Rural Hospital Support Act

Administrative and Legislative monitoring and outreach related to healthcare billing practices. Administrative and Legislative monitoring and outreach related to COVID-19 response. Legislative support for HR 1887 and S 4009 Rural Hospital Support Act and extending Medicare payment for LVH and MDH.

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

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

H.R. 1330 / S. 4130 - "Patient Access to Higher Quality Health Care Act of 2021" - Provisions that would weaken or repeal current law limiting self-referral to physician-owned hospitals. Advocate for legislation that would reform rural hospital DSH payments. H.R. 4040 - "Advancing Telehealth Beyond COVID-19 Act of 2021" - Expanding access to telehealth beyond PHE. S. 1568 / H.R. 4407 - "Technical Reset to Advance the Instruction of Nurses Act" - CMS payments for Nursing Education Hospitals. H.R. 1887 / S. 4009 - "Rural Hospital Support Act" - Rural Extenders. H.R. 3173/H.R. 8487 - The Improving Seniors Timely Access to Care Act of 2021 - Simplify/streamline Medicare Advantage prior authorization process. Urge Congress to Support Improvements to IPPS Proposed Rule. H.R. 8747 - "The Assistance for Rural Community Hospitals (ARCH) Act" - Rural health payment program extensions. Discussions with Congress regarding waiving PAYGO. Urge Congress to address Medicare Physician Fee Schedule reimbursement rate S. 4747 - "Investing in Kids Mental Health Now Act of 2022" - Medicaid reimbursement for pediatric mental health and substance use disorder treatment services

Client expense: $620,000 · Firm income: Not reported

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

Support for elimination of statutory PAY-GO reductions Support for fair and reasonable implementation of No Surprises Act regulations Support for Improving Seniors Timely Access to Care Act (H.R. 3173/S. 3018) Support for Healthcare Workforce Resilience Act of 2021 Support for delay/elimination of Medicare sequestration cuts Support for increased flexibility and expansion of eligible expenses eligible for reimbursement under COVID-19 FEMA Public Assistance program. Support for Hospital Inpatient Services Modernization Act (H.R. 7053) Support for additional Provider Relief Funding Support for Protecting Rural Access to Care Act (H.R. 489) Support for Substance Use Disorder Workforce Act of 2021 (H.R.3441)/Opioid Workforce Act of 2021 (S.1438) Support for bolstering Medicare Graduate Medical Education program including the Resident Physician Shortage Reduction Act of 2021 (H.R. 2256/S.834) Support for Rural Hospital Support Act (H.R. 1887) and making permanent the Medicare Dependent Hospital and enhanced Low-Volume Payment Adjustment Support for The Assistance for Rural Community Hospitals (ARCH) Act (H.R. 8747) Support for Medicaid DSH Payment Adjustment Fairness Act (H.R. 5015) and amending Medicaid DSH Cap policy established in Section 203 of CAA of 2021. Support for continuing telehealth flexibilities beyond COVID-19 pandemic including the Advancing Telehealth Beyond COVID-19 Act (H.R. 4040) Support for extending hospital at home program flexibilities including the Hospital Inpatient Services Modernization Act (H.R. 7053/S. 3792). Support for preserving Medicares previously longstanding Critical Access Hospital mileage requirements

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

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

Issues relating to Medicare reimbursement for rural referral centers (RRCs), sole community hospitals (SCHs) and Medicare dependent hospitals (MDHs), including the Rural Hospital Support Act (H.R. 1887/S. 4009), the RURAL HELP Act (H.R. 1749), and the ARCH Act (H.R. 8747).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), 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

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

The "Rural Hospital Support Act (H.R. 1887)"; the "Improving Seniors' Timely Access to Care Act (H.R. 3173/S.3018)"; the "Advancing Telehealth Beyond COVID-19 Act of 2022 (H.R. 4040)"; the "Further Continuing Appropriations and Extensions Act, 2023 (P.L. 117-229)"; and the Consolidated Appropriations Act, 2023 (P.L. 117-328)".

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Medicare-dependent Hospitals (MDH) and Low-volume Hospital (LVH) adjustment programs o The Assistance for Rural Community Hospitals (ARCH) Act (H.R. 8747) would extend the Medicare-dependent hospital (MDH) program and low-volume hospital (LVH) adjustment for five years. o The Rural Hospital Support Act (H.R. 1887 / S.4009) would make both the MDH and the enhanced LVH adjustment programs permanent. PAYGO cut Extend Telehealth flexibilities - Advancing Telehealth Beyond COVID-19 Act (H.R. 4040) Hospital at Home waiver - Hospital Inpatient Services Modernization Act would extend by 2 years the Hospital at Home waiver program (S. 3792/ H.R. 7053). The Rural America Health Corps Act (S. 924/H.R. 2130) - support for this legislation which will provide incentives for clinicians to practice in rural health professional shortage areas. Improving Seniors Timely Access to Care Act (S. 3018 / H.R. 3173) - steamline Medicare Advantage Prior Authorization Conrad State 30 and Physician Access Reauthorization Act (S. 1810 / H.R. 3541) Mental and Behavioral Health - Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R. 7666) Area wage index - Save Rural Hospitals Act (S.999, H.R. 4066); Inpatient Rehabilitation Facilities - CMS Review Choice Demonstration

