The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021

S2999 A bill to prohibit the Secretary of Health and Human Services, any officer or employee of the Department of Health and Human Services, and States from requiring COVID-19 vaccination as a condition of eligibility for benefits or assistance under the Medicare, Medicaid, or CHIP programs; HR 1349 The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R.2228 To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program. S999 A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments; H.R.1887 To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes; S.2048 -HR3650 Improving Access to care Coverage Act of 2021;. H.R. 1330 Patient Access to Higher Quality Health Care Act of 2021;S.J.Res.32 A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination; H.J.Res.67 Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination;S.4050 Medicare Advantage Quality Payment Relief Act of 2022; H.R.6895 Commission on Sustaining Medicare and Social Security Act of 2022.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for federal childcare benefits for members of the health care workforce. Advocate for increasing borrowing limits on SBA loans and ensuring health care providers are eligible. Support direct funding for health care providers treating COVID-19 patients, including funding through the Hospital Preparedness Program. Support funding and efforts to ensure health care providers have access to essential materials, such as PPE, for COVID-19 response and readiness. Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Advocate for direct Federal funding for state and local governments during the COVID-19 crisis. Discuss the distribution methodology for the Public Health and Social Services Emergency Fund with the White House, HHS, CMS, and Congressional staff. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS, and Congressional staff. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts to Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), funding for hospital infrastructure (support), the Affordable Care Act (support), and liver allocation reforms (support). Educate Congressional staff and lawmakers on Medicare for All. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256), the Opioid Workforce Act (S. 1438), the Substance Use Disorder Workforce Act (H.R. 3441) the Training Psychiatrist for the Future Act, and President Biden's FY 2024 Budget. Discuss technical assistance regarding graduate medical education legislation with committee staff. Discuss the Prescription Drug Pricing Reduction Act of 2021 (S. 909) with Congressional staff and committee staff. Support surprise billing legislation reform and work with committee and Congressional staff on a range of issues. Discussed several bills, including the No Surprises Act (P.L. 116-260). Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues Discuss provisions in the CARES Act (H.R. 748) related to health care provider liability and immunity with Congressional and committee staff. Attend cybersecurity briefing related to foreign threats with FBI. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House and Congressional staff. Discuss drug shortages related to the COVID-19 crisis with Congressional and Administration staff. Coordinate with ASPR, the Department of Defense, FEMA and the FDA on COVID-19 response efforts. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss hospital infrastructure spending with the White House and Congressional staff, including the LIFT America Act (H.R. 1848) and INVEST in America Act (H.R. 3684). Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 1349 (support). Discuss supply chain issues, including PPE and ventilators, with Congressional staff, HHS and White House. Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss insurance companies transactions and policies affecting health care providers with Congressional staff and support for the Improving Seniors' Timely Access to Care Act (H.R. 3173). Discuss surprise billing legislation with White House staff. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS. Discuss the regulation of laboratory developed tests and the VALID Act with Congressional and committee staff. Discuss family planning funding with staff at HHS. Discuss federal climate pledge with staff at HHS. Discuss monkeypox therapeutics, FDA Commissioner Discuss support for the Hospital Inpatient Services Modernization Act (H.R. 7053) with congressional staff. Discuss FEMA reimbursement with FEMA and congressional staff. Discuss hospital and health care provisions included in the Consolidated Appropriations Act of 2023. Discuss support for legislation to reduce proposed reimbursement cuts to home health providers.

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

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

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS, and Congressional staff. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), and the Affordable Care Act (support). Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256), the Opioid Workforce Act (S. 1438), the Substance Use Disorder Workforce Act (H.R. 3441), the Training Psychiatrist for The Future Act, and President Biden's FY 2024 Budget request. graduate medical education legislation Discuss the Prescription Drug Pricing Reduction Act of 2021 (S. 909) with Congressional staff and committee staff. Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House, and Congressional staff. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 1349 (support). Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS. Discuss opposition to Medicare statutory PAYGO cuts with congressional staff. Discuss Medicaid waiver proposal with CMS staff. Discuss visitation issues with HHS staff. Discuss support for the Advancing Telehealth Beyond COVID-19 Act of 2021. Discuss support for the Acute Hospital Care at Home program. Support legislation to provide support for safety-net hospitals.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE

HR 366 Authorize HHS Secretary to waive or modify application of Medicare requirements with respect to telehealth services during any emergency period. HR 955 and S 285 To allow for medical assistance under Medicaid for inmates during 30-day period preceding release from a public institution. HR 1332 and S 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 1349 To provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program. S 834 To create an additional 14,000 Medicare-supported residency slots over seven years. HR 2166 To require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs. HR 3371 To improve access to home health care furnished by telehealth amid PHEs. HR 3589 Medicare AAP loan repayment delay HR 3746 To improve the benchmarking process for the Medicare Shared Savings Program. S. 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 4587 To direct HHS to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage program participation. S. 2622 To provide for Medicaid coverage of comprehensive tobacco cessation services. HR 5514 To improve extended care services by providing Medicare beneficiaries with an option for cost effective home-based extended care. S 3018 To establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Oppose Medicare sequester. S. 3593 To extend certain telehealth services covered by Medicare and to evaluate the impact of telehealth services on Medicare beneficiaries HR 7573 To extend certain telehealth services covered by Medicare and to evaluate the impact of telehealth services on Medicare beneficiaries HR 4407/S 1568 To modify the methodology and application of Medicare Advantage nursing and allied health education payments for hospitals HR 4040 To extend telehealth flexibilities under the Medicare program HR 5370 To establish a CMS demo for medically tailored meals for Medicare beneficiaries HR 8487 To establish requirements with respect to the use of prior authorization under Medicare Advantage plans HR 8800 To extend certain increases in payments for physicians services under the Medicare program through 2023

