, the Reduce Unemployment for Veterans of All Ages Act of 2019 H.R. 445, the Help Hire Our Heroes Act H.R. 485, the Veterans Reimbursement for Emergency Ambulance Services Act H.R. 561, the Preparing Business Opportunities for Veterans Act of 2019 H.R. 566, the Agent Orange Exposure Fairness Act H.R. 592, the Protect Veterans from Financial Fraud Act H.R. 663/S. 191, the Burn Pits Accountability Act H.R. 712, the VA Medicinal Cannabis Research Act of 2019 H.R. 840, the Veterans Access to Child Care Act H.R. 1163/S. 902, the VA Hiring Enhancement Act H.R. 1271, the Veterans-Specific Education for Tomorrows Health Professionals Act of 2019 (VET HP Act) H.R. 1381/S. 554, the Burn Pit Registry Enhancement Act H.R. 1527, the Long Term Care Veterans Choice Act H.R. 1718/S. 791, the GI Education Benefits Fairness Act H.R. 1721, the Veterans Healthcare Improvement Act H.R. 1722, the Build a Better VA Act H.R. 1749, the PFC Joseph P. Dwyer Peer Support Act H.R. 1750, the Supporting Veteran Families in Need Act H.R. 1963, the Expanding Care for Veterans Act H.R. 2045/S. 1003, the Veterans Education, Transition, and Opportunity Prioritization Plan Act of 2019 H.R. 2094/S. 1034, the CHAMPVA Childrens Care Protection Act of 2019 H.R. 2109, the Boosting Rates of American Veteran Employment (BRAVE) Act H.R. 2223, the Helping Homeless Veterans Act of 2019 H.R. 2224, the Homeless Veterans with Children Reintegration Act H.R. 2225 H.R. 2227/S. 1118, the Gold Star Spouses and Spouses of Injured Servicemembers Leasing Relief Expansion Act of 2019 H.R. 2333, the Support for Suicide Prevention Coordinators Act H.R. 2340, the Fostering Intergovernmental Health Transparency in Veterans Suicides Act H.R. 2398, the Veterans HOUSE Act H.R. 2435, the Accelerating Veterans Recovery Outdoors Act H.R. 2557, the Get Veterans a Doctor Now Act H.R. 2555, the Never Forgotten Korean War POW Act H.R. 2628, the VET CARE Act of 2019 H.R. 2645, the Newborn Care Improvement Act of 2019 H.R. 2681 H.R. 2752, the VA Newborn Emergency Treatment Act H.R. 2791, the Department of Veterans Affairs Tribal Advisory Committee Act of 2019 H.R. 2798, the Building Supportive Networks for Women Veterans Act H.R. 2816, the Vietnam-Era Veterans Hepatitis C Testing Enhancement Act of 2019 H.R. 2846, the Improving Veterans Access to Congressional Services Act H.R. 2866, the VA Community Infrastructure Act H.R. 2924, the Housing for Women Veterans Act H.R. 2934, the GI Bill Access to Career Credentials Act H.R. 2942/S. 3182, the HEALTH Act H.R. 2972 H.R. 2982, the Women Veterans Health Care Accountability Act H.R. 3010, the Honoring All Veterans Act H.R. 3036, the Breaking Barriers for Women Veterans Act H.R. 3083, the AIR Acceleration Act H.R. 3112, the For Profit Fraud Act H.R. 3224, the Deborah Sampson Act H.R. 3350, the VA Emergency Transportation Act H.R. 3495, the IMPROVE Act H.R. 3504, the Ryan Kules Specially Adaptive Housing Improvement Act of 2019 H.R. 3535, the GI Bill Work Study Improvement Act of 2019 H.R. 3598, the FREED Vets Act H.R. 3636, the Caring for Our Women Veterans Act H.R. 3798, the Equal Access to Contraception for Veterans Act H.R. 3867, the Violence Against Women Veterans Act H.R. 4096, the Improving Oversight of Women Veterans' Care Act of 2019 H.R. 4138, the State Veterans Home Inspection Simplification Act H.R. 4154, the Leave No Veteran Behind Act H.R. 4182, the Women Veterans Support Act H.R. 4281, the ACCESS to Contraception Expansion for Veterans Act H.R. 4305, the Puppies Assisting Wounded Servicemembers (PAWS) for Veterans Therapy Act. H.R. 4334, the Improving Oversight of Women Veterans Care Act H.R. 4451, the Support Our Services to Veterans Caregivers Act H.R. 4526, the Brian Tally VA Employment Transparency Act H.R. 4554 H.R. 4588, the Modernizing VAs Records Management Program Act H.R. 4589 H.R. 4748, the Justice for ALS Veterans Act of 2019 H.R. 4908, the Native American Veteran Parity in Access to Care Today Act H.R. 4920, the Department of Veterans Affairs Contracting Preference Consistency Act H.R. 4949, the VA Hospitals Establishing Leadership Performance Act H.R. 5030, the VA Suicide Prevention Services Accountability Act H.R. 5045, the Veteran Employment and Child Care Access Act H.R. 5447, to provide certain veterans with nonarticulating trailers H.R. 5610, the Fair Care for Vietnam Veterans Act H.R. 5739, the Blast Exposure Protection Act H.R. 5750, the Streamlining GI Bill Processing Act of 2020 H.R. 5761, the Advancing Uniform Transportation Opportunities for Veterans (AUTO) Act H.R. 5766, the VET TEC Expansion Act H.R. 5724, the Same-Day Accountability for Veterans Enhancement Act H.R. 5781 H.R. 6013, the Veteran Families Financial Support Act H.R. 6073 H.R. 6092, the Veterans Prostate Cancer Treatment and Research Act H.R. 6157, the Transparency for Student Veterans Act H.R. 6262, the Disabled Veterans Education Relief Act H. Res. 107, the SFC Sean Cooley and SPC Christopher Horton Congressional Gold Star Family Fellowship Program Act H. Res. 698 H. Res. 729 House Draft Bill, Find our Valor Act House Draft Bill, TAP Modernization House Draft Bill, Expand caregiver benefits House Draft Bill, Modify the Interagency Program Office House Draft Bill, Hear our Heroes Act House Draft Bill, Relief for Defrauded Students Act of 2019 House Draft Bill, Criminal penalties for individuals acting as agents or attorneys for VA claims House Draft Bill, to establish in the Department of Veterans Affairs the Office of Womens Health House Draft Bill, Grants for VSOs for ADA Compliance House Draft Bill, the Blast Exposure Protection Act of 2019 House Draft Bill, the Protecting Moms Who Served Act House Draft Bill, Oath of Exit Act House Draft Bill, to amend title 38, USC to improve the Edith Nourse Rogers STEM scholarship program House Draft Bill, Class Evaluation Act House Draft Bill, to provide for an extended time frame for certain students to find employment following completion of VA high technology education program and for other purposes House Draft Bill, to provide for the eligibility of members of the Armed Forces on terminal leave for the VA high technology education program House Draft Bill, to increase the frequency of benefits under the VAs automobile assistance program House Draft Bill, to authorize VA to provide or assist in providing a second vehicle adapted for operation by disabled individuals to certain eligible persons. House Draft Bill, to reduce the loan fees paid by certain veterans who have been affected by major disasters and are obtaining new loan guarantees, insured, or made by VA House Draft Bill, to provide for the treatment by VA of for-profit educational institutions converted to non-profit educational institutions House Draft Bill, Veteran Transition Technology Act House Draft Bill, Native VetSuccess on Tribal Colleges and Universities Pilot Program House Draft Bill, direct VA to conduct consumer testing to improve the VAs internet website that provides individuals with postsecondary education information House Draft Bill, to clarify the location of an educational institution conducting programs of education exclusively by distance learning for purposes of the VA approval process House Draft Bill, to make certain improvements to educational assistance administered by VA and to the Transition Assistance Program and Skillbridge program of the Department of Defense House Draft Bill, Reducing Veteran Homelessness Act of 2020 House Draft Bill, Authorize VA to enter into a memorandum of understanding with the Secretary of Health and Human Services to coordinate case management services for veterans receiving housing vouchers under Tribal HUD-VASH program House Draft Bill, to authorize VA to reimburse a recipient of a certain grant, made by the Secretary relating to homeless veterans, the fee to use the homeless management information system House Draft Bill, to make a technical correction to clarify that colleges and universities located outside the United States may participate in the VA Yellow Ribbon Program House Draft Bill, to rename VAs Vocational Rehabilitation Program as the Vocational Readiness and Employment Program House Draft Bill, VA Vocational Rehabilitation and Employment program reform House Draft Bill, VA Spinal Cord Injury and Disorders nurse specialty pay House Draft Bill, regarding technical qualifications for licensed hearing aid specialists and appointment of such specialists House Draft Bill, to increase rates of VAs Aid and Attendance by 25 percent during the COVID-19 emergency S. 123, the Ensuring Quality Care for our Veterans Act S. 179/H.R. 712, the VA Medicinal Cannabis Research Act of 2019 S. 221, the VA Provider Accountability Act S. 318, the VA Newborn Emergency Treatment Act S. 319, the Women Veterans and Families Health Services Act of 2019 S. 322, the Agent Orange Exposure Fairness Act S. 408, the Veterans Disability Compensation Automatic COLA Act of 2019 S. 450, the Veterans Improved Access and Care Act of 2019 S. 524, the Department of Veterans Affairs Tribal Advisory Committee Act of 2019 S. 598, the BRAVE Act of 2019 S. 679, the Honoring American Veterans in Extreme Need Act (HAVEN) of 2019 S. 760, the Support for Veterans in Effective Apprenticeships Act of 2019 S. 785, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act and amendments S. 850, the Highly Rural Veteran Transportation Program Extension Act S. 1003, the Veterans' Education, Transition, and Opportunity Prioritization Plan Act of 2019 S. 1101, the Better Examiner Standards and Transparency for Veterans Act of 2019 S. 1316, the Wounded Warrior Research Enhancement Act S. 1563, the Janey Ensminger Act of 2019 S. 1934, the Parity in Veterans Health Care Rights Act S. 2022, the Paul Benne Specially Adaptive Housing Improvement Act of 2019 S. 2027 S. 2049 S. 2061, the Veterans Housing Opportunities and Unemployment Support Extension Act of 2019 S. 2216, the Transparency and Effective Accountability Measures (TEAM) for Veteran Caregivers Act S. 2336, the Department of Veterans Affairs Information Technology Reform Act of 2019 S. 2594, the Veterans Preference Parity Act S. 2822, the Post-9/11 Veteran Suicide Prevention Counseling Act S. 2864, the Sergeant Daniel Somers Veterans Network of Support Act of 2019 S. 2944, the Better and Robust Screening Today (BRST) Act S. 2950, the Veterans Burn Pits Exposure Recognition Act of 2019 S. 2966, the Rural Veterans Travel Enhancement Act of 2019 S. 3020, the Veteran Support and Outreach Act S. 2864, the Sergeant Daniel Somers Veterans Network of Support S. 3089 the BUILD for Veterans Act of 2019 S. 3091, the Justice for ALS Veterans Act S. 3110, the Identifying Barriers and Best Practices Study Act of 2019 Senate Draft Bill, VA Provider Accountability Act Senate Draft Bill, extending the authority of VA to continue to pay educational assistance or subsistence allowances to eligible persons when educational institutions are temporarily closed, and for other purposes Senate Draft Bill, the Enhancing Veterans Access to Legal Services Act of 2019 or the EVALS Act of 2019 Senate Draft Bill, the Protection and Advocacy for Veterans Act Implementation of P.L. 113-146, the Veterans Access, Choice, and Accountability Act Implementation of P.L. 115-55, the Veterans Appeals Improvement and Modernization Act of 2017 Implementation of P.L. 115-48, the Harry W. Colmery Veterans Educational Assistance Act of 2017 Implementation of P.L. 115-182, the VA MISSION Act of 2018 Implementation of P.L. 115-41, the Department of Veterans Affairs Accountability & Whistleblower Protection Act Implementation of P.L. 116-123, the Blue Water Navy Vietnam Veterans Act of 2019 Discussions on women veterans health care Discussions regarding reducing veterans and servicemembers suicide rates Discussions regarding improved access to IVF Discussions of improved access to VA long-term services and supports, including caregiver supports Discussions regarding the Transition Assistance Program Discussed collection of veterans demographic information to research potential benefits and services disparities