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues/Topics Public health funding  Behavioral health and crisis intervention Healthcare Workforce Rural health care and rural hospitals Telehealth  Medicare   Medicaid  Dual Medicare and Medicaid Eligibility Hospital Consolidation  Nutrition Services and Food Security  Obesity in older adults School meals Child nutrition Opioids and Substance Use Disorders Caregiving and Aging Home and Community Based Services Pandemic Preparedness Bills S. 3799, PREVENT Pandemics Act H.R. 6613, Keeping School Meals Flexible Act S. 1536 / H.R. 3108, Medical Nutrition Therapy Act of 2021 H.R. 5218, Collaborate in an Orderly and Cohesive Manner H.R. 7232, 9-8-8 and Parity Assistance Act of 2022 H.R. 7666, Restoring Hope for Mental Health and Well-Being Act of 2022 H.R. 1887 / S. 4009, Rural Hospital Support Act S. 2089, Keep Kids Fed Act S. 3913 / H.R. 8481, Improving DATA in Public Health Act S.4264, Advancing Integration in Medicare and Medicaid (AIM) Act S.3534 / H.R.7152, Tracking Pathogens Act S. 1162 / H.R. 6770, PACE Plus Act S.3626, PACE Expanded Act S. 569 / H.R. 1577, Treat and Reduce Obesity Act H.R. 4040, Advancing Telehealth Beyond COVID-19 Act of 2021

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support H.R. 315,Medicare Sequester COVID Moratorium Act, a bill to amend the Coronavirus Aid, Relief, and Economic Security Act to extend the temporary suspension of Medicare sequestration; Support H.R. 1332 and S.368,Telehealth Modernization Act, a bill to amend 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; Discussion with the Center for Medicare and Medicaid Innovation (CMMI) about the Radiation Oncology Alternative Payment Model; Support H.R. 1868, a bill that, among other health care provisions, would eliminate the 2% across-the-board cut to all Medicare payments, known as sequestration, until the end of 2021; Support H.R. 2455, The Resetting the Impact Act (TRIA), a bill to amend the IMPACT Act of 2014 to reset data collection and the development of a payment system technical prototype for post-acute care providers under the Medicare program to take into account the effects of COVID-19; Support H.R. 3173/ S.3018, Improving Seniors Timely Access to Care Act of 2021, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, and for other purposes; Support H.R. 1887/ S. 4009, Rural Hospital Support Act, a bill to make permanent the Medicare Dependent Hospital (MDH) and Low-volume Adjustment programs and rebases the MDH and Sole Community Hospital programs; Support relief for Medicare advanced payments; Discussion with CMMI about the priorities for alternative payment models; Support HR 4587, Value in Health Care Act of 2021, a bill to direct the Secretary of Health and Human Services to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage participation in such program, and for other purposes; Support HR 3746, Accountable Care in Rural America Act, a bill to amend title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program; Support H.R. 5425/ S. 1988, Protecting Rural Telehealth Access Act, a bill to amend title XVIII of the Social Security Act to protect access to telehealth services under the Medicare program; Letter asking Congress to address two important issues by the end of the year: an extension of the moratorium on Medicare sequester cuts, as well as preventing the Statutory Pay-As-You-Go (PAYGO) sequester from taking effect; Letter urging Congress to remove the reductions to the Medicaid disproportionate share hospital (DSH) program and uncompensated care pools from the Build Back Better Act; Support H.R. 5674/ S. 3061Medicare Mental Health Inpatient Equity Act of 2021, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Letter to the HHS secretary asking for PHE extension and urging HHS to extend the declaration for at least 90 days; Letter to the HHS secretary asking to renew the COVID-19 PHE; Letter to CMS urging changes to MA prior authorization requirements for PHE; Letter expressing our disappointment that Congress is adjourning for April recess without addressing the needs of hospitals and health systems and urging Congress to act to ensure health care providers have the critical relief, including but not limited to extending the Medicare sequester relief, adding more PRF dollars, and providing flexibility in the repayment terms for Medicare accelerated and advance repayments; Provide comments in response to the (CMS) request for information regarding access to coverage and care in the Medicaid and Childrens Health Insurance Program (CHIP) programs. The critical components for a comprehensive access and coverage strategy for Medicaid and CHIP should include: Robust outreach and enrollment efforts to secure and maintain coverage for eligible individuals and families, as well as ensure beneficiary knowledge of how to use this coverage, Standards to ensure timely and equitable access to quality care, and Provider payments that are sufficient to enable beneficiaries' access to quality care; Provide comments in response to the Department of Homeland Securitys (DHS) proposed rule to codify standards and clarify policies that govern public charge determinations. Public charge determinations assess how likely it is that an individual will become dependent on government assistance (public benefits) for support and subsistence. These policy clarifications are intended to help immigrants and their family members better understand when the use of certain public benefits could impact their future immigration status and address the chilling effects of the now-repealed 2019 public charge final rule. The AHA supports DHSs efforts to clarify policies regarding how public charge determinations are made to help reverse the damaging effects of the repealed 2019 public charge rule; A bill to amend title XIX of the Social Security Act to expand the availability of mental, emotional, and behavioral health services under the Medicaid program; Letter urging Congress to halt further cuts to hospital payments. Need to stop a harmful Medicare payment cut to providers that will go into effect July 1 without congressional action. Specifically, a 1% Medicare sequester cut took effect April 1, and that cut will increase to 2% on July 1 if Congress does not act. This will result in billions of dollars being cut from hospitals and health systems by the end of the year; Submitted comment letter regarding Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2023 and Updates to the IRF Quality Reporting Program. We note that the proposed IRF PPS labor-related share would only modestly shift upward from 72.9% in FY 2022 to 73.2% in FY 2022. AHA is concerned that these changes neither align regarding massive cost growth in recent months and years; Provide Comments on the Medicare Program - Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities and Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023 which stated the Proposed FY 2023 Payment Update warrants closer examination and we urge CMS to discuss in the final rule how the agency will account for these increased costs. The timing of this proposed net decrease in payments could not be worse, given the well-documented impact of the COVID-19 public emergency (PHE) on the SNF and nursing home field; Letter sent to the bipartisan, bicameral Leadership of the House and Senate, urging Congress to act to prevent further Medicare sequester cuts scheduled to take effect on July 1; Submitted comment letter about inpatient and long-term care hospital prospective payment system proposed rule for fiscal year 2023. Concerned that CMS is proposing policies and payment adjustment that do not take into account the current the COVID-19 public health emergency (PHE) and its atypical market forces and pandemic-driven aberrations affecting the utilization and cost of providing LTCH services. Specifically, we are concerned by proposals for an inadequate market basket update and an untenable spike in the high-cost outlier threshold; Letter urges Congress to call on CMS to make changes to the hospital inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2023 in order to ensure that Medicare payments for acute care services more accurately reflect the cost of providing hospital care to patients and communities; Support the bipartisan Dear Colleague letters that ask CMS to make critical changes to the hospital inpatient prospective payment system proposed rule for fiscal year (FY) 2023 to more accurately reflect the cost of providing hospital care to patients; Support HR 8487/ S 3173 Improving Seniors Timely Access to Care Act of 2022, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans; Support HR 8747 Assistance for Rural Community Hospitals Act of 2022 or the ARCH Act of 2022, a bill to amend title XVIII of the Social Security Act to extend Medicare-dependent hospital and Medicare low-volume hospital payments; Oppose HR 1330/ S 4130 Patient Access to Higher Quality Health Care Act of 2022, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 8188/ S4449 Saving Access to Laboratory Services Act, a bill to amend title XVIII of the Social Security Act to improve the accuracy of market-based Medicare payment for clinical diagnostic laboratory services, to reduce administrative burdens in the collection of data, and for other purposes.