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021- Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - Treatment in Place Act - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - Jack Reynolds Memory Medigap Expansion Act - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - KEEP Telehealth Options Act of 2021 - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - Stabilize Medicaid and CHIP Coverage Act - Rep. Dingell, Debbie - Medicaid and CHIP continuous enrollment H.R. 1784 - Medicaid REACH Act - Rep. Doggett, Lloyd - requirements for non-expansion H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - Immediate Coverage for Former Foster Youth Act - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - Foster Youth Dental Act of 2021 - Rep. Bass, Karen - Medicaid dental coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - Territories Medicare Prescription Drug Assistance Equality Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare Part D premium and cost-sharing subsidies H.R. 1826 - Fairness in Medicare Part B Enrollment Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - RUSH Protection Act of 2021 - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - Rural Hospital Support Act - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - Health Insurance Consumer Protection Act - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - CAHOOTS Act - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - Improving Access to Mental Health Act of 2021 - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - SAVE Act - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri - Medicare Advantage payments for audio-only diagnoses H.R. 2168 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 2170 - HAPI Act - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - Affordable Insulin for the COVID-19 Emergency Act - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicaid FMAP for Territories H.R. 2228 - Rural Behavioral Health Access Act of 2021 - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. - Medicare Advantage supplemental benefits H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd - Medigap policies H.R. 6833 - Affordable Insulin Now Act - Rep. Craig, Angie - Insulin prices and cost sharing S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - HAPI Act -Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - KEEP Telehealth Options Act of 2021 - Sen. Fischer, Deb - telehealth expansion S. 644 - Rural Hospital Closure Relief Act of 2021 - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - Stabilize Medicaid and CHIP Coverage Act of 2021 - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - COMP Act - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - Dosha Joi Immediate Coverage for Former Foster Youth Act - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne - Medicare payment sequestration S. 764 - CAHOOTS Act - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - Medicare Patient Empowerment Act of 2021 - Sen. Paul, Rand - Medicaid payment options S. 870 - Improving Access to Mental Health Act of 2021 - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - Save Rural Hospitals Act of 2021 - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2023 policy and technical regulation for MA and Part D; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2023 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; issues related to specialty infant formula; issues related to the Inflation Reduction Act passage and implementation; contraceptive coverage and reproductive health; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; issues related to Managed Long Term Services and Supports (MLTSS); issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations or legislation, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); issues relating to potential Medicare mental health parity requirements; Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.

Client expense: $3,230,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Resetting the Impact (TRIA) Act of 2021 (H.R. 2455) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S.3018) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments Organ acquisition payment policies Clinical lab fee schedule False Claims Act amendments CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule Hospital Inpatient Services Modernization Act (H.R. 7053 /S. 3792) - to extend the hospital at home waiver program Medicare Mental Health Inpatient Equity Act (S. 3061/H.R. 5674) HR 4040: Advancing Telehealth Beyond COVID-19 Act HELP Act Inpatient Psychiatric Facility Improvement Act MIND Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S2999 A bill to prohibit the Secretary of Health and Human Services, any officer or employee of the Department of Health and Human Services, and States from requiring COVID-19 vaccination as a condition of eligibility for benefits or assistance under the Medicare, Medicaid, or CHIP programs; HR 1349 The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R.2228 To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program. S999 A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments; H.R.1887 To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes; S.2048 -HR3650 Improving Access to care Coverage Act of 2021;. H.R. 1330 Patient Access to Higher Quality Health Care Act of 2021;S.J.Res.32 A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination; H.J.Res.67 Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination;S.4050 Medicare Advantage Quality Payment Relief Act of 2022; H.R.6895 Commission on Sustaining Medicare and Social Security Act of 2022.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Assist client with healthcare issues; S.571 Public Health Funding Prevents Pandemics Act; H.R.295 Pandemic Healthcare Access Act; S889 Prescription Drug Monitoring Act of 2021; HR 1349 The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R.2228 Rural Healthcare Act; S2021-HR3806 SAFE Hospitals Act of 2021; HR3203 & S773 To enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program, and for other purposes; S1567 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021; H.R.4479 Facilitating Innovative Nuclear Diagnostics Act of 2021-to amend title XVIII of the Social Security Act to ensure equitable payment for, and preserve Medicare beneficiary access to, diagnostic radiopharmaceuticals under the Medicare hospital outpatient prospective payment system; H.R.1811 To amend the Indian Health Care Improvement Act to authorize additional funding for planning, design, construction, modernization, and renovation of hospitals and outpatient health care facilities; S.3105 Hospital Revitalization Act of 2021; H.R.5106 To prohibit any entity that receives Federal funds from the COVID relief packages from mandating employees receive a COVID-19 vaccine, and for other purposes; S.3749 Hospital Transparency Compliance Enforcement Ac7; HR8133 Transparency of Hospital Billing Act;H.R.1887 and S4009 Rural Hospital Support Act; H.R.7053 Hospital Inpatient Services Modernization Act; S.3792 Hospital Inpatient Services Modernization Act;S 4414 Expose Hospitals Violating Price Transparency Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S.3018) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules CMS review of Medicaid Managed Care contracts and approval Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments Organ acquisition payment policies

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Q3 Lobbying Report (July 1- September 30) HCR Provider Relief Fund Deadline Extension Act (S. 2493/H.R. 4735) Infrastructure Investment and Jobs Act Build Back Better Act (H.R. 5376) Dr. Lorna Breen Health Care Provider Protection Act (HR 1667) Provider Relief Fund Improvement Act (H.R. 5963 / S. 3611) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Resident Physician Shortage Act (S. 834/H.R. 2256) No Surprises Act regulations Public Health Emergency designation Blood shortages PREVENT Pandemics Act (S. 3799) CMS Region IX re: Guidance on California State Bill 311 The Compassionate Access to Medical Cannabis Act Meeting with OMB re: Physician Loan Forgiveness CMS Regional Office re: Admission, Discharge, and Transfer Patient Event Notification Conditions of Participation (42 CFR 482.24(d), 482.61(f), and 485.638(d)) Food and Drug Amendments of 2022 (H.R. 7667) Improving Seniors Timely Access to Care Act (H.R. 1587/S. 3018) Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 7961) Bipartisan Safer Communities Act (S. 2938) Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R. 7666) Saving Access to Laboratory Services Act (SALSA Act) (H.R. 8188/S.4449) Assistance for Rural Community Hospitals (ARCH) Act (H.R. 8747) Meetings with FEMA re: COVID-19 related reimbursement MMM Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 (S. 834/H.R. 2256) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332) Hospital Inpatient Services Modernization Act (H.R. 7053) Annual Prospective Payment System Rules Organ acquisition payment policies Clinical lab fee schedule BUD FY2022 Appropriations bills Consolidated Appropriations Act of 2022 (HR 2471) - omnibus Further Additional Extending Government Funding Act, HR 6617 Nursing and allied health workforce funding FY 2023 budget request Submitted Comments Methodology for Preventing Duplication of FEMA Benefits SUBJECT: Forthcoming Guidance on Discharge Planning Requirements; August 4, 2022 RE: Public Service Loan Forgiveness Regulations Docket ID ED-2021-OPE-0077: Student Assistance General Provisions, Federal Perkins Loan Program, Federal Family Ed Loan Program, and William D. Ford Federal Direct Loan Program SUBJECT: CMS-4203-NC, Medicare Program; Request for Information on Medicare; Vol. 87, No. 146, August 1, 2022 SUBJECT: CMS-3419-P, Medicare and Medicaid Programs; Conditions of Participation (CoPs) for rural emergency hospitals and critical access hospital CoPs Updates (Vol 87, No 128), July 6, 2022 SUBJECT: CMS-1772-P, Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating, (Vol 87, No 142), July 26, 2022 SUBJECT: CMS-1770-P, Medicare and Medicaid Programs; CY 2023 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicare and Medicaid Provider Enrollment Policies, Including for Skilled Nursing Facilities; Conditions of Payment for Suppliers of Durable Medicaid Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); and Implementing Requirements for Manufacturers of Certain Single-Dose Container or Single-Use Package Drugs To Provide Refunds With Respect to Discarded Amounts (Vol 87, No 145), July 29, 2022 SUBJECT: CMS1766P Medicare Program; Calendar Year 2023 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Program Requirements; Home Health Value Based Purchasing Expanded Model Requirements; and Home Infusion Therapy Services Requirement; Federal Register (Vol. 87, No. 120) June 23, 2022