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. Pilot test 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, to take effect in 2020, 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. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically, the College urged Congress to develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expand cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introduce legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care. Urged that Congress pass the Protecting Pre-existing Conditions and Making Health Care More Affordable Act of 2019 (H.R. 1884), which strengthens and expands tax credits; stops skimpy health plans that do not cover essential benefits and that discriminate against people with pre-existing conditions; and provides funding for reinsurance programs. 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; Urged that the E/M documentation requirements in the FY2019 Physician Fee Schedule should be implemented immediately and not coupled with the E/M payment policy reforms planned for 2021. 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. Climate Change: The College educated Congress on the harmful health impacts of climate change. Climate change adaptation strategies must be established, and mitigation measures, like switching to clean, renewable energy and promoting active transportation, must be adopted. The College opposed the United States withdrawal from the Paris Agreement and urged Congress to pass the Climate Action Now Act, HR 9, which would reinstitute the U.S. in the agreement. Governments should commit to providing substantial and sufficient climate change research funding to understand, adapt to, and mitigate the human health effects of climate change. The College opposes weakening the limits on carbon emissions from new and reconstructed sources, which would open the door for more greenhouse gas emissions. Urged Congress to support the goal of a 100% clean energy economy by 2050 to protect health from the impacts of climate change. Urged congressional appropriators to increase funding for the Centers for Disease Control and Preventions Climate and Health Program to $15 million in FY 2021. 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. Women and Families: Urged that Congress improve care and services for women and families by removing barriers to care that interfere with the physician-patient relationship. Urged $400 million in funding for the Title X program, and rolling back the harmful final regulations on Title X, as included in the House FY2020 Labor-HHS-Education appropriations bill. Urged that Congress pass the Family and Medical Insurance Leave (FAMILY) Act (H.R.1185/S. 463) to establish a federal paid family leave 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). 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. Physician Fee Schedule: Commented to CMS on its 2020 fee schedule final rule to: finalize E/M codes, current Procedural Terminology (CPT) guidelines, and RUC recommended values exactly as implemented by the CPT Editorial Panel and submitted by the RUC; finalize proposals to 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. 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.

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. Pilot test 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, to take effect in 2020, 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. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically, the College urged Congress to develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expand cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introduce legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care. Urged that Congress pass the Protecting Pre-existing Conditions and Making Health Care More Affordable Act of 2019 (H.R. 1884), which strengthens and expands tax credits; stops skimpy health plans that do not cover essential benefits and that discriminate against people with pre-existing conditions; and provides funding for reinsurance programs. 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; Urged that the E/M documentation requirements in the FY2019 Physician Fee Schedule should be implemented immediately and not coupled with the E/M payment policy reforms planned for 2021. 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. Climate Change: The College educated Congress on the harmful health impacts of climate change. Climate change adaptation strategies must be established, and mitigation measures, like switching to clean, renewable energy and promoting active transportation, must be adopted. The College opposed the United States withdrawal from the Paris Agreement and urged Congress to pass the Climate Action Now Act, HR 9, which would reinstitute the U.S. in the agreement. Governments should commit to providing substantial and sufficient climate change research funding to understand, adapt to, and mitigate the human health effects of climate change. The College opposes weakening the limits on carbon emissions from new and reconstructed sources, which would open the door for more greenhouse gas emissions. Urged Congress to support the goal of a 100% clean energy economy by 2050 to protect health from the impacts of climate change. Urged congressional appropriators to increase funding for the Centers for Disease Control and Preventions Climate and Health Program to $15 million in FY 2021. 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. Women and Families: Urged that Congress improve care and services for women and families by removing barriers to care that interfere with the physician-patient relationship. Urged $400 million in funding for the Title X program, and rolling back the harmful final regulations on Title X, as included in the House FY2020 Labor-HHS-Education appropriations bill. Urged that Congress pass the Family and Medical Insurance Leave (FAMILY) Act (H.R.1185/S. 463) to establish a federal paid family leave 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). 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. Physician Fee Schedule: Commented to CMS on its 2020 fee schedule final rule to: finalize E/M codes, current Procedural Terminology (CPT) guidelines, and RUC recommended values exactly as implemented by the CPT Editorial Panel and submitted by the RUC; finalize proposals to 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. 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.