Client expense: $5,120,000 · Firm income: Not reported

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

H.R. 1330 / S. 4130 - "Patient Access to Higher Quality Health Care Act of 2021" - Provisions that would weaken or repeal current law limiting self-referral to physician-owned hospitals. Advocate for legislation that would reform rural hospital DSH payments. H.R. 4040 - "Advancing Telehealth Beyond COVID-19 Act of 2021" - Expanding access to telehealth beyond PHE. S. 1568 / H.R. 4407 - "Technical Reset to Advance the Instruction of Nurses Act" - CMS payments for Nursing Education Hospitals. H.R. 1887 / S. 4009 - "Rural Hospital Support Act" - Rural Extenders. H.R. 4066 / S. 999 - "Save Rural Hospitals Act of 2021" - Area wage adjustment for certain Medicare hospitals. H.R. 3173/H.R. 8487 - The Improving Seniors Timely Access to Care Act of 2021 - Simplify/streamline Medicare Advantage prior authorization process. Urge Congress to Support Improvements to IPPS Proposed Rule. H.R. 8747 - "The Assistance for Rural Community Hospitals (ARCH) Act" - Rural health payment program extensions. H.R. 6833 - "Legislative Vehicle for Continuing Resolution Until Dec. 16" - Rural health payment program extensions. S. 1512 / H.R. 2903- "Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021" - Telehealth provisions. H.R. 2455 - The Resetting the IMPACT Act (TRIA) of 2021 - IMPACT Act implementation / unified payment timeline reset. Garner Congressional support for CMS to withdraw the Inpatient Rehabilitation Facility Review Choice Demonstration (IRF RCD). Discussions with Congress regarding waiving PAYGO.