Client expense: $300,000 · Firm income: Not reported

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

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS, and Congressional staff. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), and the Affordable Care Act (support). Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256), the Opioid Workforce Act (S. 1438), the Substance Use Disorder Workforce Act (H.R. 3441), the Training Psychiatrist for The Future Act, and President Biden's FY 2024 Budget request. graduate medical education legislation Discuss the Prescription Drug Pricing Reduction Act of 2021 (S. 909) with Congressional staff and committee staff. Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House, and Congressional staff. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 1349 (support). Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS. Discuss opposition to Medicare statutory PAYGO cuts with congressional staff.

Client expense: $330,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for federal childcare benefits for members of the health care workforce. Advocate for increasing borrowing limits on SBA loans and ensuring health care providers are eligible. Support direct funding for health care providers treating COVID-19 patients, including funding through the Hospital Preparedness Program. Support funding and efforts to ensure health care providers have access to essential materials, such as PPE, for COVID-19 response and readiness. Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Advocate for direct Federal funding for state and local governments during the COVID-19 crisis. Discuss the distribution methodology for the Public Health and Social Services Emergency Fund with the White House, HHS, CMS, and Congressional staff. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS, and Congressional staff. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts to Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), funding for hospital infrastructure (support), the Affordable Care Act (support), and liver allocation reforms (support). Educate Congressional staff and lawmakers on Medicare for All. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256), the Opioid Workforce Act (S. 1438), the Substance Use Disorder Workforce Act (H.R. 3441) the Training Psychiatrist for the Future Act, and President Biden's FY 2024 Budget. Discuss technical assistance regarding graduate medical education legislation with committee staff. Discuss the Prescription Drug Pricing Reduction Act of 2021 (S. 909) with Congressional staff and committee staff. Support surprise billing legislation reform and work with committee and Congressional staff on a range of issues. Discussed several bills, including the No Surprises Act (P.L. 116-260). Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues Discuss provisions in the CARES Act (H.R. 748) related to health care provider liability and immunity with Congressional and committee staff. Attend cybersecurity briefing related to foreign threats with FBI. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House and Congressional staff. Discuss drug shortages related to the COVID-19 crisis with Congressional and Administration staff. Coordinate with ASPR, the Department of Defense, FEMA and the FDA on COVID-19 response efforts. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss hospital infrastructure spending with the White House and Congressional staff, including the LIFT America Act (H.R. 1848) and INVEST in America Act (H.R. 3684). Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 1349 (support). Discuss supply chain issues, including PPE and ventilators, with Congressional staff, HHS and White House. Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss insurance companies transactions and policies affecting health care providers with Congressional staff and support for the Improving Seniors' Timely Access to Care Act (H.R. 3173). Discuss surprise billing legislation with White House staff. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS. Discuss the regulation of laboratory developed tests and the VALID Act with Congressional and committee staff. Discuss family planning funding with staff at HHS. Discuss federal climate pledge with staff at HHS. Discuss monkeypox therapeutics, FDA Commissioner Discuss support for the Hospital Inpatient Services Modernization Act (H.R. 7053) with congressional staff. Discuss FEMA reimbursement with FEMA and congressional staff.

Client expense: $330,000 · Firm income: Not reported

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

H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021- Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - Treatment in Place Act - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - Jack Reynolds Memory Medigap Expansion Act - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - KEEP Telehealth Options Act of 2021 - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - Stabilize Medicaid and CHIP Coverage Act - Rep. Dingell, Debbie - Medicaid and CHIP continuous enrollment H.R. 1784 - Medicaid REACH Act - Rep. Doggett, Lloyd - requirements for non-expansion H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - Immediate Coverage for Former Foster Youth Act - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - Foster Youth Dental Act of 2021 - Rep. Bass, Karen - Medicaid dental coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - Territories Medicare Prescription Drug Assistance Equality Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare Part D premium and cost-sharing subsidies H.R. 1826 - Fairness in Medicare Part B Enrollment Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - RUSH Protection Act of 2021 - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - Rural Hospital Support Act - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - Health Insurance Consumer Protection Act - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - CAHOOTS Act - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - Improving Access to Mental Health Act of 2021 - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - SAVE Act - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri - Medicare Advantage payments for audio-only diagnoses H.R. 2168 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 2170 - HAPI Act - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - Affordable Insulin for the COVID-19 Emergency Act - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicaid FMAP for Territories H.R. 2228 - Rural Behavioral Health Access Act of 2021 - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. - Medicare Advantage supplemental benefits H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd - Medigap policies H.R. 6833 - Affordable Insulin Now Act - Rep. Craig, Angie - Insulin prices and cost sharing S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - HAPI Act -Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - KEEP Telehealth Options Act of 2021 - Sen. Fischer, Deb - telehealth expansion S. 644 - Rural Hospital Closure Relief Act of 2021 - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - Stabilize Medicaid and CHIP Coverage Act of 2021 - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - COMP Act - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - Dosha Joi Immediate Coverage for Former Foster Youth Act - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne - Medicare payment sequestration S. 764 - CAHOOTS Act - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - Medicare Patient Empowerment Act of 2021 - Sen. Paul, Rand - Medicaid payment options S. 870 - Improving Access to Mental Health Act of 2021 - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - Save Rural Hospitals Act of 2021 - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2023 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2023 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; contraceptive coverage and reproductive health; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations or legislation, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); issues relating to potential Medicare mental health parity requirements; Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