Improving benefits for survivors of deceased servicemembers and to restore and improve veterans' benefits. H.R. 2846, Improving Veterans Access to Congressional Services; H.R. 4588, modernizing VA's record management; H.R. 2752, VA newborn emergency treatment act; H.R. 3036, improvements to VA medical facilities for women veterans; H.R. 4096, improving oversight of women veterans care; H.R. 3504, adaptive housing rules for disabled veterans; H.R. 4360, VA overpayment accountability; H.R. 592, fraud protection improvements for veterans; H.R. 1030, veteran spouses equal treatment; H.R. 4165, a report on veterans receiving VA benefits, broken down by sex and minority status; H.R. 4183, a GAO study on disability benefits for members of the National Guard and Reserve; H.R. 628, WINGMAN Act; H.R. 1424, Fallen Warrior Battlefield Cross Memorial Act; H.R. 1911, improvements to eligibility for VA benefits for survivors and remarried spouses; H.R. 3224, Deborah Sampson Act; H.R. 2227, amending SCRA to authorize spouses of servicemembers who incur a catastrophic injury or illness or die while in military service to terminate leases of premises and motor vehicles; H.R. 3495, VA suicide prevention grants; H.R. 4356, amending SCRA to allow certain individuals to terminate contracts; H.R. 3530, improvements to licensure and employment requirements for VA medical providers; H.R. 4771, authorization for appellants in disability compensation cases to appear at hearings via Skype; H.R. 4852, improvements to GI and VA education benefits; H.R. 3996, changes to design-build construction rules for VA facilities; H.R. 2997, to ensure that certain veterans receive in-patient psychiatric care provided by the VA; H.R. 2333, GAO report on the responsibilities, workload, training, and vacancy rates of suicide prevention coordinators at the VA; H.R. 1158, consolidated appropriations bill; H.R. 1865, consolidated appropriations bill; H.R. 4305, PAWS for veterans therapy act.

Improving benefits for survivors of deceased servicemembers and to restore and improve veterans' benefits. H.R. 2846, Improving Veterans Access to Congressional Services; H.R. 4588, modernizing VA's record management; H.R. 2752, VA newborn emergency treatment act; H.R. 3036, improvements to VA medical facilities for women veterans; H.R. 4096, improving oversight of women veterans care; H.R. 3504, adaptive housing rules for disabled veterans; H.R. 4360, VA overpayment accountability; H.R. 592, fraud protection improvements for veterans; H.R. 1030, veteran spouses equal treatment; H.R. 4165, a report on veterans receiving VA benefits, broken down by sex and minority status; H.R. 4183, a GAO study on disability benefits for members of the National Guard and Reserve; H.R. 628, WINGMAN Act; H.R. 1424, Fallen Warrior Battlefield Cross Memorial Act; H.R. 1911, improvements to eligibility for VA benefits for survivors and remarried spouses; H.R. 3224, Deborah Sampson Act; H.R. 2227, amending SCRA to authorize spouses of servicemembers who incur a catastrophic injury or illness or die while in military service to terminate leases of premises and motor vehicles; H.R. 3495, VA suicide prevention grants; H.R. 4356, amending SCRA to allow certain individuals to terminate contracts; H.R. 3530, improvements to licensure and employment requirements for VA medical providers; H.R. 4771, authorization for appellants in disability compensation cases to appear at hearings via Skype; H.R. 4852, improvements to GI and VA education benefits; H.R. 3996, changes to design-build construction rules for VA facilities; H.R. 2997, to ensure that certain veterans receive in-patient psychiatric care provided by the VA; H.R. 2333, GAO report on the responsibilities, workload, training, and vacancy rates of suicide prevention coordinators at the VA; H.R. 1158, consolidated appropriations bill; H.R. 1865, consolidated appropriations bill; H.R. 4305, PAWS for veterans therapy act.

Improving benefits for survivors of deceased servicemembers and to restore and improve veterans' benefits. H.R. 2846, Improving Veterans Access to Congressional Services; H.R. 4588, modernizing VA's record management; H.R. 2752, VA newborn emergency treatment act; H.R. 3036, improvements to VA medical facilities for women veterans; H.R. 4096, improving oversight of women veterans care; H.R. 3504, adaptive housing rules for disabled veterans; H.R. 4360, VA overpayment accountability; H.R. 592, fraud protection improvements for veterans; H.R. 1030, veteran spouses equal treatment; H.R. 4165, a report on veterans receiving VA benefits, broken down by sex and minority status; H.R. 4183, a GAO study on disability benefits for members of the National Guard and Reserve; H.R. 628, WINGMAN Act; H.R. 1424, Fallen Warrior Battlefield Cross Memorial Act; H.R. 1911, improvements to eligibility for VA benefits for survivors and remarried spouses; H.R. 3224, Deborah Sampson Act; H.R. 2227, amending SCRA to authorize spouses of servicemembers who incur a catastrophic injury or illness or die while in military service to terminate leases of premises and motor vehicles; H.R. 3495, VA suicide prevention grants; H.R. 4356, amending SCRA to allow certain individuals to terminate contracts; H.R. 3530, improvements to licensure and employment requirements for VA medical providers; H.R. 4771, authorization for appellants in disability compensation cases to appear at hearings via Skype; H.R. 4852, improvements to GI and VA education benefits; H.R. 3996, changes to design-build construction rules for VA facilities; H.R. 2997, to ensure that certain veterans receive in-patient psychiatric care provided by the VA; H.R. 2333, GAO report on the responsibilities, workload, training, and vacancy rates of suicide prevention coordinators at the VA; H.R. 1158, consolidated appropriations bill; H.R. 1865, consolidated appropriations bill; H.R. 4305, PAWS for veterans therapy act.

Improving benefits for survivors of deceased servicemembers and to restore and improve veterans' benefits. H.R. 2846, Improving Veterans Access to Congressional Services; H.R. 4588, modernizing VA's record management; H.R. 2752, VA newborn emergency treatment act; H.R. 3036, improvements to VA medical facilities for women veterans; H.R. 4096, improving oversight of women veterans care; H.R. 3504, adaptive housing rules for disabled veterans; H.R. 4360, VA overpayment accountability; H.R. 592, fraud protection improvements for veterans; H.R. 1030, veteran spouses equal treatment; H.R. 4165, a report on veterans receiving VA benefits, broken down by sex and minority status; H.R. 4183, a GAO study on disability benefits for members of the National Guard and Reserve; H.R. 628, WINGMAN Act; H.R. 1424, Fallen Warrior Battlefield Cross Memorial Act; H.R. 1911, improvements to eligibility for VA benefits for survivors and remarried spouses; H.R. 3224, Deborah Sampson Act; H.R. 2227, amending SCRA to authorize spouses of servicemembers who incur a catastrophic injury or illness or die while in military service to terminate leases of premises and motor vehicles; H.R. 3495, VA suicide prevention grants; H.R. 4356, amending SCRA to allow certain individuals to terminate contracts; H.R. 3530, improvements to licensure and employment requirements for VA medical providers; H.R. 4771, authorization for appellants in disability compensation cases to appear at hearings via Skype; H.R. 4852, improvements to GI and VA education benefits; H.R. 3996, changes to design-build construction rules for VA facilities; H.R. 2997, to ensure that certain veterans receive in-patient psychiatric care provided by the VA; H.R. 2333, GAO report on the responsibilities, workload, training, and vacancy rates of suicide prevention coordinators at the VA; H.R. 1158, consolidated appropriations bill; H.R. 1865, consolidated appropriations bill; H.R. 4305, PAWS for veterans therapy act.