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

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

Support for fair and reasonable implementation of No Surprises Act regulations Support for Improving Seniors Timely Access to Care Act (H.R. 3173/S. 3018) Support for Healthcare Workforce Resilience Act of 2021 Support for delay/elimination of Medicare sequestration cuts Support for increased flexibility and expansion of eligible expenses eligible for reimbursement under COVID-19 FEMA Public Assistance program. Support for Hospital Inpatient Services Modernization Act (H.R. 7053) Support for additional Provider Relief Funding Support for Protecting Rural Access to Care Act (H.R. 489) Support for Substance Use Disorder Workforce Act of 2021 (H.R.3441)/Opioid Workforce Act of 2021 (S.1438) Support for Resident Physician Shortage Reduction Act of 2021 (H.R. 2256/S.834) Support for Rural Hospital Support Act (H.R. 1887) Support for The Assistance for Rural Community Hospitals (ARCH) Act (H.R. 8747) Support for Medicaid DSH Payment Adjustment Fairness Act (H.R. 5015). Support for continuing telehealth flexibilities beyond COVID-19 pandemic including the Advancing Telehealth Beyond COVID-19 Act (H.R. 4040) Support for preserving Medicares previously longstanding Critical Access Hospital mileage requirements

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), 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 H.R. 1887/S. 4009, the Rural Hospital Support Act Site-neutral payment policies Build Back Better Act proposals 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 Proposals to reduce drug costs Hospital at Home Care Model H.R. 7053/S. 3792, Hospital Inpatient Services Modernization Act - provisions related to extending the CMS waiver beyond the end of the PHE

Client expense: Not reported · Firm income: $75,000

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

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

Administrative and Legislative monitoring and outreach related to healthcare billing practices. Administrative and Legislative monitoring and outreach related to COVID-19 response. Legislative support for HR 1887 and S 4009 Rural Hospital Support Act and extending Medicare payment for LVH and MDH.

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

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

The Medicare-dependent Hospitals (MDH) and Low-volume Hospital (LVH) adjustment programs o The Assistance for Rural Community Hospitals (ARCH) Act (H.R. 8747) would extend the Medicare-dependent hospital (MDH) program and low-volume hospital (LVH) adjustment for five years. o The Rural Hospital Support Act (H.R. 1887 / S.4009) would make both the MDH and the enhanced LVH adjustment programs permanent. PAYGO cut Extend Telehealth flexibilities - Advancing Telehealth Beyond COVID-19 Act (H.R. 4040) Hospital at Home waiver - Hospital Inpatient Services Modernization Act would extend by 2 years the Hospital at Home waiver program (S. 3792/ H.R. 7053). The Rural America Health Corps Act (S. 924/H.R. 2130) - support for this legislation which will provide incentives for clinicians to practice in rural health professional shortage areas. Improving Seniors Timely Access to Care Act (S. 3018 / H.R. 3173) - steamline Medicare Advantage Prior Authorization Conrad State 30 and Physician Access Reauthorization Act (S. 1810 / H.R. 3541) Mental and Behavioral Health - Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R. 7666) Area wage index - Save Rural Hospitals Act (S.999, H.R. 4066); Inpatient Rehabilitation Facilities - CMS Review Choice Demonstration

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The "Build Back Better Act (H.R. 5376)"; the "Rural Hospital Support Act (H.R. 1887)", the "Improving Seniors' Timely Access to Care Act (H.R. 3173/S.3018)" and the "Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023 (H.R. 6833)".

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 4994/PL 113-185 Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (all sections) HR 3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (all sections) HR 2797 - Patient Choice and Quality Care Act (all sections) S 1334 - Patient Choice and Quality Care Act (all sections) HR 1892 - Bipartisan Budget Act of 2018 (Sec. 51005. Extension of Blended Site-Neutral Payment Rate for Certain Long-Term Care Hospital Discharges; Temporary Adjustment to Site Neutral Payment Rates, Title III-Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care.) HR 3107 - Improving Seniors Timely Access to Care Act of 2019 (all sections) HR 266 - Paycheck Protection Program and Health Care Enforcement Act (all sections) HR 748 - Coronavirus Aid, Relief, and Economic Security (CARES) Act (all sections) HR 8600 - Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (all sections) HR 8702 - Holding Providers Harmless from Medicare Cuts during COVID-19 Act of 2020 (all sections) HR 133/PL 116-260 - Consolidated Appropriations Act, 2021 (Division M - Coronavirus Response & Relief Supplemental Appropriations Act, 2021) HR 2455 - The Resetting the IMPACT Act (TRIA) of 2021 (all sections) S. 610 - Protecting Medicare and American Farmers from Sequester Acts Cut (all sections) HR 1887 - Rural Hospital Support Act (all sections) S. 4009 - Rural Hospital Support Act (all sections) HR 3173 - Improving Seniors Timely Access to Care Act of 2021 (all sections) S. 3018 - Improving Seniors Timely Access to Care Act of 2021 (all sections) HR 8487 - Improving Senior Timely Access to Care Act of 2022 (all sections) H.R.6833 - Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023 (Div. D, Title 1 - Medicare and Medicaid, sec. 101 (extension of increases on patient hospital payment adjustment for certain low volume hospitals) and sec. 102 (extension of the Medicare-dependent hospital (MDH) program)

Client expense: $277,000 · 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), Office of Management & Budget (OMB), SENATE

Issues relating to Medicare reimbursement for rural referral centers (RRCs), sole community hospitals (SCHs) and Medicare dependent hospitals (MDHs), including the Rural Hospital Support Act (H.R. 1887/S. 4009), the RURAL HELP Act (H.R. 1749), and the ARCH Act (H.R. 8747).