Client expense: $2,890,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Medicare Graduate Medical Education S. 834/H.R. 2256 - the Physician Shortage Reduction Act of 2021 Site-neutral payment policies Build Back Better Act proposals related to health policy, Medicare, workforce and hospital emergency preparedness H.R. 1227/S. 386, "Medicare-X Choice Act" - provisions related to the establishment of a public health plan H.R. 1976, To establish an improved Medicare for All national health insurance program - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans Proposals to reduce drug costs H.R. 1349, "COVID-19 Hospital and Health Provider Loan Conversion Act of 2021"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Resetting the Impact (TRIA) Act of 2021 (H.R. 2455) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S.3018) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules CMS review of Medicaid Managed Care contracts and approval Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments Organ acquisition payment policies Clinical lab fee schedule False Claims Act amendments CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule Hospital Inpatient Services Modernization Act (H.R. 7053 /S. 3792) - to extend the hospital at home waiver program Medicare Mental Health Inpatient Equity Act (S. 3061/H.R. 5674)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Q2 Lobbying Report (April 1 - June 30) HCR Provider Relief Fund Deadline Extension Act (S. 2493/H.R. 4735) Infrastructure Investment and Jobs Act Build Back Better Act (H.R. 5376) Dr. Lorna Breen Health Care Provider Protection Act (HR 1667) Provider Relief Fund Improvement Act (H.R. 5963 / S. 3611) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Resident Physician Shortage Act (S. 834/H.R. 2256) No Surprises Act regulations Public Health Emergency designation Blood shortages PREVENT Pandemics Act (S. 3799) CMS Region IX re: Guidance on California State Bill 311 The Compassionate Access to Medical Cannabis Act Meeting with OMB re: Physician Loan Forgiveness CMS Regional Office re: Admission, Discharge, and Transfer Patient Event Notification Conditions of Participation (42 CFR 482.24(d), 482.61(f), and 485.638(d)) Food and Drug Amendments of 2022 (H.R. 7667) Improving Seniors Timely Access to Care Act (H.R. 1587/S. 3018) Safety from Violence for Healthcare Employees (SAVE) Act (HR 7961) Bipartisan Safer Communities Act (S. 2938) Restoring Hope for Mental Health and Well-Being Act of 2022 (HR 7666) MMM Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 (S. 834/H.R. 2256) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332) Hospital Inpatient Services Modernization Act (H.R. 7053) Annual Prospective Payment System Rules Organ acquisition payment policies Clinical lab fee schedule BUD FY2022 Appropriations bills Consolidated Appropriations Act of 2022 (HR 2471) - omnibus Further Additional Extending Government Funding Act, HR 6617 Nursing and allied health workforce funding FY 2023 budget request Submitted Comments SUBJECT: [CIS No. 2715-22; DHS Docket No. USCIS-2021-0013]; Public Charge Ground of Inadmissibility; Notice of Proposed Rulemaking (Federal Register Vol. 87, No. 37), February 24, 2022 SUBJECT: CMS-1769-P, Medicare Program; FFY 2023 Inpatient Psychiatric Facilities Prospective Payment System-Rate Update and Quality Reporting-Request for Information Proposed Rule, Federal Register (Vol. 87, No. 64), April 4, 2022 SUBJECT: CMS-1767-P, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2023 and Updates to the IRF Quality Reporting Program, Proposed Rule, Federal Register (Vol. 87, No. 66), April 6, 2022 Drug Enforcement Administration re: California Senate Bill 311, April 7, 2022 SUBJECT: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023; Request for Information on Revising the Requirements for Long-Term Care Facilities To Establish Mandatory Minimum Staffing Levels (Vol 87, No 73), April 15, 2022 Centers for Medicare & Medicaid Services Request for Information on improving access to care and coverage for individuals enrolled in Medicaid and the Childrens Health Insurance Program, April 18, 2022 SUBJECT: CMS-1771-P, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation (Vol 87, No 90), May 10, 2022

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

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

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for federal childcare benefits for members of the health care workforce. Advocate for increasing borrowing limits on SBA loans and ensuring health care providers are eligible. Support direct funding for health care providers treating COVID-19 patients, including funding through the Hospital Preparedness Program. Support funding and efforts to ensure health care providers have access to essential materials, such as PPE, for COVID-19 response and readiness. Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Advocate for direct Federal funding for state and local governments during the COVID-19 crisis. Discuss the distribution methodology for the Public Health and Social Services Emergency Fund with the White House, HHS, CMS, and Congressional staff. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS, and Congressional staff. Advocate for continued Federal funding for New York States DSRIP program. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts to Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), funding for hospital infrastructure (support), the Affordable Care Act (support), and liver allocation reforms (support). Discuss the need to reform the United States' liver allocation system with Congressional staff/members, HHS, HRSA, UNOS and OPTN. Educate Congressional staff and lawmakers on Medicare for All. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256), the Opioid Workforce Act (S. 1438), and the Substance Use Disorder Workforce Act (H.R. 3441). Discuss technical assistance regarding graduate medical education legislation with committee staff. Discuss the Prescription Drug Pricing Reduction Act of 2021 (S. 909) with Congressional staff and committee staff. Support surprise billing legislation reform and work with committee and Congressional staff on a range of issues. Discussed several bills, including the No Surprises Act (P.L. 116-260). Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues Discuss provisions in the CARES Act (H.R. 748) related to health care provider liability and immunity with Congressional and committee staff. Attend cybersecurity briefing related to foreign threats with FBI. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House and Congressional staff. Discuss drug shortages related to the COVID-19 crisis with Congressional and Administration staff. Coordinate with ASPR, the Department of Defense, FEMA and the FDA on COVID-19 response efforts. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss hospital infrastructure spending with the White House and Congressional staff, including the LIFT America Act (H.R. 1848) and INVEST in America Act (H.R. 3684). Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 1349 (support). Discuss supply chain issues, including PPE and ventilators, with Congressional staff, HHS and White House. Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss increased Federal Medical Assistance Percentages (support) and increased funding for state and local governments (support) with Congressional staff. Discuss insurance companies transactions and policies affecting health care providers with Congressional staff. Discuss surprise billing legislation with White House staff. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS. Discuss the regulation of laboratory developed tests and the VALID Act with Congressional and committee staff.

Client expense: $360,000 · Firm income: Not reported

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

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS, and Congressional staff. Advocate for continued Federal funding for New York States DSRIP program. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), and the Affordable Care Act (support). Educate Congressional staff and lawmakers on Medicare for All. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256), the Opioid Workforce Act (S. 1438), and the Substance Use Disorder Workforce Act (H.R. 3441). graduate medical education legislation Discuss the Prescription Drug Pricing Reduction Act of 2021 (S. 909) with Congressional staff and committee staff. Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House, and Congressional staff. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 1349 (support). Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss increased Federal Medical Assistance Percentages (support) and increased funding for state and local governments (support) with Congressional staff. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS.