S. 2136 S. 2106 S. 2096 S. 2073 S. 2072 S. 2027 S. 2022 S. 2011 S. 1946 S. 1934 S. 1906 S. 1896 S. 1718 S. 1656 S. 1648 S. 1646 S. 1635 S. 1621 S. 1594 S. 1573 S. 1563 S. 1545 S. 1392 S. 1390 S. 1381 S. 1331 S. 1315 S. 1283 S. 1263 S. 1222 S. 1195 S. 1154 S. 1118 S. 1105 S. 1101 S. 1047 S. 1034 S. 1024 S. 1023 S. 1003 S. 997 S. 980 S. 902 S. 900 S. 898 S. 891 S. 857 S. 853 S. 850 S. 835 S. 805 S. 791 S. 785 S. 746 S. 711 S. 699 S. 666 S. 646 S. 629 S. 606 S. 598 S. 576 S. 555 S. 554 S. 524 S. 514 S. 462 S. 450 S. 408 S. 374 S. 341 S. 332 S. 319 S. 318 S. 221 S. 179 S. 154 S. 127 S. 123 S. 91 S.Res. 256 S.Res. 55 H.R. 1553 H.R. 46 H.R. 2274 H.R. 3504 H.R. 2943 H.R. 2372 H.R. 2359 H.R. 2340 H.R. 2333 H.R. 2045 H.R. 1947 H.R. 1812 H.R. 1200 H.R. 1199 H.R. 299 H.R. 2196 H.R. 2109 H.R. 326 H.Res. 404 H.Res. 403 H.R. 3746 H.R. 2970 H.R. 2942 H.R. 2941 H.R. 2195 H.R. 2056 H.R. 1779 H.R. 1092 H.R. 955 H.R. 2326 H.R. 3867 H.R. 3866 H.R. 3826 H.R. 3813 H.R. 3798 H.R. 3788 H.R. 3752 H.R. 3749 H.R. 3700 H.R. 3640 H.R. 3636 H.R. 3608 H.R. 3582 H.R. 3535 H.R. 3530 H.R. 3527 H.R. 3495 H.R. 3450 H.R. 3350 H.R. 3277 H.R. 3231 H.R. 3228 H.R. 3224 H.R. 3221 H.R. 3189 H.R. 3147 H.R. 3103 H.R. 3083 H.R. 3036 H.R. 3012 H.R. 3010 H.R. 2997 H.R. 2994 H.R. 2982 H.R. 2972 H.R. 2948 H.R. 2934 H.R. 2931 H.R. 2924 H.R. 2916 H.R. 2898 H.R. 2885 H.R. 2884 H.R. 2866 H.R. 2846 H.R. 2823 H.R. 2816 H.R. 2798 H.R. 2791 H.R. 2752 H.R. 2736 H.R. 2681 H.R. 2677 H.R. 2676 H.R. 2675 H.R. 2645 H.R. 2629 H.R. 2628 H.R. 2568 H.R. 2557 H.R. 2556 H.R. 2493 H.R. 2487 H.R. 2435 H.R. 2385 H.R. 2334 H.R. 2308 H.R. 2230 H.R. 2227 H.R. 2224 H.R. 2223 H.R. 2221 H.R. 2201 H.R. 2200 H.R. 2191 H.R. 2184 H.R. 2138 H.R. 2102 H.R. 2094 H.R. 1997 H.R. 1963 H.R. 1962 H.R. 1944 H.R. 1925 H.R. 1924 H.R. 1918 H.R. 1913 H.R. 1826 H.R. 1807 H.R. 1802 H.R. 1758 H.R. 1752 H.R. 1750 H.R. 1749 H.R. 1722 H.R. 1721 H.R. 1718 H.R. 1713 H.R. 1674 H.R. 1658 H.R. 1647 H.R. 1628 H.R. 1599 H.R. 1577 H.R. 1552 H.R. 1527 H.R. 1482 H.R. 1448 H.R. 1424 H.R. 1381 H.R. 1377 H.R. 1360 H.R. 1341 H.R. 1271 H.R. 1182 H.R. 1163 H.R. 1155 H.R. 1133 H.R. 1126 H.R. 1125 H.R. 1030 H.R. 1005 H.R. 1001 H.R. 941 H.R. 846 H.R. 749 H.R. 747 H.R. 730 H.R. 716 H.R. 713 H.R. 712 H.R. 698 H.R. 697 H.R. 685 H.R. 637 H.R. 628 H.R. 610 H.R. 592 H.R. 578 H.R. 566 H.R. 561 H.R. 547 H.R. 497 H.R. 485 H.R. 464 H.R. 445 H.R. 444 H.R. 433 H.R. 203 H.R. 154 H.R. 100 H.R. 96 H.R. 95 H.R. 80 H.R. 54 H.R. 23 H.Con.Res. 13 H.Res. 483 H.Res. 451 H.Res. 434 H.Res. 270 S. 863 H.R. 840 S. 49 H.R. 617 H.R. 1615 H.R. 3357 H.R. 688 H.R. 2406 H.R. 2750 H.R. 2635 H.R. 1585 H.R. 1119 H.R. 2098 H.R. 1078 H.Res. 152 H.R. 3356 H.R. 1837 H.R. 1810 H.R. 2399 H.R. 2398 S. 1749 H.R. 1988 H.R. 2777 H.R. 3652 H.R. 562 H.Res. 413 H.R. 3517 H.R. 3178 H.R. 3072 H.R. 2947 H.R. 2886 H.R. 2618 H.R. 2617 H.R. 1911 H.R. 663 H.R. 333 H.R. 303 H.Res. 455 H.Res. 269 H.Res. 39 H.R. 2384 H.R. 2401 H.R. 3112 H.R. 1565 H.R. 2148 H.Res. 100 H.R. 1966 H.R. 1183 H.R. 269 H.R. 1151 H.R. 601 H.R. 127 H.R. 2803 H.R. 3815 H.R. 3523

Improving benefits for survivors of deceased servicemembers and to restore and improve veterans' benefits. H.R. 2846, Improving Veterans Access to Congressional Services; H.R. 4588, modernizing VA's record management; H.R. 2752, VA newborn emergency treatment act; H.R. 3036, improvements to VA medical facilities for women veterans; H.R. 4096, improving oversight of women veterans care; H.R. 3504, adaptive housing rules for disabled veterans; H.R. 4360, VA overpayment accountability; H.R. 592, fraud protection improvements for veterans; H.R. 1030, veteran spouses equal treatment; H.R. 4165, a report on veterans receiving VA benefits, broken down by sex and minority status; H.R. 4183, a GAO study on disability benefits for members of the National Guard and Reserve; H.R. 628, WINGMAN Act; H.R. 1424, Fallen Warrior Battlefield Cross Memorial Act; H.R. 1911, improvements to eligibility for VA benefits for survivors and remarried spouses; H.R. 3224, Deborah Sampson Act; H.R. 2227, amending SCRA to authorize spouses of servicemembers who incur a catastrophic injury or illness or die while in military service to terminate leases of premises and motor vehicles; H.R. 3495, VA suicide prevention grants; H.R. 4356, amending SCRA to allow certain individuals to terminate contracts; H.R. 3530, improvements to licensure and employment requirements for VA medical providers; H.R. 4771, authorization for appellants in disability compensation cases to appear at hearings via Skype; H.R. 4852, improvements to GI and VA education benefits; H.R. 3996, changes to design-build construction rules for VA facilities; H.R. 2997, to ensure that certain veterans receive in-patient psychiatric care provided by the VA; H.R. 2333, GAO report on the responsibilities, workload, training, and vacancy rates of suicide prevention coordinators at the VA; H.R. 1158, consolidated appropriations bill; H.R. 1865, consolidated appropriations bill; H.R. 4305, PAWS for veterans therapy act.

Pharmacy issues, prescription drug supply chain issues, drug shortages, prescription drug abuse and diversion; support for legislation to preserve patient access to oral oncolytics dispensed by community-based cancer clinics (H.R. 1316); DIR (H.R. 1038), advocacy related to ending retroactive direct and indirect renumeration fees levied on pharmacists; Provider status (H.R. 592), advocacy related to recognizing and reimbursing pharmacists for providing appropriate medical services; H.R. 6688, The Analyzing and Leveraging Existing Rx Transactions (ALERT) Act.