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

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

HR 4994/PL 113-185 Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (all sections) HR 3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (all sections) HR 2797 - Patient Choice and Quality Care Act (all sections) S 1334 - Patient Choice and Quality Care Act (all sections) HR 1892 - Bipartisan Budget Act of 2018 (Sec. 51005. Extension of Blended Site-Neutral Payment Rate for Certain Long-Term Care Hospital Discharges; Temporary Adjustment to Site Neutral Payment Rates, Title III-Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care.) HR 3107 - Improving Seniors Timely Access to Care Act of 2019 (all sections) HR 266 - Paycheck Protection Program and Health Care Enforcement Act (all sections) HR 748 - Coronavirus Aid, Relief, and Economic Security (CARES) Act (all sections) HR 8600 - Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (all sections) HR 8702 - Holding Providers Harmless from Medicare Cuts during COVID-19 Act of 2020 (all sections) HR 133/PL 116-260 - Consolidated Appropriations Act, 2021 (Division M - Coronavirus Response & Relief Supplemental Appropriations Act, 2021) HR 2455 - The Resetting the IMPACT Act (TRIA) of 2021 (all sections) S. 610 - Protecting Medicare and American Farmers from Sequester Acts Cut (all sections) HR 1887 - Rural Hospital Support Act (all sections) S. 4009 - Rural Hospital Support Act (all sections) HR 3173 - Improving Seniors Timely Access to Care Act of 2021 (all sections) S. 3018 - Improving Seniors Timely Access to Care Act of 2021 (all sections) HR 8487 - Improving Senior Timely Access to Care Act of 2022 (all sections) H.R.6833 - Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023 (Div. D, Title 1 - Medicare and Medicaid, sec. 101 (extension of increases on patient hospital payment adjustment for certain low volume hospitals) and sec. 102 (extension of the Medicare-dependent hospital (MDH) program)

Client expense: $277,000 · 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), Office of Management & Budget (OMB), SENATE