Client expense: $360,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE

Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021) Sequestration relief Rural hospital policies (Rural Health Clinic payment - H.R. 1868; Rural Hospital Closure Relief Act H.R. 1639/S.644; Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885); Rural America Health Corps Act (S. 924/H.R. 2130); Rural America Health Corps Act S.54)) Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053) Value in Health Care Act (H.R. 4587) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 S. 834/H.R. 2256); Opioid Workforce Act S. 1438/ Substance Use Disorder Workforce Act H.R. 3441 Telehealth flexibilities and payment (Telehealth Extension Act - H.R. 6202; TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act - S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166) Resetting the Impact (TRIA) Act of 2021 H.R. 2455 Technical Reset to Advance the Instruction of Nurses (TRAIN) Act Value in Healthcare Act (H.R. 4587) Improving Seniors Timely Access to Care Act (S. 3018/H.R. 3173)

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

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

Assist client with healthcare issues; S.571 Public Health Funding Prevents Pandemics Act; H.R.295 Pandemic Healthcare Access Act; S889 Prescription Drug Monitoring Act of 2021; HR 1349 The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R.2228 Rural Healthcare Act; S2021-HR3806 SAFE Hospitals Act of 2021; HR3203 & S773 To enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program, and for other purposes; S1567 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021; H.R.4479 Facilitating Innovative Nuclear Diagnostics Act of 2021-to amend title XVIII of the Social Security Act to ensure equitable payment for, and preserve Medicare beneficiary access to, diagnostic radiopharmaceuticals under the Medicare hospital outpatient prospective payment system; H.R.1811 To amend the Indian Health Care Improvement Act to authorize additional funding for planning, design, construction, modernization, and renovation of hospitals and outpatient health care facilities; S.3105 Hospital Revitalization Act of 2021; H.R.5106 To prohibit any entity that receives Federal funds from the COVID relief packages from mandating employees receive a COVID-19 vaccine, and for other purposes; S.3749 Hospital Transparency Compliance Enforcement Ac7; HR8133 Transparency of Hospital Billing Act;H.R.1887 and S4009 Rural Hospital Support Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S2999 A bill to prohibit the Secretary of Health and Human Services, any officer or employee of the Department of Health and Human Services, and States from requiring COVID-19 vaccination as a condition of eligibility for benefits or assistance under the Medicare, Medicaid, or CHIP programs; HR 1349 The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R.2228 To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program. S999 A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments; H.R.1887 To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes; S.2048 -HR3650 Improving Access to care Coverage Act of 2021;. H.R. 1330 Patient Access to Higher Quality Health Care Act of 2021;S.J.Res.32 A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination; H.J.Res.67 Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination;S.4050 Medicare Advantage Quality Payment Relief Act of 2022; H.R.6895 Commission on Sustaining Medicare and Social Security Act of 2022.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 366 Authorize HHS Secretary to waive or modify application of Medicare requirements with respect to telehealth services during any emergency period. HR 955 and S 285 To allow for medical assistance under Medicaid for inmates during 30-day period preceding release from a public institution. HR 1332 and S 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 1349 To provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program. S 834 To create an additional 14,000 Medicare-supported residency slots over seven years. HR 2166 To require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs. HR 3371 To improve access to home health care furnished by telehealth amid PHEs. HR 3589 Medicare AAP loan repayment delay HR 3746 To improve the benchmarking process for the Medicare Shared Savings Program. S. 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 4587 To direct HHS to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage program participation. S. 2622 To provide for Medicaid coverage of comprehensive tobacco cessation services. HR 5514 To improve extended care services by providing Medicare beneficiaries with an option for cost effective home-based extended care. S 3018 To establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Oppose Medicare sequester. S. 3593 To extend certain telehealth services covered by Medicare and to evaluate the impact of telehealth services on Medicare beneficiaries HR 7573 To extend certain telehealth services covered by Medicare and to evaluate the impact of telehealth services on Medicare beneficiaries

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

HR 366 Authorize HHS Secretary to waive or modify application of Medicare requirements with respect to telehealth services during any emergency period. HR 955 and S 285 To allow for medical assistance under Medicaid for inmates during 30-day period preceding release from a public institution. HR 1332 and S 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 1349 To provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program. S 834 To create an additional 14,000 Medicare-supported residency slots over seven years. HR 2166 To require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs. HR 3371 To improve access to home health care furnished by telehealth amid PHEs. HR 3589 Medicare AAP loan repayment delay HR 3746 To improve the benchmarking process for the Medicare Shared Savings Program. S. 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 4587 To direct HHS to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage program participation. S. 2622 To provide for Medicaid coverage of comprehensive tobacco cessation services. HR 5514 To improve extended care services by providing Medicare beneficiaries with an option for cost effective home-based extended care. S 3018 To establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Oppose Medicare sequester. S. 3593 To extend certain telehealth services covered by Medicare and to evaluate the impact of telehealth services on Medicare beneficiaries

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021- Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - Treatment in Place Act - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - Jack Reynolds Memory Medigap Expansion Act - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - KEEP Telehealth Options Act of 2021 - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - Stabilize Medicaid and CHIP Coverage Act - Rep. Dingell, Debbie - Medicaid and CHIP continuous enrollment H.R. 1784 - Medicaid REACH Act - Rep. Doggett, Lloyd - requirements for non-expansion H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - Immediate Coverage for Former Foster Youth Act - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - Foster Youth Dental Act of 2021 - Rep. Bass, Karen - Medicaid dental coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - Territories Medicare Prescription Drug Assistance Equality Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare Part D premium and cost-sharing subsidies H.R. 1826 - Fairness in Medicare Part B Enrollment Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - RUSH Protection Act of 2021 - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - Rural Hospital Support Act - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - Health Insurance Consumer Protection Act - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - CAHOOTS Act - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - Improving Access to Mental Health Act of 2021 - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - SAVE Act - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri - Medicare Advantage payments for audio-only diagnoses H.R. 2168 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 2170 - HAPI Act - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - Affordable Insulin for the COVID-19 Emergency Act - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicaid FMAP for Territories H.R. 2228 - Rural Behavioral Health Access Act of 2021 - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. - Medicare Advantage supplemental benefits H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd -- Medigap policies H.R. 6833 - Affordable Insulin Now Act - Rep. Craig, Angie - Insulin prices and cost sharing S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - HAPI Act -Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - KEEP Telehealth Options Act of 2021 - Sen. Fischer, Deb - telehealth expansion S. 644 - Rural Hospital Closure Relief Act of 2021 - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - Stabilize Medicaid and CHIP Coverage Act of 2021 - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - COMP Act - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - Dosha Joi Immediate Coverage for Former Foster Youth Act - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne - Medicare payment sequestration S. 764 - CAHOOTS Act - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - Medicare Patient Empowerment Act of 2021 - Sen. Paul, Rand - Medicaid payment options S. 870 - Improving Access to Mental Health Act of 2021 - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - Save Rural Hospitals Act of 2021 - Sen. Warner, Mark - Medicare hospital payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2023 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2023 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