Client expense: $710,000 · Firm income: Not reported

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

Lobbying in support of the Incorporating Measurements and Providing Resources for Outreach to Veterans Everywhere (IMPROVE) Well-Being for Veterans Act (H.R. 3495, S. 1906), to establish a mental health and suicide prevention grant program; the Paul Benne Specially Adaptive Housing Improvement Act (S. 2022), to improve VAs Specially Adaptive Housing program; the ABLE Age Adjustment Act (H.R. 1814, S. 651) to extend veteran access to Achieving a Better Life Experience accounts; the Veterans Expedited TSA Screening (VETS) Safe Travel Act (H.R. 3356, S. 1881) to provide TSA Pre-Check to veterans with disabilities; the Deborah Sampson Act (H.R. 3224), to improve VA programs and services for women veterans; the Veterans Burn Pits Exposure Recognition Act (S. 2950), to concede certain veterans exposure to airborne hazards and toxins; the National Suicide Hotline Designation Act (S. 2661), to establish a three-digit dialing code to access the National Suicide Hotline; the Improving Veterans Access to Congressional Services Act (H.R. 2846), to allow members of Congress access to VA facilities; Draft legislation to improve maternal care for women veterans; Draft legislation to improve research and healthcare for toxic exposure-related illnesses; Draft legislation to provide grants to Veteran Service Organizations to upgrade facilities to comply with the Americans with Disabilities Act; the Protect Veterans from Financial Fraud Act (H.R. 592), to expand VAs ability reissue stolen benefits through the Fiduciary Program; the Veteran Spouses Equal Treatment Act (H.R. 1030), to amend VAs definition of a spouse to include same-sex couples; the Fallen Warrior Battlefield Cross Memorial Act (H.R. 1424), to permit a Fallen Soldier Display in any national cemetery; the VA Overpayment Accountability Act (H.R. 4360), to improve VAs IT system to avoid overpayments; the Identifying Barriers and Best Practices Study Act (H.R. 4183), to examine benefits provided to Reservists who served in special missions; the Justice for ALS Veterans Act (H.R. 4748), to reduce criteria for the receipt of Dependency and Indemnity Compensation for survivors of veterans who died of service-connected ALS; the VA Tele-Hearing Modernization Act (H.R. 4771), to expand access to Board of Veterans Appeals tele-hearings. Lobbying in opposition to the Working to Integrate Networks Guaranteeing Member Access Now (WINGMAN) Act (H.R. 628), to increase congressional staff access to veterans benefits records; the SFC Brian Woods Gold Star and Military Survivors Act (H.R. 1911), to expand benefits for survivors; the Improving Benefits for Underserved Veterans Act (H.R. 4615), to publish a report on VA benefits received disaggregated by sex and minority group status.

H.R. 95, the Homeless Veteran Families Act H.R. 96 H.R. 100, the Veteran Overmedication and Suicide Prevention Act of 2019 H.R. 299, the Blue Water Navy Vietnam Veterans Act of 2019 H.R. 444, the Reduce Unemployment for Veterans of All Ages Act of 2019 H.R. 445, the Help Hire Our Heroes Act H.R. 485, the Veterans Reimbursement for Emergency Ambulance Services Act H.R. 561, the Preparing Business Opportunities for Veterans Act of 2019 H.R. 566, the Agent Orange Exposure Fairness Act H.R. 592, the Protect Veterans from Financial Fraud Act H.R. 663/S. 191, the Burn Pits Accountability Act H.R. 712, the VA Medicinal Cannabis Research Act of 2019 H.R. 840, the Veterans Access to Child Care Act H.R. 1163/S. 902, the VA Hiring Enhancement Act H.R. 1271, the Veterans-Specific Education for Tomorrows Health Professionals Act of 2019 (VET HP Act) H.R. 1381/S. 554, the Burn Pit Registry Enhancement Act H.R. 1527, the Long Term Care Veterans Choice Act H.R. 1718/S. 791, the GI Education Benefits Fairness Act H.R. 1721, the Veterans Healthcare Improvement Act H.R. 1722, the Build a Better VA Act H.R. 1749, the PFC Joseph P. Dwyer Peer Support Act H.R. 1750, the Supporting Veteran Families in Need Act H.R. 1963, the Expanding Care for Veterans Act H.R. 2045/S. 1003, the Veterans Education, Transition, and Opportunity Prioritization Plan Act of 2019 H.R. 2094/S. 1034, the CHAMPVA Childrens Care Protection Act of 2019 H.R. 2109, the Boosting Rates of American Veteran Employment (BRAVE) Act H.R. 2223, the Helping Homeless Veterans Act of 2019 H.R. 2224, the Homeless Veterans with Children Reintegration Act H.R. 2225 H.R. 2227/S. 1118, the Gold Star Spouses and Spouses of Injured Servicemembers Leasing Relief Expansion Act of 2019 H.R. 2333, the Support for Suicide Prevention Coordinators Act H.R. 2340, the Fostering Intergovernmental Health Transparency in Veterans Suicides Act H.R. 2398, the Veterans HOUSE Act H.R. 2435, the Accelerating Veterans Recovery Outdoors Act H.R. 2557, the Get Veterans a Doctor Now Act H.R. 2555, the Never Forgotten Korean War POW Act H.R. 2628, the VET CARE Act of 2019 H.R. 2645, the Newborn Care Improvement Act of 2019 H.R. 2681 H.R. 2752, the VA Newborn Emergency Treatment Act H.R. 2798, the Building Supportive Networks for Women Veterans Act H.R. 2816, the Vietnam-Era Veterans Hepatitis C Testing Enhancement Act of 2019 H.R. 2846, the Improving Veterans Access to Congressional Services Act H.R. 2866, the VA Community Infrastructure Act H.R. 2924, the Housing for Women Veterans Act H.R. 2934, the GI Bill Access to Career Credentials Act H.R. 2942, the HEALTH Act H.R. 2972 H.R. 2982, the Women Veterans Health Care Accountability Act H.R. 3010, the Honoring All Veterans Act H.R. 3036, the Breaking Barriers for Women Veterans Act H.R. 3083, the AIR Acceleration Act H.R. 3112, the For Profit Fraud Act H.R. 3224, the Deborah Sampson Act H.R. 3350, the VA Emergency Transportation Act H.R. 3495, the IMPROVE Act H.R. 3504, the Ryan Kules Specially Adaptive Housing Improvement Act of 2019 H.R. 3535, the GI Bill Work Study Improvement Act of 2019 H.R. 3598, the FREED Vets Act H.R. 3636, the Caring for Our Women Veterans Act H.R. 3798, the Equal Access to Contraception for Veterans Act H.R. 3867, the Violence Against Women Veterans Act H.R. 4096, the Improving Oversight of Women Veterans' Care Act of 2019 H.R. 4138, the State Veterans Home Inspection Simplification Act H.R. 4154, the Leave No Veteran Behind Act H.R. 4305, the Puppies Assisting Wounded Servicemembers (PAWS) for Veterans Therapy Act. H.R. 4334, the Improving Oversight of Women Veterans Care Act H.R. 4451, the Support Our Services to Veterans Caregivers Act H.R. 4554 H.R. 4588, the Modernizing VAs Records Management Program Act H.R. 4589 H.R. 4748, the Justice for ALS Veterans Act of 2019 H.R. 4920, the Department of Veterans Affairs Contracting Preference Consistency Act H.R. 4949, the VA Hospitals Establishing Leadership Performance Act H.R. 5045, the Veteran Employment and Child Care Access Act H.R. 5447, to provide certain veterans with nonarticulating trailers H. Res. 107, the SFC Sean Cooley and SPC Christopher Horton Congressional Gold Star Family Fellowship Program Act H. Res. 698 H. Res. 729 House Draft Bill, Find our Valor Act House Draft Bill, TAP Modernization House Draft Bill, Expand caregiver benefits House Draft Bill, Modify the Interagency Program Office House Draft Bill, Hear our Heroes Act House Draft Bill, Relief for Defrauded Students Act of 2019 House Draft Bill, Criminal penalties for individuals acting as agents or attorneys for VA claims House Draft Bill, to establish in the Department of Veterans Affairs the Office of Womens Health House Draft Bill, Grants for VSOs for ADA Compliance House Draft Bill, the Blast Exposure Protection Act of 2019 House Draft Bill, the Protecting Moms Who Served Act House Draft Bill, Authorize a Second Automobile Grant House Draft Bill, Oath of Exit Act S. 123, the Ensuring Quality Care for our Veterans Act S. 179/H.R. 712, the VA Medicinal Cannabis Research Act of 2019 S. 221, the VA Provider Accountability Act S. 318, the VA Newborn Emergency Treatment Act S. 319, the Women Veterans and Families Health Services Act of 2019 S. 322, the Agent Orange Exposure Fairness Act S. 408, the Veterans Disability Compensation Automatic COLA Act of 2019 S. 450, the Veterans Improved Access and Care Act of 2019 S. 524, the Department of Veterans Affairs Tribal Advisory Committee Act of 2019 S. 598, the BRAVE Act of 2019 S. 679, the Honoring American Veterans in Extreme Need Act (HAVEN) of 2019 S. 760, the Support for Veterans in Effective Apprenticeships Act of 2019 S. 785, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act S. 1101, the Better Examiner Standards and Transparency for Veterans Act of 2019 S. 1316, the Wounded Warrior Research Enhancement Act S. 1563, the Janey Ensminger Act of 2019 S. 1934, the Parity in Veterans Health Care Rights Act S. 2022, the Paul Benne Specially Adaptive Housing Improvement Act of 2019 S. 2027 S. 2061, the Veterans Housing Opportunities and Unemployment Support Extension Act of 2019 S. 2216, the Transparency and Effective Accountability Measures (TEAM) for Veteran Caregivers Act S. 2822, the Post-9/11 Veteran Suicide Prevention Counseling Act S. 2944, the Better and Robust Screening Today (BRST) Act S. 2950, the Veterans Burn Pits Exposure Recognition Act of 2019 S. 2966, the Rural Veterans Travel Enhancement Act of 2019 S. 3020, the Veteran Support and Outreach Act S. 2864, the Sergeant Daniel Somers Veterans Network of Support S. 3089 the BUILD for Veterans Act of 2019 S. 3091, the Justice for ALS Veterans Act Senate Draft Bill, VA Provider Accountability Act Senate Draft Bill, extending the authority of the Secretary of Veterans Affairs to continue to pay educational assistance or subsistence allowances to eligible persons when educational institutions are temporarily closed, and for other purposes Senate Draft Bill, the Enhancing Veterans Access to Legal Services Act of 2019 or the EVALS Act of 2019 Senate Draft Bill, the Protection and Advocacy for Veterans Act Implementation of P.L. 113-146, the Veterans Access, Choice, and Accountability Act Implementation of P.L. 115-55, the Veterans Appeals Improvement and Modernization Act of 2017 Implementation of P.L. 115-48, the Harry W. Colmery Veterans Educational Assistance Act of 2017 Implementation of P.L. 115-182, the VA MISSION Act of 2018 Implementation of P.L. 115-41, the Department of Veterans Affairs Accountability & Whistleblower Protection Act Implementation of P.L. 116-123, the Blue Water Navy Vietnam Veterans Act of 2019 Discussions on women veterans health care Discussions regarding reducing veterans and servicemembers suicide rates Discussions regarding improved access to IVF Discussions of improved access to VA long-term services and supports, including caregiver supports Discussions regarding the Transition Assistance Program Discussed collection of veterans demographic information to research potential benefits and services disparities