S.1512 - Connect for Health Act of 2021 - all provisions relating to removing restrictions on Medicare coverage of telehealth. Actions by the Health Resources and Services Administration to redesignate health professional shortage areas, in relation to 86 FR 35808 S. 3792/H.R.7053 - the Hospital Inpatient Services Modernization Act - all provisions. S. 3792 and H.R. 7053 The Hospital Inpatient Services Modernization Act - all provisions. H.R. 5883 - The Rural Health Fairness in Competition Act - all provisions. S. 4009 & H.R 1887- The Rural Hospital Support Act - all provisions. H.R.4587 - The Value in Health Care Act of 2021 - all provisions. S.4182 - Workplace Violence Prevention for Health Care and Social Service Workers Act - all provisions. Suspending the 2% Medicare Sequester cuts to hospitals. Funding for the Provider Relief Fund. Health Care loan repayment programs. Special Immigrant Visas. Extending flexibilities to critical access hospitals made possible by the public health emergency, including the 25-bed cap, the 96-hour average length of stay, and the skilled nursing facility 3-day rule. Extending EMTALA flexibilities made possible by the public health emergency.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.1512 - Connect for Health Act of 2021 - all provisions relating to removing restrictions on Medicare coverage of telehealth. Actions by the Health Resources and Services Administration to redesignate health professional shortage areas, in relation to 86 FR 35808 S. 3792/H.R.7053 - the Hospital Inpatient Services Modernization Act - all provisions. H.R. 5883 - The Rural Health Fairness in Competition Act - all provisions. S. 4009 & H.R 1887- The Rural Hospital Support Act - all provisions. H.R.4587 - The Value in Health Care Act of 2021 - all provisions. Suspending the 2% Medicare Sequester cuts to hospitals. Extending flexibilities to critical access hospitals made possible by the public health emergency, including the 25-bed cap, the 96-hour average length of stay, and the skilled nursing facility 3-day rule. Extending EMTALA flexibilities made possible by the public health emergency.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support H.R. 315,Medicare Sequester COVID Moratorium Act, a bill to amend the Coronavirus Aid, Relief, and Economic Security Act to extend the temporary suspension of Medicare sequestration; Support H.R. 1332 and S.368,Telehealth Modernization Act, a bill to amend 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; Discussion with the Center for Medicare and Medicaid Innovation (CMMI) about the Radiation Oncology Alternative Payment Model; Support H.R. 1868, a bill that, among other health care provisions, would eliminate the 2% across-the-board cut to all Medicare payments, known as sequestration, until the end of 2021; Support H.R. 2455, The Resetting the Impact Act (TRIA), a bill to amend the IMPACT Act of 2014 to reset data collection and the development of a payment system technical prototype for post-acute care providers under the Medicare program to take into account the effects of COVID-19; Support H.R. 3173/ S.3018, Improving Seniors Timely Access to Care Act of 2021, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, and for other purposes; Support H.R. 1887/ S. 4009, Rural Hospital Support Act, a bill to make permanent the Medicare Dependent Hospital (MDH) and Low-volume Adjustment programs and rebases the MDH and Sole Community Hospital programs; Support relief for Medicare advanced payments; Discussion with CMMI about the priorities for alternative payment models; Support HR 4587, Value in Health Care Act of 2021, a bill to direct the Secretary of Health and Human Services to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage participation in such program, and for other purposes; Support HR 3746, Accountable Care in Rural America Act, a bill to amend title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program; Support H.R. 5425/ S. 1988, Protecting Rural Telehealth Access Act, a bill to amend title XVIII of the Social Security Act to protect access to telehealth services under the Medicare program; Letter asking Congress to address two important issues by the end of the year: an extension of the moratorium on Medicare sequester cuts, as well as preventing the Statutory Pay-As-You-Go (PAYGO) sequester from taking effect; Letter urging Congress to remove the reductions to the Medicaid disproportionate share hospital (DSH) program and uncompensated care pools from the Build Back Better Act; Support H.R. 5674/ S. 3061Medicare Mental Health Inpatient Equity Act of 2021, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Letter to the HHS secretary asking for PHE extension and urging HHS to extend the declaration for at least 90 days; Letter to the HHS secretary asking to renew the COVID-19 PHE; Letter to CMS urging changes to MA prior authorization requirements for PHE; Letter expressing our disappointment that Congress is adjourning for April recess without addressing the needs of hospitals and health systems and urging Congress to act to ensure health care providers have the critical relief, including but not limited to extending the Medicare sequester relief, adding more PRF dollars, and providing flexibility in the repayment terms for Medicare accelerated and advance repayments; Provide comments in response to the (CMS) request for information regarding access to coverage and care in the Medicaid and Childrens Health Insurance Program (CHIP) programs. The critical components for a comprehensive access and coverage strategy for Medicaid and CHIP should include: Robust outreach and enrollment efforts to secure and maintain coverage for eligible individuals and families, as well as ensure beneficiary knowledge of how to use this coverage, Standards to ensure timely and equitable access to quality care, and Provider payments that are sufficient to enable beneficiaries' access to quality care; Provide comments in response to the Department of Homeland Securitys (DHS) proposed rule to codify standards and clarify policies that govern public charge determinations. Public charge determinations assess how likely it is that an individual will become dependent on government assistance (public benefits) for support and subsistence. These policy clarifications are intended to help immigrants and their family members better understand when the use of certain public benefits could impact their future immigration status and address the chilling effects of the now-repealed 2019 public charge final rule. The AHA supports DHSs efforts to clarify policies regarding how public charge determinations are made to help reverse the damaging effects of the repealed 2019 public charge rule; A bill to amend title XIX of the Social Security Act to expand the availability of mental, emotional, and behavioral health services under the Medicaid program; Letter urging Congress to halt further cuts to hospital payments. Need to stop a harmful Medicare payment cut to providers that will go into effect July 1 without congressional action. Specifically, a 1% Medicare sequester cut took effect April 1, and that cut will increase to 2% on July 1 if Congress does not act. This will result in billions of dollars being cut from hospitals and health systems by the end of the year; Submitted comment letter regarding Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2023 and Updates to the IRF Quality Reporting Program. We note that the proposed IRF PPS labor-related share would only modestly shift upward from 72.9% in FY 2022 to 73.2% in FY 2022. AHA is concerned that these changes neither align regarding massive cost growth in recent months and years; Provide Comments on the Medicare Program - Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities and Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023 which stated the Proposed FY 2023 Payment Update warrants closer examination and we urge CMS to discuss in the final rule how the agency will account for these increased costs. The timing of this proposed net decrease in payments could not be worse, given the well-documented impact of the COVID-19 public emergency (PHE) on the SNF and nursing home field; Letter sent to the bipartisan, bicameral Leadership of the House and Senate, urging Congress to act to prevent further Medicare sequester cuts scheduled to take effect on July 1; Submitted comment letter about inpatient and long-term care hospital prospective payment system proposed rule for fiscal year 2023. Concerned that CMS is proposing policies and payment adjustment that do not take into account the current the COVID-19 public health emergency (PHE) and its atypical market forces and pandemic-driven aberrations affecting the utilization and cost of providing LTCH services. Specifically, we are concerned by proposals for an inadequate market basket update and an untenable spike in the high-cost outlier threshold; Letter urges Congress to call on CMS to make changes to the hospital inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2023 in order to ensure that Medicare payments for acute care services more accurately reflect the cost of providing hospital care to patients and communities.