Client expense: $4,680,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Medicare Graduate Medical Education S. 834/H.R. 2256 - the Physician Shortage Reduction Act of 2021 Site-neutral payment policies Build Back Better Act proposals related to health policy, Medicare, workforce and hospital emergency preparedness H.R. 1227/S. 386, "Medicare-X Choice Act" - provisions related to the establishment of a public health plan H.R. 1976, To establish an improved Medicare for All national health insurance program - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans Proposals to reduce drug costs H.R. 1349, "COVID-19 Hospital and Health Provider Loan Conversion Act of 2021"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Q1 Lobbying Report (January 1 - March 31) HCR Provider Relief Fund Deadline Extension Act (S. 2493/H.R. 4735) Infrastructure Investment and Jobs Act Build Back Better Act (H.R. 5376) Dr. Lorna Breen Health Care Provider Protection Act (HR 1667) Provider Relief Fund Improvement Act (H.R. 5963 / S. 3611) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Resident Physician Shortage Act (S. 834/H.R. 2256) No Surprises Act regulations Public Health Emergency designation Blood shortages PREVENT Pandemics Act (S. 3799) CMS Region IX re: Guidance on California State Bill 311 The Compassionate Access to Medical Cannabis Act MMM Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 (S. 834/H.R. 2256) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332) Hospital Inpatient Services Modernization Act (H.R. 7053) Annual Prospective Payment System Rules Organ acquisition payment policies Clinical lab fee schedule BUD FY2022 Appropriations bills Consolidated Appropriations Act of 2022 (HR 2471) - omnibus Further Additional Extending Government Funding Act, HR 6617 Nursing and allied health workforce funding FY 2023 budget request Submitted Comments California Department of Managed Health Care Draft All Plan Letter - No Surprises Act (NSA) Guidance Specified State Law for Payment for Out-of-Network Emergency Services, February 3, 2022 SUBJECT: CMS-4192-P, Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (Vol 87, No 8), January 12, 2022 SUBJECT: CMS-1752-FC3, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals; Changes to Medicare Graduate Medical Education Payments for Teaching Hospitals; Changes to Organ Acquisition Payment Policies (Vol 86, No 245), December 27, 2021

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

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

S2999 A bill to prohibit the Secretary of Health and Human Services, any officer or employee of the Department of Health and Human Services, and States from requiring COVID-19 vaccination as a condition of eligibility for benefits or assistance under the Medicare, Medicaid, or CHIP programs; HR 1349 The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R.2228 To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program. S999 A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments; H.R.1887 To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes; S.2048 -HR3650 Improving Access to Medicare Coverage Act of 2021;. H.R. 1330 Patient Access to Higher Quality Health Care Act of 2021; .

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Assist client with healthcare issues; S.571 Public Health Funding Prevents Pandemics Act; H.R.295 Pandemic Healthcare Access Act; S889 Prescription Drug Monitoring Act of 2021; HR 1349 The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R.2228 Rural Healthcare Act; S2021-HR3806 SAFE Hospitals Act of 2021; HR3203 & S773 To enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program, and for other purposes; S1567 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021; H.R.4479 Facilitating Innovative Nuclear Diagnostics Act of 2021-to amend title XVIII of the Social Security Act to ensure equitable payment for, and preserve Medicare beneficiary access to, diagnostic radiopharmaceuticals under the Medicare hospital outpatient prospective payment system; H.R.1811 To amend the Indian Health Care Improvement Act to authorize additional funding for planning, design, construction, modernization, and renovation of hospitals and outpatient health care facilities; S.3105 Hospital Revitalization Act of 2021; H.R.5106 To prohibit any entity that receives Federal funds from the COVID relief packages from mandating employees receive a COVID-19 vaccine, and for other purposes;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments S. 999, (addressing the Area Wage Index for rural hospitals) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Resetting the Impact (TRIA) Act of 2021 (H.R. 2455) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules Organ acquisition payment policies Clinical lab fee schedule False Claims Act amendments CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule Hospital Inpatient Services Modernization Act (H.R. 7053 /S. 3792) - to extend the hospital at home waiver program Medicare Mental Health Inpatient Equity Act (S. 3061/H.R. 5674) CMS review of Medicaid Managed Care contracts and approval process

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for federal childcare benefits for members of the health care workforce. Advocate for increasing borrowing limits on SBA loans and ensuring health care providers are eligible. Support direct funding for health care providers treating COVID-19 patients, including funding through the Hospital Preparedness Program. Support funding and efforts to ensure health care providers have access to essential materials, such as PPE, for COVID-19 response and readiness. Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Advocate for direct Federal funding for state and local governments during the COVID-19 crisis. Discuss the distribution methodology for the Public Health and Social Services Emergency Fund with the White House, HHS, CMS, and Congressional staff. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS, and Congressional staff. Advocate for continued Federal funding for New York States DSRIP program. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts to Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), funding for hospital infrastructure (support), the Affordable Care Act (support), and liver allocation reforms (support). Discuss the need to reform the United States' liver allocation system with Congressional staff/members, HHS, HRSA, UNOS and OPTN. Educate Congressional staff and lawmakers on Medicare for All. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256), the Opioid Workforce Act (S. 1438), and the Substance Use Disorder Workforce Act (H.R. 3441). Discuss technical assistance regarding graduate medical education legislation with committee staff. Discuss the Prescription Drug Pricing Reduction Act of 2021 (S. 909) with Congressional staff and committee staff. Support surprise billing legislation reform and work with committee and Congressional staff on a range of issues. Discussed several bills, including the No Surprises Act (P.L. 116-260). Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues Discuss provisions in the CARES Act (H.R. 748) related to health care provider liability and immunity with Congressional and committee staff. Attend cybersecurity briefing related to foreign threats with FBI. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House and Congressional staff. Discuss drug shortages related to the COVID-19 crisis with Congressional and Administration staff. Coordinate with ASPR, the Department of Defense, FEMA and the FDA on COVID-19 response efforts. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss hospital infrastructure spending with the White House and Congressional staff, including the LIFT America Act (H.R. 1848) and INVEST in America Act (H.R. 3684). Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 1349 (support). Discuss supply chain issues, including PPE and ventilators, with Congressional staff, HHS and White House. Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss increased Federal Medical Assistance Percentages (support) and increased funding for state and local governments (support) with Congressional staff. Discuss insurance companies transactions and policies affecting health care providers with Congressional staff. Discuss surprise billing legislation with White House staff. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS.