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. Pilot test 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, to take effect in 2020, 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. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically, the College urged Congress to develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expand cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introduce legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care. Urged that Congress pass the Protecting Pre-existing Conditions and Making Health Care More Affordable Act of 2019 (H.R. 1884), which strengthens and expands tax credits; stops skimpy health plans that do not cover essential benefits and that discriminate against people with pre-existing conditions; and provides funding for reinsurance programs. 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; Urged that the E/M documentation requirements in the FY2019 Physician Fee Schedule should be implemented immediately and not coupled with the E/M payment policy reforms planned for 2021. 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. Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2020 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. Climate Change: The College educated Congress on the harmful health impacts of climate change. Climate change adaptation strategies must be established, and mitigation measures, like switching to clean, renewable energy and promoting active transportation, must be adopted. The College opposed the United States withdrawal from the Paris Agreement and urged Congress to pass the Climate Action Now Act, HR 9, which would reinstitute the U.S. in the agreement. Governments should commit to providing substantial and sufficient climate change research funding to understand, adapt to, and mitigate the human health effects of climate change. The College opposes weakening the limits on carbon emissions from new and reconstructed sources, which would open the door for more greenhouse gas emissions. Urged Congress to support the goal of a 100% clean energy economy by 2050 to protect health from the impacts of climate change. 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. Women and Families: Urged that Congress improve care and services for women and families by removing barriers to care that interfere with the physician-patient relationship. Urged $400 million in funding for the Title X program, and rolling back the harmful final regulations on Title X, as included in the House FY2020 Labor-HHS-Education appropriations bill. Urged that Congress pass the Family and Medical Insurance Leave (FAMILY) Act (H.R.1185/S. 463) to establish a federal paid family leave 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). 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 2020; Fund the Agency for Health Care Research and Quality (AHRQ) at $460 million for fiscal year 2020; Fund the National Health Service Corps (NHSC) at $830 million for fiscal year 2020; Fund the Title X Family Planning Program at $400 million for fiscal year 2020 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 2020; Fund the National Institutes of Health (NIH) at $42.1 billion for fiscal year 2020; Fund the Centers for Disease Control and Prevention (CDC) at $8.275 billion for fiscal year 2020. Physician Fee Schedule: Commented to CMS noting encouragement for its proposed 2020 fee schedule rule and making further recommendations to: finalize E/M codes, current Procedural Terminology (CPT) guidelines, and RUC recommended values exactly as implemented by the CPT Editorial Panel and submitted by the RUC; finalize proposals to 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. Nicotine: Supported the Administrations plan to clear the market of all non-tobacco-flavored e-cigarettes, including mint and menthol flavors, until they can be reviewed by the Food and Drug Administration; Recommended that the FDA regulate e-cigarettes based on the evidence that Electronic Nicotine Delivery System products contain harmful toxins, that the quality control of the actual ENDS devices is limited at best, and most alarmingly, that youth access and marketing are unrestricted in many jurisdictions.

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. Pilot test 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, to take effect in 2020, 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. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically, the College urged Congress to develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expand cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introduce legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care. Urged that Congress pass the Protecting Pre-existing Conditions and Making Health Care More Affordable Act of 2019 (H.R. 1884), which strengthens and expands tax credits; stops skimpy health plans that do not cover essential benefits and that discriminate against people with pre-existing conditions; and provides funding for reinsurance programs. 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; Urged that the E/M documentation requirements in the FY2019 Physician Fee Schedule should be implemented immediately and not coupled with the E/M payment policy reforms planned for 2021. 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. Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2020 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. Climate Change: The College educated Congress on the harmful health impacts of climate change. Climate change adaptation strategies must be established, and mitigation measures, like switching to clean, renewable energy and promoting active transportation, must be adopted. The College opposed the United States withdrawal from the Paris Agreement and urged Congress to pass the Climate Action Now Act, HR 9, which would reinstitute the U.S. in the agreement. Governments should commit to providing substantial and sufficient climate change research funding to understand, adapt to, and mitigate the human health effects of climate change. The College opposes weakening the limits on carbon emissions from new and reconstructed sources, which would open the door for more greenhouse gas emissions. Urged Congress to support the goal of a 100% clean energy economy by 2050 to protect health from the impacts of climate change. 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. Women and Families: Urged that Congress improve care and services for women and families by removing barriers to care that interfere with the physician-patient relationship. Urged $400 million in funding for the Title X program, and rolling back the harmful final regulations on Title X, as included in the House FY2020 Labor-HHS-Education appropriations bill. Urged that Congress pass the Family and Medical Insurance Leave (FAMILY) Act (H.R.1185/S. 463) to establish a federal paid family leave 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). 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 2020; Fund the Agency for Health Care Research and Quality (AHRQ) at $460 million for fiscal year 2020; Fund the National Health Service Corps (NHSC) at $830 million for fiscal year 2020; Fund the Title X Family Planning Program at $400 million for fiscal year 2020 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 2020; Fund the National Institutes of Health (NIH) at $42.1 billion for fiscal year 2020; Fund the Centers for Disease Control and Prevention (CDC) at $8.275 billion for fiscal year 2020. Physician Fee Schedule: Commented to CMS noting encouragement for its proposed 2020 fee schedule rule and making further recommendations to: finalize E/M codes, current Procedural Terminology (CPT) guidelines, and RUC recommended values exactly as implemented by the CPT Editorial Panel and submitted by the RUC; finalize proposals to 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. Nicotine: Supported the Administrations plan to clear the market of all non-tobacco-flavored e-cigarettes, including mint and menthol flavors, until they can be reviewed by the Food and Drug Administration; Recommended that the FDA regulate e-cigarettes based on the evidence that Electronic Nicotine Delivery System products contain harmful toxins, that the quality control of the actual ENDS devices is limited at best, and most alarmingly, that youth access and marketing are unrestricted in many jurisdictions.

S. 679 - Haven Act, S. 785 - Mental Health, HR 3530 - Improve Vets Care, HR 3640 - Blind Vets, HR 3608 - VA Ed, HR 4165- Underserved Vets, HR 2645 - Newborn Care, HR 4137 - HOPE Act, S. 332 - Agent Orange, S. 2216 - TEAM Act, HR 592 - Finance Fraud,

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 679 - Haven Act, S. 785 - Mental Health, HR 3530 - Improve Vets Care, HR 3640 - Blind Vets, HR 3608 - VA Ed, HR 4165- Underserved Vets, HR 2645 - Newborn Care, HR 4137 - HOPE Act, S. 332 - Agent Orange, S. 2216 - TEAM Act, HR 592 - Finance Fraud,

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 679 - Haven Act, S. 785 - Mental Health, HR 3530 - Improve Vets Care, HR 3640 - Blind Vets, HR 3608 - VA Ed, HR 4165- Underserved Vets, HR 2645 - Newborn Care, HR 4137 - HOPE Act, S. 332 - Agent Orange, S. 2216 - TEAM Act, HR 592 - Finance Fraud,

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.679 - HAVEN Act, S.785 - Commander John Scott Hannon Veterans Mental Health Care Improvement Act, H.R.2942 - HEALTH Act, H.R.3813 - Brian Tally VA Medical Care and Liability Improvement Act, Veterans Care HR 3530 - Housing for blind vets - HR 3640 - veterans education, HR 3608 - Underserved veterans, HR4165 - Vet Newborn Care, HR 2645 - HOPE HR 4137 - TEAM Caregiver Act, S. 2216 - Financial Fraud, HR 592 - Agent Orange Exposure, HR 566 -

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 2136 S. 2106 S. 2096 S. 2073 S. 2072 S. 2027 S. 2022 S. 2011 S. 1946 S. 1934 S. 1906 S. 1896 S. 1718 S. 1656 S. 1648 S. 1646 S. 1635 S. 1621 S. 1594 S. 1573 S. 1563 S. 1545 S. 1392 S. 1390 S. 1381 S. 1331 S. 1315 S. 1283 S. 1263 S. 1222 S. 1195 S. 1154 S. 1118 S. 1105 S. 1101 S. 1047 S. 1034 S. 1024 S. 1023 S. 1003 S. 997 S. 980 S. 902 S. 900 S. 898 S. 891 S. 857 S. 853 S. 850 S. 835 S. 805 S. 791 S. 785 S. 746 S. 711 S. 699 S. 666 S. 646 S. 629 S. 606 S. 598 S. 576 S. 555 S. 554 S. 524 S. 514 S. 462 S. 450 S. 408 S. 374 S. 341 S. 332 S. 319 S. 318 S. 221 S. 179 S. 154 S. 127 S. 123 S. 91 S.Res. 256 S.Res. 55 H.R. 1553 H.R. 46 H.R. 2274 H.R. 3504 H.R. 2943 H.R. 2372 H.R. 2359 H.R. 2340 H.R. 2333 H.R. 2045 H.R. 1947 H.R. 1812 H.R. 1200 H.R. 1199 H.R. 299 H.R. 2196 H.R. 2109 H.R. 326 H.Res. 404 H.Res. 403 H.R. 3746 H.R. 2970 H.R. 2942 H.R. 2941 H.R. 2195 H.R. 2056 H.R. 1779 H.R. 1092 H.R. 955 H.R. 2326 H.R. 3867 H.R. 3866 H.R. 3826 H.R. 3813 H.R. 3798 H.R. 3788 H.R. 3752 H.R. 3749 H.R. 3700 H.R. 3640 H.R. 3636 H.R. 3608 H.R. 3582 H.R. 3535 H.R. 3530 H.R. 3527 H.R. 3495 H.R. 3450 H.R. 3350 H.R. 3277 H.R. 3231 H.R. 3228 H.R. 3224 H.R. 3221 H.R. 3189 H.R. 3147 H.R. 3103 H.R. 3083 H.R. 3036 H.R. 3012 H.R. 3010 H.R. 2997 H.R. 2994 H.R. 2982 H.R. 2972 H.R. 2948 H.R. 2934 H.R. 2931 H.R. 2924 H.R. 2916 H.R. 2898 H.R. 2885 H.R. 2884 H.R. 2866 H.R. 2846 H.R. 2823 H.R. 2816 H.R. 2798 H.R. 2791 H.R. 2752 H.R. 2736 H.R. 2681 H.R. 2677 H.R. 2676 H.R. 2675 H.R. 2645 H.R. 2629 H.R. 2628 H.R. 2568 H.R. 2557 H.R. 2556 H.R. 2493 H.R. 2487 H.R. 2435 H.R. 2385 H.R. 2334 H.R. 2308 H.R. 2230 H.R. 2227 H.R. 2224 H.R. 2223 H.R. 2221 H.R. 2201 H.R. 2200 H.R. 2191 H.R. 2184 H.R. 2138 H.R. 2102 H.R. 2094 H.R. 1997 H.R. 1963 H.R. 1962 H.R. 1944 H.R. 1925 H.R. 1924 H.R. 1918 H.R. 1913 H.R. 1826 H.R. 1807 H.R. 1802 H.R. 1758 H.R. 1752 H.R. 1750 H.R. 1749 H.R. 1722 H.R. 1721 H.R. 1718 H.R. 1713 H.R. 1674 H.R. 1658 H.R. 1647 H.R. 1628 H.R. 1599 H.R. 1577 H.R. 1552 H.R. 1527 H.R. 1482 H.R. 1448 H.R. 1424 H.R. 1381 H.R. 1377 H.R. 1360 H.R. 1341 H.R. 1271 H.R. 1182 H.R. 1163 H.R. 1155 H.R. 1133 H.R. 1126 H.R. 1125 H.R. 1030 H.R. 1005 H.R. 1001 H.R. 941 H.R. 846 H.R. 749 H.R. 747 H.R. 730 H.R. 716 H.R. 713 H.R. 712 H.R. 698 H.R. 697 H.R. 685 H.R. 637 H.R. 628 H.R. 610 H.R. 592 H.R. 578 H.R. 566 H.R. 561 H.R. 547 H.R. 497 H.R. 485 H.R. 464 H.R. 445 H.R. 444 H.R. 433 H.R. 203 H.R. 154 H.R. 100 H.R. 96 H.R. 95 H.R. 80 H.R. 54 H.R. 23 H.Con.Res. 13 H.Res. 483 H.Res. 451 H.Res. 434 H.Res. 270 S. 863 H.R. 840 S. 49 H.R. 617 H.R. 1615 H.R. 3357 H.R. 688 H.R. 2406 H.R. 2750 H.R. 2635 H.R. 1585 H.R. 1119 H.R. 2098 H.R. 1078 H.Res. 152 H.R. 3356 H.R. 1837 H.R. 1810 H.R. 2399 H.R. 2398 S. 1749 H.R. 1988 H.R. 2777 H.R. 3652 H.R. 562 H.Res. 413 H.R. 3517 H.R. 3178 H.R. 3072 H.R. 2947 H.R. 2886 H.R. 2618 H.R. 2617 H.R. 1911 H.R. 663 H.R. 333 H.R. 303 H.Res. 455 H.Res. 269 H.Res. 39 H.R. 2384 H.R. 2401 H.R. 3112 H.R. 1565 H.R. 2148 H.Res. 100 H.R. 1966 H.R. 1183 H.R. 269 H.R. 1151 H.R. 601 H.R. 127 H.R. 2803 H.R. 3815 H.R. 3523

Pharmacy issues, prescription drug supply chain issues, drug shortages, prescription drug abuse and diversion; support for legislation to preserve patient access to oral oncolytics dispensed by community-based cancer clinics (H.R. 1316); DIR (H.R. 1038), advocacy related to ending retroactive direct and indirect renumeration fees levied on pharmacists; Provider status (H.R. 592), advocacy related to recognizing and reimbursing pharmacists for providing appropriate medical services; H.R. 6688, The Analyzing and Leveraging Existing Rx Transactions (ALERT) Act.