Client expense: $4,580,000 · Firm income: Not reported

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

Issues/Topics Public health funding  Behavioral health and crisis intervention Healthcare Workforce Rural health care and rural hospitals Telehealth  Medicare   Medicaid  Dual Medicare and Medicaid Eligibility Hospital Consolidation     Nutrition Services and Food Security  Obesity in older adults School meals Child nutrition Opioids and Substance Use Disorders Caregiving and Aging Home and Community Based Services Pandemic Preparedness Bills S3799 PREVENT Pandemics Act H.R. 6613 - Keeping School Meals Flexible Act S1536/HR3108 - Medical Nutrition Therapy Act of 2021 HR 5218 - Collaborate in an Orderly and Cohesive Manner HR 7232 - 9-8-8 and Parity Assistance Act of 2022 HR 7666 - Restoring Hope for Mental Health and Well-Being Act of 2022 H.R.1887/ S.4009 - Rural Hospital Support Act S.2089 - Keep Kids Fed Act H.R.6613 - Keeping School Meals Flexible Act S.3913 - Improving DATA in Public Health Act S.4264 - Advancing Integration in Medicare and Medicaid (AIM) Act S.3534/HR.7152 - Tracking Pathogens Act

Client expense: $720,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, 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; 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

The "Build Back Better Act (H.R. 5376)"; the "Rural Hospital Support Act (H.R. 1887)" and the "Improving Seniors' Timely Access to Care Act (H.R. 3173/S.3018)".

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

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 H.R. 1887/S. 4009, the Rural Hospital Support Act Site-neutral payment policies Build Back Better Act proposals 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 Proposals to reduce drug costs Hospital at Home Care Model H.R. 7053/S. 3792, Hospital Inpatient Services Modernization Act - provisions related to extending the CMS waiver beyond the end of the PHE

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Build Back Better Act (H.R. 5376) VALID Act (H.R 4128) Provider Relief Fund Improvement Act (H.R. 5963 / S. 3611) No Surprises Act regulations Improving Seniors Timely Access to Care Act (H.R. 1587/S. 3018) Healthcare Workforce Resilience Act of 2021 Support for delay/elimination of Medicare sequestration cuts Support for legislation to continue expansion of telehealth services during and beyond COVID-19 pandemic Support for additional Provider Relief Funding Support for changes to Medicare Volume Decrease Adjustment calculation Support for Protecting Rural Access to Care Act (H.R. 489) Support for flexibility in 340B drug pricing program DSH threshold (H.R. 3203/S.773) Support for Substance Use Disorder Workforce Act of 2021 (H.R.3441)/Opioid Workforce Act of 2021 (S.1438) Support for Resident Physician Shortage Reduction Act of 2021 (H.R. 2256/S.834) Support for Rural Hospital Support Act (H.R. 1887) Support for Medicaid DSH Payment Adjustment Fairness Act (H.R. 5015). Support for continuing telehealth flexibilities beyond COVID-19 pandemic Support for preserving Medicares previously longstanding Critical Access Hospital mileage requirements

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

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

Administrative and Legislative monitoring and outreach related to healthcare billing practices. Administrative and Legislative monitoring and outreach related to COVID-19 response. Legislative support for HR 1887 and S 4009 Rural Hospital Support Act and extending Medicare payment for LVH and MDH.

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

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

H.R. 1330 / S. 4130 - "Patient Access to Higher Quality Health Care Act of 2021" - Provisions that would weaken or repeal current law limiting self-referral to physician-owned hospitals. H.R. 2455 - "The Resetting the IMPACT Act (TRIA) of 2021" - Unified Post-Acute PPS. S. 1512 / H.R. 2903- "Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021" - Telehealth provisions. S. 1568 / H.R. 4407 - "Technical Reset to Advance the Instruction of Nurses Act" - CMS payments for Nursing Education Hospitals. H.R. 1887 / S. 4009 - "Rural Hospital Support Act" - Rural Extenders. H.R. 3173 - The Improving Seniors Timely Access to Care Act of 2021 - Simplify/streamline Medicare Advantage prior authorization processes. H.R. 2455 - The Resetting the IMPACT Act (TRIA) of 2021 - IMPACT Act implementation / unified payment timeline reset. Garner Congressional support for CMS to withdraw the Inpatient Rehabilitation Facility Review Choice Demonstration (IRF RCD) Discussions regarding Rural DSH payment policy.

Client expense: $820,000 · Firm income: Not reported

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

H.R. 1330 / S. 4130 - "Patient Access to Higher Quality Health Care Act of 2021" - Provisions that would weaken or repeal current law limiting self-referral to physician-owned hospitals. H.R. 2455 - "The Resetting the IMPACT Act (TRIA) of 2021" - Unified Post-Acute PPS. S. 1512 / H.R. 2903- "Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021" - Telehealth provisions. S. 1568 / H.R. 4407 - "Technical Reset to Advance the Instruction of Nurses Act" - CMS payments for Nursing Education Hospitals. H.R. 1887 / S. 4009 - "Rural Hospital Support Act" - Rural Extenders. H.R. 3173 - The Improving Seniors Timely Access to Care Act of 2021 - Simplify/streamline Medicare Advantage prior authorization processes. H.R. 2455 - The Resetting the IMPACT Act (TRIA) of 2021 - IMPACT Act implementation / unified payment timeline reset. Garner Congressional support for CMS to withdraw the Inpatient Rehabilitation Facility Review Choice Demonstration (IRF RCD) Discussions regarding Rural DSH payment policy.

Client expense: $730,000 · Firm income: Not reported

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

Issues relating to Medicare reimbursement for rural referral centers (RRCs), sole community hospitals (SCHs) and Medicare dependent hospitals (MDHs), including the Rural Hospital Support Act (H.R. 1887) and the RURAL HELP Act (H.R. 1749).