Client expense: $320,000 · Firm income: Not reported

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

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS, and Congressional staff. Advocate for continued Federal funding for New York States DSRIP program. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), and the Affordable Care Act (support). Educate Congressional staff and lawmakers on Medicare for All. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256), the Opioid Workforce Act (S. 1438), and the Substance Use Disorder Workforce Act (H.R. 3441). graduate medical education legislation Discuss the Prescription Drug Pricing Reduction Act of 2021 (S. 909) with Congressional staff and committee staff. Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House, and Congressional staff. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 1349 (support). Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss increased Federal Medical Assistance Percentages (support) and increased funding for state and local governments (support) with Congressional staff. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS.

Client expense: $320,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE

CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Nursing and allied health education (NAHE) program funding Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173) Annual Prospective Payment System Rules Organ acquisition payment policies Clinical lab fee schedule False Claims Act amendments

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Nursing and allied health education (NAHE) program funding S. 999, (addressing the Area Wage Index for rural hospitals) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166) Resetting the Impact (TRIA) Act of 2021 (H.R. 2455) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules Organ acquisition payment policies Clinical lab fee schedule False Claims Act amendments CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Medicare Graduate Medical Education S. 834/H.R. 2256 - the Physician Shortage Reduction Act of 2021 Site-neutral payment policies H.R. 3684, Infrastructure Investment and Jobs Act- provisions related to the Medicare sequester H.R. 6119, Further Extending Government Funding Act - provisions funding the government and health programs for fiscal year 2022 appropriations through February 18, 2022 H.R. 5376, "Build Back Better Act" - provisions related to health policy, Medicare, workforce and hospital emergency preparedness S.610 - Protecting Medicare and American Farmers from Sequester Cuts Act - provisions related to Medicare payments and the Medicare sequester H.R. 1227/S. 386, "Medicare-X Choice Act" - provisions related to the establishment of a public health plan H.R. 1976, To establish an improved Medicare for All national health insurance program - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 3, "Elijah E. Cummings Lower Drug Prices Now Act" Proposals to reduce drug costs H.R. 1349, "COVID-19 Hospital and Health Provider Loan Conversion Act of 2021"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 366 Authorize HHS Secretary to waive or modify application of Medicare requirements with respect to telehealth services during any emergency period. HR 955 and S 285 To allow for medical assistance under Medicaid for inmates during 30-day period preceding release from a public institution. HR 1332 and S 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 1349 To provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program. S 834 To create an additional 14,000 Medicare-supported residency slots over seven years. HR 2166 To require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs. HR 3371 To improve access to home health care furnished by telehealth amid PHEs. HR 3589 Medicare AAP loan repayment delay HR 3746 To improve the benchmarking process for the Medicare Shared Savings Program. S. 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 4587 To direct HHS to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage program participation. S. 2622 To provide for Medicaid coverage of comprehensive tobacco cessation services. HR 5514 To improve extended care services by providing Medicare beneficiaries with an option for cost effective home-based extended care. S 3018 To establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Oppose Medicare sequester.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), SENATE

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for federal childcare benefits for members of the health care workforce. Advocate for increasing borrowing limits on SBA loans and ensuring health care providers are eligible. Support direct funding for health care providers treating COVID-19 patients, including funding through the Hospital Preparedness Program. Support funding and efforts to ensure health care providers have access to essential materials, such as PPE, for COVID-19 response and readiness. Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Advocate for direct Federal funding for state and local governments during the COVID-19 crisis. Discuss the distribution methodology for the Public Health and Social Services Emergency Fund with the White House, HHS, CMS, and Congressional staff. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS, and Congressional staff. Advocate for continued Federal funding for New York States DSRIP program. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts to Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), funding for hospital infrastructure (support), the Affordable Care Act (support), and liver allocation reforms (support). Discuss the need to reform the United States' liver allocation system with Congressional staff/members, HHS, HRSA, UNOS and OPTN. Educate Congressional staff and lawmakers on Medicare for All. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256), the Opioid Workforce Act (S. 1438), and the Substance Use Disorder Workforce Act (H.R. 3441). Discuss technical assistance regarding graduate medical education legislation with committee staff. Discuss the Prescription Drug Pricing Reduction Act of 2021 (S. 909) with Congressional staff and committee staff. Support surprise billing legislation reform and work with committee and Congressional staff on a range of issues. Discussed several bills, including the No Surprises Act (P.L. 116-260). Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues Discuss provisions in the CARES Act (H.R. 748) related to health care provider liability and immunity with Congressional and committee staff. Attend cybersecurity briefing related to foreign threats with FBI. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House and Congressional staff. Discuss drug shortages related to the COVID-19 crisis with Congressional and Administration staff. Coordinate with ASPR, the Department of Defense, FEMA and the FDA on COVID-19 response efforts. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss hospital infrastructure spending with the White House and Congressional staff, including the LIFT America Act (H.R. 1848) and INVEST in America Act (H.R. 3684). Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 1349 (support). Discuss supply chain issues, including PPE and ventilators, with Congressional staff, HHS and White House. Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss increased Federal Medical Assistance Percentages (support) and increased funding for state and local governments (support) with Congressional staff. Discuss insurance companies transactions and policies affecting health care providers with Congressional staff. Discuss surprise billing legislation with White House staff. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS.