Client expense: $430,000 · Firm income: Not reported

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

S. 2136 S. 2106 S. 2096 S. 2073 S. 2072 S. 2027 S. 2022 S. 2011 S. 1946 S. 1934 S. 1906 S. 1896 S. 1718 S. 1656 S. 1648 S. 1646 S. 1635 S. 1621 S. 1594 S. 1573 S. 1563 S. 1545 S. 1392 S. 1390 S. 1381 S. 1331 S. 1315 S. 1283 S. 1263 S. 1222 S. 1195 S. 1154 S. 1118 S. 1105 S. 1101 S. 1047 S. 1034 S. 1024 S. 1023 S. 1003 S. 997 S. 980 S. 902 S. 900 S. 898 S. 891 S. 857 S. 853 S. 850 S. 835 S. 805 S. 791 S. 785 S. 746 S. 711 S. 699 S. 666 S. 646 S. 629 S. 606 S. 598 S. 576 S. 555 S. 554 S. 524 S. 514 S. 462 S. 450 S. 408 S. 374 S. 341 S. 332 S. 319 S. 318 S. 221 S. 179 S. 154 S. 127 S. 123 S. 91 S.Res. 256 S.Res. 55 H.R. 1553 H.R. 46 H.R. 2274 H.R. 3504 H.R. 2943 H.R. 2372 H.R. 2359 H.R. 2340 H.R. 2333 H.R. 2045 H.R. 1947 H.R. 1812 H.R. 1200 H.R. 1199 H.R. 299 H.R. 2196 H.R. 2109 H.R. 326 H.Res. 404 H.Res. 403 H.R. 3746 H.R. 2970 H.R. 2942 H.R. 2941 H.R. 2195 H.R. 2056 H.R. 1779 H.R. 1092 H.R. 955 H.R. 2326 H.R. 3867 H.R. 3866 H.R. 3826 H.R. 3813 H.R. 3798 H.R. 3788 H.R. 3752 H.R. 3749 H.R. 3700 H.R. 3640 H.R. 3636 H.R. 3608 H.R. 3582 H.R. 3535 H.R. 3530 H.R. 3527 H.R. 3495 H.R. 3450 H.R. 3350 H.R. 3277 H.R. 3231 H.R. 3228 H.R. 3224 H.R. 3221 H.R. 3189 H.R. 3147 H.R. 3103 H.R. 3083 H.R. 3036 H.R. 3012 H.R. 3010 H.R. 2997 H.R. 2994 H.R. 2982 H.R. 2972 H.R. 2948 H.R. 2934 H.R. 2931 H.R. 2924 H.R. 2916 H.R. 2898 H.R. 2885 H.R. 2884 H.R. 2866 H.R. 2846 H.R. 2823 H.R. 2816 H.R. 2798 H.R. 2791 H.R. 2752 H.R. 2736 H.R. 2681 H.R. 2677 H.R. 2676 H.R. 2675 H.R. 2645 H.R. 2629 H.R. 2628 H.R. 2568 H.R. 2557 H.R. 2556 H.R. 2493 H.R. 2487 H.R. 2435 H.R. 2385 H.R. 2334 H.R. 2308 H.R. 2230 H.R. 2227 H.R. 2224 H.R. 2223 H.R. 2221 H.R. 2201 H.R. 2200 H.R. 2191 H.R. 2184 H.R. 2138 H.R. 2102 H.R. 2094 H.R. 1997 H.R. 1963 H.R. 1962 H.R. 1944 H.R. 1925 H.R. 1924 H.R. 1918 H.R. 1913 H.R. 1826 H.R. 1807 H.R. 1802 H.R. 1758 H.R. 1752 H.R. 1750 H.R. 1749 H.R. 1722 H.R. 1721 H.R. 1718 H.R. 1713 H.R. 1674 H.R. 1658 H.R. 1647 H.R. 1628 H.R. 1599 H.R. 1577 H.R. 1552 H.R. 1527 H.R. 1482 H.R. 1448 H.R. 1424 H.R. 1381 H.R. 1377 H.R. 1360 H.R. 1341 H.R. 1271 H.R. 1182 H.R. 1163 H.R. 1155 H.R. 1133 H.R. 1126 H.R. 1125 H.R. 1030 H.R. 1005 H.R. 1001 H.R. 941 H.R. 846 H.R. 749 H.R. 747 H.R. 730 H.R. 716 H.R. 713 H.R. 712 H.R. 698 H.R. 697 H.R. 685 H.R. 637 H.R. 628 H.R. 610 H.R. 592 H.R. 578 H.R. 566 H.R. 561 H.R. 547 H.R. 497 H.R. 485 H.R. 464 H.R. 445 H.R. 444 H.R. 433 H.R. 203 H.R. 154 H.R. 100 H.R. 96 H.R. 95 H.R. 80 H.R. 54 H.R. 23 H.Con.Res. 13 H.Res. 483 H.Res. 451 H.Res. 434 H.Res. 270 S. 863 H.R. 840 S. 49 H.R. 617 H.R. 1615 H.R. 3357 H.R. 688 H.R. 2406 H.R. 2750 H.R. 2635 H.R. 1585 H.R. 1119 H.R. 2098 H.R. 1078 H.Res. 152 H.R. 3356 H.R. 1837 H.R. 1810 H.R. 2399 H.R. 2398 S. 1749 H.R. 1988 H.R. 2777 H.R. 3652 H.R. 562 H.Res. 413 H.R. 3517 H.R. 3178 H.R. 3072 H.R. 2947 H.R. 2886 H.R. 2618 H.R. 2617 H.R. 1911 H.R. 663 H.R. 333 H.R. 303 H.Res. 455 H.Res. 269 H.Res. 39 H.R. 2384 H.R. 2401 H.R. 3112 H.R. 1565 H.R. 2148 H.Res. 100 H.R. 1966 H.R. 1183 H.R. 269 H.R. 1151 H.R. 601 H.R. 127 H.R. 2803 H.R. 3815 H.R. 3523

Pharmacy issues, prescription drug supply chain issues, drug shortages, prescription drug abuse and diversion; support for legislation to preserve patient access to oral oncolytics dispensed by community-based cancer clinics (H.R. 1316); DIR (H.R. 1038), advocacy related to ending retroactive direct and indirect renumeration fees levied on pharmacists; Provider status (H.R. 592), advocacy related to recognizing and reimbursing pharmacists for providing appropriate medical services; H.R. 6688, The Analyzing and Leveraging Existing Rx Transactions (ALERT) Act.

Client expense: $340,000 · Firm income: Not reported

Pharmacy issues, prescription drug supply chain issues, drug shortages, prescription drug abuse and diversion; support for legislation to preserve patient access to oral oncolytics dispensed by community-based cancer clinics (H.R. 1316); DIR (H.R. 1038), advocacy related to ending retroactive direct and indirect renumeration fees levied on pharmacists; Provider status (H.R. 592), advocacy related to recognizing and reimbursing pharmacists for providing appropriate medical services; H.R. 6688, The Analyzing and Leveraging Existing Rx Transactions (ALERT) Act.

Client expense: $670,000 · Firm income: Not reported