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

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

S. 4009 - Rural Hospital Support Act and HR 1887 - Rural Hospital Support Act

Client expense: Not reported · Firm income: Not reported

S. 4009 - Rural Hospital Support Act and HR 1887 - Rural Hospital Support Act

Client expense: Not reported · Firm income: Not reported

S. 4009 - Rural Hospital Support Act and HR 1887 - Rural Hospital Support Act

Client expense: Not reported · Firm income: Not reported

S. 4009 - Rural Hospital Support Act and HR 1887 - Rural Hospital Support Act

Client expense: Not reported · Firm income: Not reported

Support for delay/elimination of Medicare sequestration cuts Support for legislation to continue expansion of telehealth services during and beyond COVID-19 pandemic Support for additional Provider Relief Funding Support for conversion of Medicare Accelerated/Advance Payments to loans Support for changes to Medicare Volume Decrease Adjustment calculation Support for Protecting Rural Access to Care Act (H.R. 489) Support for flexibility in 340B drug pricing program DSH threshold (H.R. 3203/S.773) Support for Substance Use Disorder Workforce Act of 2021 (H.R.3441)/Opioid Workforce Act of 2021 (S.1438) Support for Resident Physician Shortage Reduction Act of 2021 (H.R. 2256/S.834) Support for Rural Hospital Support Act (H.R. 1887) Support for Medicaid DSH Payment Adjustment Fairness Act (H.R. 5015). Support for continuing telehealth flexibilities beyond COVID-19 pandemic Support for preserving Medicares previously longstanding Critical Access Hospital mileage requirements

Client expense: $140,000 · Firm income: Not reported

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

Support H.R. 315,Medicare Sequester COVID Moratorium Act, a bill to amend the Coronavirus Aid, Relief, and Economic Security Act to extend the temporary suspension of Medicare sequestration; Support H.R. 1332 and S.368,Telehealth Modernization Act, a bill to amend 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; Discussion with the Center for Medicare and Medicaid Innovation (CMMI) about the Radiation Oncology Alternative Payment Model; Support H.R. 1868, a bill that, among other health care provisions, would eliminate the 2% across-the-board cut to all Medicare payments, known as sequestration, until the end of 2021; Support H.R. 2455, The Resetting the Impact Act (TRIA), a bill to amend the IMPACT Act of 2014 to reset data collection and the development of a payment system technical prototype for post-acute care providers under the Medicare program to take into account the effects of COVID-19; Support H.R. 3173/ S.3018, Improving Seniors Timely Access to Care Act of 2021, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, and for other purposes; Support H.R. 1887, Rural Hospital Support Act, a bill to make permanent the Medicare Dependent Hospital (MDH) and Low-volume Adjustment programs and rebases the MDH and Sole Community Hospital programs; Support relief for Medicare advanced payments; Discussion with CMMI about the priorities for alternative payment models; Support HR 4587, Value in Health Care Act of 2021, a bill to direct the Secretary of Health and Human Services to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage participation in such program, and for other purposes; Support HR 3746, Accountable Care in Rural America Act, a bill to amend title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program; Support H.R. 5425/ S. 1988, Protecting Rural Telehealth Access Act, a bill to amend title XVIII of the Social Security Act to protect access to telehealth services under the Medicare program; Letter asking Congress to address two important issues by the end of the year: an extension of the moratorium on Medicare sequester cuts, as well as preventing the Statutory Pay-As-You-Go (PAYGO) sequester from taking effect; Letter urging Congress to remove the reductions to the Medicaid disproportionate share hospital (DSH) program and uncompensated care pools from the Build Back Better Act; Support H.R. 5674/ S. 3061Medicare Mental Health Inpatient Equity Act of 2021, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Letter to the HHS secretary asking for PHE extension and urging HHS to extend the declaration for at least 90 days; Letter to the HHS secretary asking to renew the COVID-19 PHE; Letter to CMS urging changes to MA prior authorization requirements for PHE.

Client expense: $5,400,000 · Firm income: Not reported

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

Support for hospital funding in federal infrastructure package Support for delay/elimination of Medicare sequestration cuts Support for legislation to continue expansion of telehealth services during and beyond COVID-19 pandemic Support for fair and accurate distribution of CARES Act Provider Relief Funds Support for conversion of Medicare Accelerated/Advance Payments to loans Support for changes to Medicare Volume Decrease Adjustment calculation Support for Protecting Rural Access to Care Act (H.R. 489) Support for flexibility in 340B drug pricing program DSH threshold (H.R. 3203/S.773) Support for Substance Use Disorder Workforce Act of 2021 (H.R.3441)/Opioid Workforce Act of 2021 (S.1438) Support for Resident Physician Shortage Reduction Act of 2021 (H.R. 2256/S.834) Support for Rural Hospital Support Act (H.R. 1887) Support for Medicaid DSH Payment Adjustment Fairness Act (H.R. 5015). Support for continuing telehealth flexibilities beyond COVID-19 pandemic Support for preserving Medicares previously longstanding Critical Access Hospital mileage requirements

Client expense: $140,000 · Firm income: Not reported

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