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

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

Advocate for several Medicare & Medicaid provisions in the CARES Act (H.R. 748), including a delay of Medicare sequestration cuts, a delay of the Medicare Fiscal Accountability Rule and Medicaid disproportionate share hospital (DSH) cut relief. Support increased Federal Medical Assistance Percentages (FMAP) and FMAP flexibility at the state level in the Families First Coronavirus Response Act (H.R. 6201) and the CARES Act (H.R. 748). Advocate for changes to indirect medical education payments to account for COVID-19 response efforts. Discuss issues related to Medicare accelerated payments with White House, HHS, CMS, and Congressional staff. Advocate for continued Federal funding for New York States DSRIP program. Discuss Medicare and Medicaid issues with the CMS Administrator. Discuss COVID-19 response with White House staff and HHS leadership, including the HHS Secretary. Discuss GNYHA's legislative priorities with Congressional staff: a delay of cuts Medicaid DSH funding (support), site-neutral policies (oppose), 340B drug discount program (support), expanding federal graduate medical education programs (support), funding to address the opioid crisis (support), and the Affordable Care Act (support). Educate Congressional staff and lawmakers on Medicare for All. Support graduate medical education funding through the Medicare program, including support for the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256), the Opioid Workforce Act (S. 1438), and the Substance Use Disorder Workforce Act (H.R. 3441). graduate medical education legislation Discuss the Prescription Drug Pricing Reduction Act of 2021 (S. 909) with Congressional staff and committee staff. Discuss New York State's Partnership for Patients initiative with CMS contract officers. Discuss GME rural training tracks and possible reforms with Congressional staff. Discuss the ET3 model with staff from CMMI. Discuss the Medicare GME program, including issues related to oversight and transparency, with congressional staff. Spoke with CMS to review Medicare DGME policy (42 CFR 413.75) on residency counting issues. Discuss issues concerning DSH hospitals with the Executive Branch. Discuss Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) with Congressional staff. Discuss issues related to telehealth and HIT with staff from CMS, the White House, and Congressional staff. Discuss disbursements from the Public Health and Social Services Emergency Fund with HHS, the White House, and Congressional staff and lawmakers. Discuss Medicare Advance Payment forgiveness with HHS and Congressional staff, advocated for H.R. 1349 (support). Discuss a range of other COVID-19 priorities with Congressional staff including ensuring Medicare advantage plans comply with increased COVID-19 Medicare payments (support), an add-on payment for COVID-19 care (support), and crisis pay for health care workers (support). Support a delay of Medicaid DSH reimbursement cuts in COVID-19 response package and a delay or repeal of the Medicaid Fiscal Accountability Regulation. Discuss increased Federal Medical Assistance Percentages (support) and increased funding for state and local governments (support) with Congressional staff. Discuss Medicare Rule on Physician Time Studies (42 CFR 415.60) with CMS. Discuss disclosure of patient information to the media with HHS. Discuss Medicare Rules regarding new teaching hospitals with CMS. Discuss alternate care site billing with CMS.

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

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

Assist client with healthcare issues; S.571 Public Health Funding Prevents Pandemics Act; H.R.295 Pandemic Healthcare Access Act; S889 Prescription Drug Monitoring Act of 2021; HR 1349 The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R.2228 Rural Healthcare Act; S2021-HR3806 SAFE Hospitals Act of 2021; HR3203 & S773 To enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program, and for other purposes; S1567 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021; H.R.4479 Facilitating Innovative Nuclear Diagnostics Act of 2021-to amend title XVIII of the Social Security Act to ensure equitable payment for, and preserve Medicare beneficiary access to, diagnostic radiopharmaceuticals under the Medicare hospital outpatient prospective payment system.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S2999 A bill to prohibit the Secretary of Health and Human Services, any officer or employee of the Department of Health and Human Services, and States from requiring COVID-19 vaccination as a condition of eligibility for benefits or assistance under the Medicare, Medicaid, or CHIP programs; HR 1349 The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R.2228 To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program. S999 A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments; H.R.1887 To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes; S.2048 -HR3650 Improving Access to Medicare Coverage Act of 2021;. H.R. 1330 Patient Access to Higher Quality Health Care Act of 2021.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare annual payment rules; Graduate Medical Education; COVID-19 Hospital and Health Provider Loan Conversion Act (H.R. 1349); Provider Relief Fund; Medicare Sequester Relief Act (S. 748 / H.R. 1868) ; Parity Enforcement Act (H.R. 1364); Resident Physician Shortage Reduction Act of 2021 (S.834); Dr. Lorna Breen Health Care Provider Protection Act (S. 610 / H.R. 1667); H.R. 2903, the CONNECT for Health Act; Medicare Area Wage Index - Imputed Rural Floor, Core Based Statistical Areas; H.R. 1319, American Rescue Plan Act of 2021

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare annual payment rules; Graduate Medical Education; COVID-19 Hospital and Health Provider Loan Conversion Act (H.R. 1349); Provider Relief Fund; Medicare Sequester Relief Act (S. 748 / H.R. 1868) ; Parity Enforcement Act (H.R. 1364); Resident Physician Shortage Reduction Act of 2021 (S.834); Dr. Lorna Breen Health Care Provider Protection Act (S. 610 / H.R. 1667); H.R. 2903, the CONNECT for Health Act; Medicare Area Wage Index - Imputed Rural Floor, Core Based Statistical Areas; H.R. 1319, American Rescue Plan Act of 202

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare annual payment rules; Graduate Medical Education; COVID-19 Hospital and Health Provider Loan Conversion Act (H.R. 1349); Provider Relief Fund; Medicare Sequester Relief Act (S. 748 / H.R. 1868) ; Parity Enforcement Act (H.R. 1364); Resident Physician Shortage Reduction Act of 2021 (S.834); Dr. Lorna Breen Health Care Provider Protection Act (S. 610 / H.R. 1667); H.R. 2903, the CONNECT for Health Act; Medicare Area Wage Index - Imputed Rural Floor, Core Based Statistical Areas; H.R. 1319, American Rescue Plan Act of 202

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare annual payment rules; Graduate Medical Education; COVID-19 Hospital and Health Provider Loan Conversion Act (H.R. 1349); Provider Relief Fund; Medicare Sequester Relief Act (S. 748 / H.R. 1868) ; Parity Enforcement Act (H.R. 1364); Resident Physician Shortage Reduction Act of 2021 (S.834); Dr. Lorna Breen Health Care Provider Protection Act (S. 610 / H.R. 1667); H.R. 2903, the CONNECT for Health Act; Medicare Area Wage Index - Imputed Rural Floor, Core Based Statistical Areas; H.R. 1319, American Rescue Plan Act of 202

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Sequestration relief (H.R. 1868) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) Disproportionate share hospital allotment increase (technical correction) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Nursing and allied health education (NAHE) program funding S. 999, (addressing the Area Wage Index for rural hospitals) OMB recommendations on Metropolitan Statistical Areas Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340) Resetting the Impact (TRIA) Act of 2021 (H.R. 2455) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules Organ acquisition payment policies Clinical Lab Fee Schedule False Claims Act amendments

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Medicare Graduate Medical Education S. 834/H.R. 2256 - the Physician Shortage Reduction Act of 2021 Site-neutral payment policies H.R. 3684, Infrastructure bill - provisions related to the Medicare sequester H.R. 5305, Continuing resolution funding the government through Dec. 3, 2021 H.R. 5376, "Build Back Better Act" - provisions related to health policy, Medicare, workforce and hospital emergency preparedness Proposals to prevent future sequester cuts, including reductions in Medicare payments H.R. 1227/S. 386, "Medicare-X Choice Act" - provisions related to the establishment of a public health plan H.R. 1976, To establish an improved Medicare for All national health insurance program - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 3, "Elijah E. Cummings Lower Drug Prices Now Act" Proposals to reduce drug costs H.R. 1349, "COVID-19 Hospital and Health Provider Loan Conversion Act of 2021"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE