Conrad State 30 and Physician Access Reauthorization Act

S. 834/ H.R. 2256: Resident Physician Shortage Reduction Act S. 1024/H.R. 2255: Healthcare Workforce Resilience Act S. 1548/H.R. 3085: Equity in Neuroscience and Alzheimers Clinical Trials (ENACT) Act S. 1810/H.R. 3541: Conrad State 30 and Physician Access Reauthorization Act S. 3427: Neuroscience Center of Excellence Act of 2021 S.4348: FDASLA Act of 2022; section 506. S. 4906: National Neurological Conditions Surveillance System Reauthorization Act of 2022 H.R. 2754: COVID-19 Long Haulers Act H.R. 4122: Resident Education Deferred Interest Act of 2021 H.R. 5435: Bringing Regulatory Advances into Neuroscience (BRAIN) Act Urging reforms to proposed surprise billing regulations to align with congressional intent for payment disputes. Support for creating a Neuroscience Center of Excellence at FDA. Supporting policies to address the COVID-19 public health emergency, including maintaining telemedicine coverage and ensuring access to affordable health coverage and medications. Medical research funding related to NIH including the BRAIN Initiative, AHRQ, HEAL Initiative, and the Congressionally Directed Medical Research Programs at the Department of Defense. Support for funding for the Pediatric Subspecialty Loan Repayment Program.

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

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

H.R. 6, American Dream and Promise Act of 2021 H.R. 78, Legal Workforce Act H.R. 206/S. 4813, Paperwork Reduction for Farmers and H-2A Modernization Act H.R. 401, Landscaping Workforce Act of 2021 H.R. 427, Moving H-2A to United States Department of Agriculture Act of 2021 H.R. 865, American Jobs First Act of 2021 H.R. 1037, Better Agriculture Resources Now (BARN) Act H.R. 1177/S. 348, U.S. Citizenship Act H.R. 1571, Dairy H-2A Eligibility Act H.R. 1603, Farm Workforce Modernization Act of 2021 H.R. 2064, TPS and DED Protection Act of 2021 H.R. 2086, Agricultural Guest Worker Reform Initiative Act of 2021 H.R. 2255/S. 1024, Healthcare Workforce Resilience Act H.R. 2298, Accountability Through Electronic Verification Act H.R. 2839/S. 1358, Bipartisan Border Solutions Act of 2021 H.R. 2901/S. 831, EB-5 Reform and Integrity Act of 2021 H.R. 3215, Temporary Family Visitation Act H.R. 3237, Emergency Security Supplemental Appropriations Act, 2021 H.R. 3385/S. 2083, HOPE for Afghan SIVs Act of 2021 H.R. 3513/S. 2032, Afghan Allies Protection Act of 2021 H.R. 3541, Conrad State 30 and Physician Access Reauthorization Act H.R. 3648, Equal Access to Green cards for Legal Employment (EAGLE) Act of 2021 H.R. 3897, H-2B Returning Worker Exception Act of 2021 H.R. 4288, Workforce for an Expanding Economy Act H.R. 4331, Americas Cultivation of Hope and Inclusion for Long-term Dependents Raised and Educated Natively Act of 2021 (Americas CHILDREN Act of 2021) H.R. 4521, America Creating Opportunities for Manufacturing, Pre-Eminence in Technology, and Economic Strength (America COMPETES) Act of 2022 H.R. 4578, Relief for Seasonal Businesses Act of 2021 H.R. 4681, Let Immigrants Kickstart Employment (LIKE) Act of 2021 H.R. 4856, Canadian Snowbird Visa Act H.R. 5498, Preserving Employment Visas Act H.R. 5887/S. 3134, Keep Food Local and Affordable Act of 2021 H.R. 5924, Keep STEM Talent Act of 2021 H.R. 6206, American Tech Workforce Act of 2021 H.R. 6637, Dignity for Immigrants while Guarding our Nation to Ignite and Deliver the American Dream (DIGNIDAD Dignity) Act H.R. 7239, Essential Workers for Economic Advancement Act H.R. 7441, Acute Labor Shortage Solutions Act of 2022 H.R. 7549, Seasonal Worker Solidarity Act of 2022 H.R. 8295, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2023 H.R. 8433, Renewing Immigration Provisions of the Immigration Act of 1929 H.R. 8685/S. 4787, Afghan Adjustment Act H. Res. 901, Expressing the sense of the House of Representatives that BridgeUSA exchange programs are vital to the economy and national interests of the United States, and that Congress should prioritize robust support to ensure equitable opportunities for Americans and people from other countries S. 71, Accountability Through Electronic Verification Act S. 264, Dream Act of 2021 S. 306, Safe Environment from Countries Under Repression and Emergency (SECURE) Act S. 418, E-Verify Act S. 478, Higher Wages for American Workers Act of 2021 S. 495, Prioritizing Help to Businesses Act S. 959, Secure and Protect Act of 2021 S. 970, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement (BELIEVE) Act S. 1810, Conrad State 30 and Physician Access Reauthorization Act S. 1861, Partner with Korea Act S. 2207, A bill to temporarily increase the availability of temporary nonimmigrant nonagricultural workers for the purposes of restoring American forests, and for other purposes S. 2443, A bill to expand the definition of H-2A nonimmigrant for purposes of the Immigration and Nationality Act to include aliens engaged in seafood processing, horticultural commodities, or the care of horses S. 2753, Protecting Children of Long-term Visa Holders Act of 2021 S. 2828, Preserving Employment Visas Act S. 3638, Keep STEM Talent Act of 2022 S. 3720, H-1B and L-1 Visa Reform Act of 2022 S. 3721, Resolving Extended Limbo for Immigrant Employees and Families (RELIEF) Act S. 3850, Securing America's Ports of Entry Act of 2022 S. 3869, A bill to add Ireland to the E-3 nonimmigrant visa program S. 4659, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2023 Draft legislation titled Affordable and Secure Food Act Proposed Rule, U.S. Immigration and Customs Enforcement, Department of Homeland Security; Optional Alternatives to the Physical Document Examination Associated with Employment Eligibility Verification (Form I-9) (87 Fed. Reg. 50,786-50,794, August 18, 2022) Various issues relating to visa waiver program; H-1B Visa Program; H-1B registration rule; H-1B reform; H-2 Visa Program and temporary rule; H-2A Visa Program; H-4 rule; L-1 Visa Program; J-1 BridgeUSA program; EB-5 Visa Program; EB-5 regional center program; E-Verify program; nonimmigrant workers in temporary or seasonal nonagricultural employment; Customs and Border Protection staffing at U.S. ports of entry; border security; immigration policy and reforms; guest worker programs; legalization concepts; visa reform; customs trade facilitation and enforcement; Deferred Action for Childhood Arrivals (DACA) program; extension of temporary protected status (TPS) designations for El Salvador, Honduras, and Haiti; administrative-regulatory efforts related to public charge, notice to appear, H-4 & OPT; delays in H-4 and L-2 Status Extensions and Employment Authorization Documents (EADs); FY22 funding for Customs and Border Protection staffing; restarting routine visa processing during the COVID-19 pandemic; high-skilled immigration; lesser skilled immigration; temporary agricultural guest workers; temporary non-agricultural guest workers; optional practical training program; size and administration of employment-based immigrant visa categories; size and administration of family-based immigrant visa categories; size and administration of employment-based nonimmigrant visa categories; expansion of the use of the E-Verify system; I-9 employment verification; interior enforcement; increased vetting of visa applicants; unfair immigration related employment practices; international travel; trusted traveler programs; biometric entry-exit; increasing the number of ICE officers, border patrol agents and Customs and Border Protection officers; aerial security enhancements; temporary DHS guidance for the I-9 employment verification process in the wake of COVID-19; State Department policy extending consular interview waiver eligibility; temporary United States Citizenship and Immigration Services (USCIS) procedures to provide flexibility with regard to filing deadlines, and temporary USCIS guidelines providing flexibility to wet-ink signatures on USCIS forms and documents; United States Citizenship and Immigration Services (USCIS) funding shortfalls and extending premium processing capability for the adjudication of various immigration forms; regulatory proposals that would restrict applicant eligibility for the H-1B program; regulatory proposals that would drastically change how prevailing wage levels are determined for the purposes of obtaining certain employment nonimmigrant and immigrant visas; proposals that would significantly change how cap-subject H-1B petitions will be chosen in the future; regulatory proposals that would change how the period of admission for student visa holders and exchange visa holders is determined; regulatory proposals that will temporarily raise the annual quota for H-2B visas; enhanced COVID-19 testing protocols for international air travel; creation/use of digital passports; reopening and expanding consular operations; fully reinstituting routine visa processing at U.S. embassies and consulates abroad; recapturing unused immigrant visas from prior years; creating exemptions to the current immigrant visa caps; proposals that would expand consular interview waivers for prospective immigrant and nonimmigrant visa applicants abroad; implementation of the EB-5 Reform and Integrity Act of 2022, P.L. 117-103, Division BB; proposals that would provide relief for Afghan refugees; granting temporary protected status and special student relief to Ukrainian nationals; ensuring Ukrainian applicants for refugee/asylee status have access; potential Reinstitution of Stateside Visa Revalidation Services; implementation of electronic visa foils in passports; consular service delays; USCIS processing delays; Visa relief for long term foreign national workers laid off by their employers while waiting for their green cards in the immigrant visa backlogs; improving wait times for CBP Processing at Ports of Entry; expanding and implementing new CBP preclearance facilities abroad

Client expense: $20,990,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), White House Office

H.R. 6, The American Dream and Promise Act of 2021 S. 264, Dream Act of 2021 Issue: Support policies allowing undocumented students to attend U.S. medical schools and graduate medical education. Support Dreamer eligibility for federal student loans. H.R. 3541/ S. 1810, Conrad State 30 and Physician Access Reauthorization Act Issue: Support reauthorization and expansion of the Conrad 30 program, and improvements to physician immigration Issue: Support policies to ensure timely and predictable processing for immigration of academic medicine community H.R. 2255/ S. 1024, Healthcare Workforce Resilience Act Issue: Support reduction of green card backlogs for health professionals

Client expense: $876,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS), White House Office

H.R. 3541, Conrad State 30 and Physician Access Reauthorization Act, all provisions S. 1810, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 6, American Dream and Promise Act of 2021, all provisions S. 1024, Healthcare Workforce Resilience Act, all provisions H.R. 2255, Healthcare Workforce Resilience Act, all provisions H.R. 3648, Equal Access to Green cards for Legal Employment (EAGLE) Act of 2022, all provisions H.R. 4521, America COMPETES Act of 2022, provisions relating to Section 80303, Doctoral STEM Programs H.R. 8019, Professionals Access To Health Workforce Integration Act of 2022, all provisions H.R. 8021, Immigrants in Nursing and Allied Health Act of 2022, all provisions H.R. 8022, International Medical Graduates Assistance Act of 2022, all provisions Migrant populations/mental health/safer medical practices and protections

Client expense: $5,060,000 · Firm income: Not reported

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

H.R. 2255/ S.1024-Healthcare Workforce Resilience Act; H.R. 3648, Equal Access to Green cards for Legal Employment Act of 2021 or the EAGLE Act of 2021; H.R. 3541/S. 1810, Conrad State 30 and Physician Access Reauthorization Act; H.R. 4521, America COMPETES Act of 2022; and policies contained in H.R. 5376, Build Back Better Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2255/S.1024, Healthcare Workforce Resilience Act; H.R. 3648, Equal Access to Green cards for Legal Employment Act of 2021 or the EAGLE Act of 2021; H.R. 3541/S. 1810, Conrad State 30 and Physician Access Reauthorization Act; policies contained in H.R. 5376, to provide for reconciliation pursuant to title II of S. Con. Res. 14.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Stopping Doctors Shortages Act (S.311), work to ensure eligibility of Texas physicians to the Public Service Loan Forgiveness Program. Conrad State 30 and Physician Access Reauthorization Act (S. 1810/H.R. 3541), allows international physicians trained in the United States to stay in country if they practice in underserved areas. Safety from Violence for Healthcare Employees, SAVE Act (HR 7961), establish legal penalties for assaulting or intimidating hospital employees.

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

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

H.R. 432 - Mental Health Access Improvement Act H.R. 909 / S. 484 - The Moms Matter Act H.R. 1475/ S. 1795 - Pursuing Equity in Mental Health Act H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 H.R. 3541 / S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 3753/ S. 1962 - Parity Implementation Assistance Act H.R. 4058 / S. 2061 - Telemental Health Care Access Act H.R. 4122 / S. 3658 - Resident Education Deferred Interest (REDI) Act H.R. 4217 / S. 2779 - TRIUMPH for New Moms Act H.R. 4770 - Evaluating Disparities and Outcomes of Telehealth (EDOT) Act of 2021 H.R. 5218 - Collaborate in an Orderly and Cohesive Manner Act H.R. 6000 - Cures 2.0 Act H.R. 6636 / S. 2697 - Due Process Continuity of Care Act H.R. 7073 / S. 3824 - Into the Light for Maternal Mental Health and Substance Use Disorders Act H.R. 7116 - 988 Implementation Act of 2022 H.R. 7232 - 988 and Parity Assistance Act of 2022 H.R. 7666 - Restoring Hope for Mental Health and Well-Being Act of 2022 H.R. 7667 - Food and Drug Amendments of 2022 H.R. 7857 - Minority Fellowship Program Reauthorization Act of 2022 H.R. 8180 - Undertaking Needed Investments in Therapy, Education, and De-Escalation (UNITED) Act of 2022 H.R. 8229 - Telemental Health Parity Act H.R. 8391 - CONNECT Act H.R. 8800 - Supporting Medicare Providers Act of 2022 H.R. 8830 / S. 4003 - Law Enforcement De-escalation Training Act H.R. 8878 - Intensive Outpatient Policy H.R. 8879 - Inpatient Psychiatric Facility Improvement Act H.R. 8881 - Mental Health Transparency Act H.R. 8884 - Medicare Opioid Use Disorder Outreach Act H.R. 8885 - Better Health Care Directories Act H.R. 8886 - Promoting Clarity in Mental Health and Substance Use Disorder Treatment Act H.R. 8889 - Readable Insurance Coverage Enhancement (RICE) Act H.R. 8890 - Physician Wellness Program Act H.R. 8891 - No Surprises for Survivors Act H.R. 8892 - Access to Mental Health Services Act H.R. 8908 - Fighting Stimulant and other Substance Use Disorders Act H.R. 8910 - Behavioral Health Integration Awareness Act H.R. 9201 - Community Mental Wellness and Resilience Act H.R. 9499 - CCBHC Expansion Act of 2022 S. 2144 - PEERS Act of 2021 S. 2425 - Suicide Prevention Lifeline Improvement Act S. 4747 - Investing in Kids Mental Health Now Act S. 4965 - A bill to amend title XVIII of the Social Security Act to remove in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology. S.5041 - Training Psychiatrists for the Future Act S.5042 - More Behavioral Health Providers Act S.5043 - Expand the Behavioral Health Workforce Act S.5061 - Expand Qualified Psychologist Services Act S.5062 - Protect Our Physicians Act S.5272 - Increasing Mental Health Options of 2022 Senate Finance Kids Mental Health Draft Senate Finance Telehealth Draft Senate Finance Integrated Care Draft Senate Finance Workforce Draft Senate Finance Parity Draft

Client expense: $194,975 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

S. 1810/ H.R. 3541 - "The Conrad State 30 and Physician Access Reauthorization Act" - Expand healthcare workforce.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Affordable Care Act (P.L. 111-148, P.L. 111-152): Continued advocacy with Congress in support of expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Advocated against a December 2018 ruling by a federal judge in Texas that the entire Affordable Care Act (ACA) is unconstitutional. Access to Primary Care (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Medicare Payments to Physicians: Urged that Congress provide incentives to physicians who transform their practices into Advanced Alternative Payment Models and continue to provide stability for physicians in the MIPS program. Specifically, Congress should extend the five percent Qualified Alternative Payment Model participant bonus beyond the 2022 performance year, replace the zero percent baseline payment updates under Medicare with positive updates. Urged congressional committees with jurisdiction over Medicare to exercise their oversight authority and urge CMS to expedite approval of more Advanced APMS, particularly those that work for small and specialty practices and to simplify the scoring structure and reporting requirements under the Merit-Based Incentive Payment System (MIPS) in order to fulfill Congress intent of a more streamlined program that reduces burdens on physicians; Supported S.2648, the Rural ACO Improvement Act, amends title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program (MSSP) to ensure that all ACOs have an equal opportunity to share in savings regardless of their geographic location; Provided recommendations to CMS on the Merit-based Incentive Payment System Value Pathway (MVP), which aims to reduce reporting burden and complexity within MIPS while improving the accuracy and effectiveness of performance measurement. The College noted specifically that a robust, multi-year transition period will be critical to the success of the MVP, that it does not support making the MVP mandatory, that CMS should continue to support numerous reporting mechanisms, including qualified registries and clinical data registries, which have been instrumental in developing specialty-specific performance measures, among other things. Regarding CMS Medicare Physician Fee Schedule and Quality Payment Program (QPP) rules, expressed support for extending some of the services and increased flexibility for telehealth through the end of 2024, namely some audio-only services that were allowed during the COVID-19 public health emergency (PHE), support for collecting additional data on health equity issues to analyze disparities that occur across their programs, support for including chronic care management as one of the seven MIPS Value Pathways (MVPs) for 2023. Urged CMS to discontinue its split/shared visits policy and not move forward with the transition set to take effect in 2023. Urged Congress to support inclusion in must-pass legislation this year provisions to provide financial stability through a baseline positive annual update to the physician fee schedule reflecting inflation in practice costs, and eliminate, revise budget neutrality requirements to allow for appropriate changes in spending growth and prevent a 4.42 percent Medicare payment cut as contained in H.R. 8800, the Supporting Medicare Providers Act of 2022; Extend the moratoriums on sequester and PAYGO cuts that were approved by Congress at the end of last year. Recommended modifications to Medicare law to establish a mechanism for savings to be calculated across all aspects of the program-that is, increased investment in relative and absolute payments for primary care and preventive health care services (Part B) results in savings due to reduced emergency department visits and hospitalizations (Part A)-and to allow these savings to be reinvested back into primary and preventive care, as well as into social and public health services. With regard to Medicares Quality Payment Program, advocated with Congress to provide flexibility to CMS to set performance thresholds, improve the cost performance category, provide scoring flexibility to CMS to allow for multi-category credit, provide CMS flexibility to score and benchmark measures as appropriate and to test and incentivize new measures and MVPs to ensure successful implementation, update the Promoting Interoperability performance category, Extend the $500 million exceptional performance bonus for an additional six years , align comparisons in the MIPS Quality performance category and Physician Compare. FY2023 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Preventions programs in the FY 2023 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Preventions (CDC) Office on Smoking and Health (OSH). COVID-19: Urged congressional appropriators to provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the virus that is commensurate with the public health emergency that the virus represents. Expressed support to Congress and the administration for a variety of COVID-related bills from the 116th Congress as follows: the Families First Coronavirus Response Act, H.R. 6201, and other stimulus reforms related to COVID-19 including: Emergency paid leave benefits, paid sick days for public health emergencies, coverage of testing for COVID-19, waiving of cost sharing under Medicare, Medicare Advantage, Medicaid, and CHIP, increasing the federal FMAP under Medicaid, providing reimbursement for CPT codes 99441 - 99443, which are telephone evaluation and management services, expediting entrance of international medical graduates who are citizens of other nations (non-US IMGs) into the country and ensuring that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic, funding for physician practices under the Public Health and Social Service Emergency Fund (PHSSEF), providing tax relief, grants, and loans to small and medium size practices impacted by COVID-19, increasing funding for personal protective equipment (PPE), ensuring Medicaid pay parity with Medicare for primary care services; Urged support for H.R. 7059, the Coronavirus Provider Protection Act, which extend liability protections to those who provide care in good faith during the COVID-19 public health emergency (plus a reasonable time, such as 60 days, after the emergency declaration ends), and not in situations of gross negligence or willful misconduct. The College also urged that pay parity between telephone claims and in-person visits and between all telehealth and in-person visits be maintained after the PHE is lifted. Urged congress to mitigate the impact of covid across racial and ethnic minority populations by collect covid-19 and racial disparity data, equitably distribute covid-19 vaccines and treatments, protect essential workers, permanently expand access to family and medical leave, address environmental and social drivers of health, integrate primary care and behavioral health, improve mental health parity with increased federal oversight and enforcement, make naloxone more available to prevent overdose, expand medication-assisted treatment (mat) for physicians, establish a national prescription drug monitoring program (PDMP); urged support for administering COVID-19 vaccinations to all eligible immigrants in Customs and Border Protection (CBP) custody. Urged CMS to support increasing COVID-19 vaccine uptake by ensuring clinicians are appropriately paid for vaccine counseling for beneficiaries of Medicaid and Medicare. Urged that telehealth services should remain in place for at least two years after the end of the PHE to ensure that our physicians are able to continue to use this modality to enhance patient care. Urged Congress to support the concept of a congressionally-mandated bipartisan commission to examine the U.S. preparations for and response to the COVID-19 pandemic, in order to inform future public policy and health systems preparedness. Urged that any uses of technology in the U.S. in the context of the pandemic should be demonstrated to be effective, be temporary, and ensure that safeguards for privacy and confidentiality are in place. Womens Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Urged support for mandatory, permanent extension of postpartum Medicaid coverage, from 60 days to 12 months after delivery. Urged support for the Womens Health Protection Act of 2021 and 2022 (H.R. 3755/S. 1975), bills that would protect a persons ability to determine whether to continue or end a pregnancy and to protect the health care clinicians ability to provide abortion services free from medically unnecessary restrictions such as waiting periods, biased counselling and admitting privilege requirements for clinicians. Access to Care: Urged members of Congress to cosponsor and pass H.R. 340, the Incentivizing Medicaid Expansion Act of 2021, to expand federal matching assistance for states that choose to expand Medicaid, regardless of when such expansion takes place: Cosponsor and pass H.R. 369, the Health Care Affordability Act of 2021, to permanently expand eligibility for higher premium tax credits under the Affordable Care Act. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2256/S. 834, the Resident Physician Reduction Shortage Act of 2021, to increase the number of GME slots to 14,000 over seven years for specialties facing shortages, including internal medicine; Cosponsor and pass S. 1024, the Healthcare Workforce Resilience Act, to recapture 40,000 unused visas and use them to provide additional green cards to 15,000 physicians and 25,000 professional nurses; Cosponsor and pass H.R. 3541/S. 1810, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R.4122/S.3658, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2023 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Public Health and Pandemic Preparedness: Urged members of Congress to support funding in FY2023 appropriations - $11 billion total for the CDC, $35 million for the CDCs Injury Prevention and Control, Firearm Injury and Mortality Prevention Research; $49 billion in total for the NIH, $25 million for the Office of the Director, Firearm Injury and Mortality Prevention Research; Cosponsor and pass the COVID Supplemental Appropriations Act, 2022, H.R. 7007, or a similar supplemental funding package, to provide $15.6 billion in additional funding for COVID relief; Cosponsor and pass the CONNECT for Health Act (H.R. 2903/S. 1512) and the Telehealth Extension Act of 2021 (H.R. 6202/S. 3593), to remove arbitrary restrictions on where a patient must be located to utilize telehealth services; enable patients to continue to receive telehealth services in their homes; ensure federally-qualified health centers and rural health centers can furnish telehealth services and improve data collection and analysis for at least two years. Prescription Drug Reform: Urged members of Congress to cosponsor and pass S. 898, the Fair Drug Pricing Act, to require drug companies to disclose and provide more information about imminent drug-price increases, including data about research and development costs; Cosponsor and pass S. 833, the Empowering Medicare Seniors to Negotiate Drug Prices Act of 2021, to help to reduce drug prices and out-of-pocket costs by allowing the federal government to negotiate lower drug prices on behalf of Medicare beneficiaries; Cosponsor and pass S. 464/H.R. 2163, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Telehealth Services: Urged Congress to support H.R. 2903/S. 1512, the CONNECT for Health Act, to remove arbitrary barriers to telehealth services such as geographic and site of service restrictions; S. 168/H.R. 708, the Temporary Reciprocity to Ensure Access to Treatment Act or the TREAT Act, to ensure that telehealth services can be provided across states lines after the public health emergency ends; H.R. 8487, the Improving Seniors Timely Access to Care Act that would help protect patients from unnecessary delays in care and reduce administrative burdens on physicians by standardizing and streamlining the prior authorization approval process in the Medicare Advantage (MA) program. Advocated with Congress for passage of H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2021, to extend coverage for critical telehealth services beyond the public health emergency. Mental and Behavioral Health: Urged members of Congress to cosponsor and pass H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act, to provide grants through the Department of Health and Human Services to primary care physicians who choose to deliver behavioral health care through the Collaborate Care Model (CoCM); Support enhanced reimbursement for CoCM payment codes under Medicare to more appropriately reflect the value of services provided to patients with mental health and substance use disorder needs. Scope of Practice: Urged Congress to oppose the Improving Care and Access to Nurses Act, or the I CAN Act, H.R. 8812, which allows non-physician clinicians to deliver care that is not commensurate with their training, skills, and demonstrated competencies in accord with national standards

Client expense: $69,651 · Firm income: Not reported

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

Continuing Appropriations Act, 2023 (H.R. 2617) Inflation Reduction Act of 2022 (H.R. 5376) Restoring Hope for Mental Health and Well-Being Act of 2022 (HR 7666) Healthcare Workforce Resilience Act of 2021 Maternal health: MOMMAs Act S. 411/HR 3407; Black Maternal Health Omnibus Act of 2021 S. 346/H.R. 959; Data to Save Moms Act S. 347/HR 925; IMPACT to Save Moms Act S 1675/HR 4387; Maternal Health Quality Improvement Act S. 1675/H.R. 4387 Conrad State 30 & Physician Access Reauthorization Act S. 1810/H.R. 3541 Public Health and Social Services Emergency Fund Regulatory relief in light of coronavirus Transparency (No Surprises Act regulations; public posting of hospital charges) 340B Drug Pricing Program Strengthening Americas Health Care Readiness Act (S. 54) Social Determinants Accelerator Act (H.R. 2503), Leveraging Integrated Networks in Communities (LINC) to Address Social Needs Act (S. 509) No Surprises Act regulations Protecting Providers Everywhere in America Act (S. 308/H.R. 1436) Behavioral health reimbursement and policies (Child Suicide Prevention and Lethal Means Safety Act - H.R. 5035; Childrens Mental Health Infrastructure Act - H.R. 4945; Helping Kids Cope Act - H.R. 4944; Restoring Hope for Mental Health and Well-Being Act of 2022 (HR 7666)) Public health emergency designation FAAN Future Advancement of Academic Nursing (FAAN) Act of 2022

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

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

The Affordable Care Act (P.L. 111-148, P.L. 111-152): Continued advocacy with Congress in support of expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Advocated against a December 2018 ruling by a federal judge in Texas that the entire Affordable Care Act (ACA) is unconstitutional. Access to Primary Care (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Medicare Payments to Physicians: Urged that Congress provide incentives to physicians who transform their practices into Advanced Alternative Payment Models and continue to provide stability for physicians in the MIPS program. Specifically, Congress should extend the five percent Qualified Alternative Payment Model participant bonus beyond the 2022 performance year, replace the zero percent baseline payment updates under Medicare with positive updates. Urged congressional committees with jurisdiction over Medicare to exercise their oversight authority and urge CMS to expedite approval of more Advanced APMS, particularly those that work for small and specialty practices and to simplify the scoring structure and reporting requirements under the Merit-Based Incentive Payment System (MIPS) in order to fulfill Congress intent of a more streamlined program that reduces burdens on physicians; Supported S.2648, the Rural ACO Improvement Act, amends title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program (MSSP) to ensure that all ACOs have an equal opportunity to share in savings regardless of their geographic location; Provided recommendations to CMS on the Merit-based Incentive Payment System Value Pathway (MVP), which aims to reduce reporting burden and complexity within MIPS while improving the accuracy and effectiveness of performance measurement. The College noted specifically that a robust, multi-year transition period will be critical to the success of the MVP, that it does not support making the MVP mandatory, that CMS should continue to support numerous reporting mechanisms, including qualified registries and clinical data registries, which have been instrumental in developing specialty-specific performance measures, among other things. Regarding CMS Medicare Physician Fee Schedule and Quality Payment Program (QPP) rules, expressed support for extending some of the services and increased flexibility for telehealth through the end of 2024, namely some audio-only services that were allowed during the COVID-19 public health emergency (PHE), support for collecting additional data on health equity issues to analyze disparities that occur across their programs, support for including chronic care management as one of the seven MIPS Value Pathways (MVPs) for 2023. Urged CMS to discontinue its split/shared visits policy and not move forward with the transition set to take effect in 2023. Urged Congress to support inclusion in must-pass legislation this year provisions to provide financial stability through a baseline positive annual update to the physician fee schedule reflecting inflation in practice costs, and eliminate, revise budget neutrality requirements to allow for appropriate changes in spending growth and prevent a 4.42 percent Medicare payment cut as contained in H.R. 8800, the Supporting Medicare Providers Act of 2022; Extend the moratoriums on sequester and PAYGO cuts that were approved by Congress at the end of last year. Recommended modifications to Medicare law to establish a mechanism for savings to be calculated across all aspects of the program-that is, increased investment in relative and absolute payments for primary care and preventive health care services (Part B) results in savings due to reduced emergency department visits and hospitalizations (Part A)-and to allow these savings to be reinvested back into primary and preventive care, as well as into social and public health services. With regard to Medicares Quality Payment Program, advocated with Congress to provide flexibility to CMS to set performance thresholds, improve the cost performance category, provide scoring flexibility to CMS to allow for multi-category credit, provide CMS flexibility to score and benchmark measures as appropriate and to test and incentivize new measures and MVPs to ensure successful implementation, update the Promoting Interoperability performance category, Extend the $500 million exceptional performance bonus for an additional six years , align comparisons in the MIPS Quality performance category and Physician Compare. FY2023 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Preventions programs in the FY 2023 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Preventions (CDC) Office on Smoking and Health (OSH). COVID-19: Urged congressional appropriators to provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the virus that is commensurate with the public health emergency that the virus represents. Expressed support to Congress and the administration for a variety of COVID-related bills from the 116th Congress as follows: the Families First Coronavirus Response Act, H.R. 6201, and other stimulus reforms related to COVID-19 including: Emergency paid leave benefits, paid sick days for public health emergencies, coverage of testing for COVID-19, waiving of cost sharing under Medicare, Medicare Advantage, Medicaid, and CHIP, increasing the federal FMAP under Medicaid, providing reimbursement for CPT codes 99441 - 99443, which are telephone evaluation and management services, expediting entrance of international medical graduates who are citizens of other nations (non-US IMGs) into the country and ensuring that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic, funding for physician practices under the Public Health and Social Service Emergency Fund (PHSSEF), providing tax relief, grants, and loans to small and medium size practices impacted by COVID-19, increasing funding for personal protective equipment (PPE), ensuring Medicaid pay parity with Medicare for primary care services; Urged support for H.R. 7059, the Coronavirus Provider Protection Act, which extend liability protections to those who provide care in good faith during the COVID-19 public health emergency (plus a reasonable time, such as 60 days, after the emergency declaration ends), and not in situations of gross negligence or willful misconduct. The College also urged that pay parity between telephone claims and in-person visits and between all telehealth and in-person visits be maintained after the PHE is lifted. Urged congress to mitigate the impact of covid across racial and ethnic minority populations by collect covid-19 and racial disparity data, equitably distribute covid-19 vaccines and treatments, protect essential workers, permanently expand access to family and medical leave, address environmental and social drivers of health, integrate primary care and behavioral health, improve mental health parity with increased federal oversight and enforcement, make naloxone more available to prevent overdose, expand medication-assisted treatment (mat) for physicians, establish a national prescription drug monitoring program (PDMP); urged support for administering COVID-19 vaccinations to all eligible immigrants in Customs and Border Protection (CBP) custody. Urged CMS to support increasing COVID-19 vaccine uptake by ensuring clinicians are appropriately paid for vaccine counseling for beneficiaries of Medicaid and Medicare. Urged that telehealth services should remain in place for at least two years after the end of the PHE to ensure that our physicians are able to continue to use this modality to enhance patient care. Urged Congress to support the concept of a congressionally-mandated bipartisan commission to examine the U.S. preparations for and response to the COVID-19 pandemic, in order to inform future public policy and health systems preparedness. Urged that any uses of technology in the U.S. in the context of the pandemic should be demonstrated to be effective, be temporary, and ensure that safeguards for privacy and confidentiality are in place. Womens Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Urged support for mandatory, permanent extension of postpartum Medicaid coverage, from 60 days to 12 months after delivery. Urged support for the Womens Health Protection Act of 2021 and 2022 (H.R. 3755/S. 1975), bills that would protect a persons ability to determine whether to continue or end a pregnancy and to protect the health care clinicians ability to provide abortion services free from medically unnecessary restrictions such as waiting periods, biased counselling and admitting privilege requirements for clinicians. Access to Care: Urged members of Congress to cosponsor and pass H.R. 340, the Incentivizing Medicaid Expansion Act of 2021, to expand federal matching assistance for states that choose to expand Medicaid, regardless of when such expansion takes place: Cosponsor and pass H.R. 369, the Health Care Affordability Act of 2021, to permanently expand eligibility for higher premium tax credits under the Affordable Care Act. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2256/S. 834, the Resident Physician Reduction Shortage Act of 2021, to increase the number of GME slots to 14,000 over seven years for specialties facing shortages, including internal medicine; Cosponsor and pass S. 1024, the Healthcare Workforce Resilience Act, to recapture 40,000 unused visas and use them to provide additional green cards to 15,000 physicians and 25,000 professional nurses; Cosponsor and pass H.R. 3541/S. 1810, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R.4122/S.3658, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2023 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Public Health and Pandemic Preparedness: Urged members of Congress to support funding in FY2023 appropriations - $11 billion total for the CDC, $35 million for the CDCs Injury Prevention and Control, Firearm Injury and Mortality Prevention Research; $49 billion in total for the NIH, $25 million for the Office of the Director, Firearm Injury and Mortality Prevention Research; Cosponsor and pass the COVID Supplemental Appropriations Act, 2022, H.R. 7007, or a similar supplemental funding package, to provide $15.6 billion in additional funding for COVID relief; Cosponsor and pass the CONNECT for Health Act (H.R. 2903/S. 1512) and the Telehealth Extension Act of 2021 (H.R. 6202/S. 3593), to remove arbitrary restrictions on where a patient must be located to utilize telehealth services; enable patients to continue to receive telehealth services in their homes; ensure federally-qualified health centers and rural health centers can furnish telehealth services and improve data collection and analysis for at least two years. Prescription Drug Reform: Urged members of Congress to cosponsor and pass S. 898, the Fair Drug Pricing Act, to require drug companies to disclose and provide more information about imminent drug-price increases, including data about research and development costs; Cosponsor and pass S. 833, the Empowering Medicare Seniors to Negotiate Drug Prices Act of 2021, to help to reduce drug prices and out-of-pocket costs by allowing the federal government to negotiate lower drug prices on behalf of Medicare beneficiaries; Cosponsor and pass S. 464/H.R. 2163, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Telehealth Services: Urged Congress to support H.R. 2903/S. 1512, the CONNECT for Health Act, to remove arbitrary barriers to telehealth services such as geographic and site of service restrictions; S. 168/H.R. 708, the Temporary Reciprocity to Ensure Access to Treatment Act or the TREAT Act, to ensure that telehealth services can be provided across states lines after the public health emergency ends; H.R. 8487, the Improving Seniors Timely Access to Care Act that would help protect patients from unnecessary delays in care and reduce administrative burdens on physicians by standardizing and streamlining the prior authorization approval process in the Medicare Advantage (MA) program. Advocated with Congress for passage of H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2021, to extend coverage for critical telehealth services beyond the public health emergency. Mental and Behavioral Health: Urged members of Congress to cosponsor and pass H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act, to provide grants through the Department of Health and Human Services to primary care physicians who choose to deliver behavioral health care through the Collaborate Care Model (CoCM); Support enhanced reimbursement for CoCM payment codes under Medicare to more appropriately reflect the value of services provided to patients with mental health and substance use disorder needs. Scope of Practice: Urged Congress to oppose the Improving Care and Access to Nurses Act, or the I CAN Act, H.R. 8812, which allows non-physician clinicians to deliver care that is not commensurate with their training, skills, and demonstrated competencies in accord with national standards.

Client expense: $300,406 · Firm income: Not reported

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

S. 1810/H.R. 3541: Conrad 30 and Physician Access Act No Bill No.: LIFT the Bar Act

Client expense: $788,015 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1893: Rural Physician Workforce Production Act - Provide federal support for rural residency training S 1958/HR 3671:DOC Act - Permanent authorization of THCGME program HR 1319: American Rescue Plan - Expansion of ACA coverage, investments in public health workforce, funding for COVID-19 response HR 2418: Student Loan Forgiveness for Frontline Health Workers- Would forgive outstanding federal and private student loan debt for frontline physicians S.1810/H.R. 3541: Conrad 30 and Physician Access Act H.R. 4014 Physician Shortage GME Cap Flex Act No Bill No.: Congressional Primary Care Caucus;117th Congress membership in the bipartisan CPCC No Bill No.: Teaching Health Centers GME; Community Health Centers- National Health Service Corps; Special Diabetes Program; Special Diabetes Program for Indians - Increased funding and allocation of resources for teaching health center programs No Bill No.: Rural MOMS Act-Demonstration program to train physicians about maternal care in rural communities

Client expense: $788,015 · Firm income: Not reported

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

FY23 Labor, Health and Human Services, and Education Appropriations Bill: Pediatric Subspecialty Loan Repayment Program, Firearm Injury and Mortality Prevention Research, Pediatric Mental Health Care Access Program, Emergency Medical Services for Children, National Center for Birth Defects and Developmental Disabilities, Global Immunization, Sudden Unexpected Infant Death and Sudden Death in Childhood, Vaccine Injury Compensation Program, VACCINES Act, Antimicrobial Resistance, Maternal and Child Health, School Based Health Centers Child passenger safety (H.R. 5736) Appropriations for the Indian Health Service Maternal, Infant, and Early Childhood Home Visiting Program (including Jackie Walorski MIECHV Reauthorization Act of 2022 (H.R. 8876)) Infant sleep product safety (S. 1259, H.R. 3182) Lead exposure prevention Food safety Paid family and medical leave Climate Change Reduction Act Button battery ingestions (H.R. 5313, S. 3278) Early Childhood education Child product safety and injury prevention Furniture tip-overs (S. 441, H.R. 1314) Child Abuse Prevention and Treatment Act reauthorization, CAPTA Reauthorization Act of 2021 CAPTA Plans of safe care grants Family First Prevention Services Act implementation Issues related to the COVID-19 pandemic and providing supports for the child welfare community CAPTA Fatalities Prevention and Response Title IV-B Reauthorization Ensuring Medicaid continuity for Children in Foster Care Act (S. 2689/H.R. 5414) Congregate care reform Mental health supports for foster youth/former foster youth Indian Child Welfare Act & Title IV-B (H.R. 8954) Regulation of high-powered magnet sets Vehicle emissions standards Access to genetic sequencing 12-Month Continuous Eligibility for Children in Medicaid/CHIP Easy Enrollment in Health Care Act of 2021 Provider Relief Fund Reporting Requirements Accelerating Kids Access to Care Act (H.R. 3089/S. 1544) Connect for Health Act of 2021 Medicaid Payment Parity Standards in CBP Custody Standards in ICE Family Detention Standards in ORR Custody Licensure of ORR Shelters Emergency Intake Sites Public Charge Child Nutrition Reauthorization/WIC SNAP Mental Health for Children H.R. 6, DREAM Act Family Separation and Detention Medical Nutrition Equity Act Lift the Bar Act Donor Human Milk CARE for Families Act HR 3107 WIC Act Keep Families Together Act Breastfeeding Peer Counseling Program Public Health Preparedness and Response Research for Pregnant and Lactating Women Funding for Pediatric Device Consortia Funding for Emergency Medical Services for Children Program Funding for HRSA Pediatric Mental Health Care Access Program PUMP Act DEMAND Act Dietary Guidelines Child Poverty Coronavirus Response Legislation Asylum Child Poverty Reduction Act Suicide Prevention Child Nutrition Waivers Universal School Meals Equality Act Mental Health Services for Students Act Youth Mental Health and Suicide Prevention Act Child Tax Credit Comprehensive Mental Health in Schools Pilot Program Supporting Childrens Mental Health Care Access Act Protect Infants from Formula Shortages Act Infant Formula Shortage White House Conference on Hunger, Nutrition, and Health Restoring Hope for Mental Health and Well-Being Act Mental Health Reform Reauthorization Act Safety of Pediatricians and Childrens Hospitals Gender Affirming Care FY23 Labor, Health and Human Services, and Education Appropriations Bill: Pediatric Subspecialty Loan Repayment Program, Firearm Injury and Mortality Prevention Research, Pediatric Mental Health Care Access Program, Emergency Medical Services for Children, National Center for Birth Defects and Developmental Disabilities, Global Immunization, Sudden Unexpected Infant Death and Sudden Death in Childhood, Vaccine Injury Compensation Program, VACCINES Act, Antimicrobial Resistance, Maternal and Child Health, School Based Health Centers COVID-19 Supplemental Appropriations H.R.482 / S.350 - Newborn Screening Saves Lives Reauthorization Act H.R.5551 - Improving the Health of Children Act H.R.2347 / S.2691 - Strengthening the Vaccines for Children Program Act of 2021 Childrens Literacy Initiative on Military Bases (CLIMB) Act of 2022 - H.R. 8208 Advancing FASD Research, Services and Prevention Act - S. 2238 / H.R. 4151 Banning Electronic Stimulation Devices - FDA User Fee Bills (H.R. 7667/S. 4348) Defense Health Agency - Autism Care Demonstration SSI Savings Penalty Elimination Act (S. 4102) FY23 National Defense Authorization Act and Halting Reductions to Military Medical Personnel Kids Online Safety Act (S. 3663) Children and Teens Online Privacy Protection Act (S. 1628) Pediatric Subspecialty Loan Repayment Program Implementation Eunice Kennedy Shriver National Institute of Child Health and Human Development FY 2023 Funding Census Bureau FY 2023 Funding Accelerating Kids Access to Care Act (H.R. 3089/S. 1544) Conrad State 30 and Physician Access Reauthorization Act (H.R. 3541/S. 1810) Clinical Trial Coverage Act (H.R. 8546) American Data Privacy and Protection Act (H.R. 8152) Department of Health and Human Services Office of Adolescent Health Fiscal Year (FY) 2023 Funding Medical Marijuana and Cannabidiol Research Expansion Act (H.R. 8454) Mainstreaming Addiction Treatment Act (H.R. 1384/S. 445) E-Cigarette and Tobacco Product Regulation (FDA) FY 2024 Funding for Adolescent Sexual and Reproductive Health Programs (White House Office of Management and Budget) Strengthening Efforts to End Violence Against Children Act International Children with Disabilities Protection Act Reach Every Mother and Child Act Appropriations - global child and youth-focused global health subaccounts at USAID (Vulnerable Children, Maternal and Child Health, Nutrition) Global Child Thrive Act Implementation

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

Government targets: Administration for Children & Families (ACF), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Consumer Product Safety Commission (CPSC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Indian Health Service, Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Science & Technology Policy (OSTP), SENATE, U.S. Agency for International Development (USAID), U.S. Customs & Border Protection, U.S. Immigration & Customs Enforcement (ICE), White House Office

S. 834/ H.R. 2256: Resident Physician Shortage Reduction Act S. 1024/H.R. 2255: Healthcare Workforce Resilience Act S. 1548/H.R. 3085: Equity in Neuroscience and Alzheimers Clinical Trials (ENACT) Act S. 1810/H.R. 3541: Conrad State 30 and Physician Access Reauthorization Act S. 3427: Neuroscience Center of Excellence Act of 2021 S.4348: FDASLA Act of 2022; section 506. S. 4906: National Neurological Conditions Surveillance System Reauthorization Act of 2022 H.R. 2754: COVID-19 Long Haulers Act H.R. 4122: Resident Education Deferred Interest Act of 2021 H.R. 5435: Bringing Regulatory Advances into Neuroscience (BRAIN) Act H.R. 5376: Inflation Reduction Act of 2022; Subtitle B Urging reforms to proposed surprise billing regulations to align with congressional intent for payment disputes. Support for creating a Neuroscience Center of Excellence at FDA. Supporting policies to address the COVID-19 public health emergency, including maintaining telemedicine coverage and ensuring access to affordable health coverage and medications. Medical research funding related to NIH including the BRAIN Initiative, AHRQ, HEAL Initiative, and the Congressionally Directed Medical Research Programs at the Department of Defense. Support for funding for the Pediatric Subspecialty Loan Repayment Program.

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. Monitoring and outreach on legislative and administrative activity related to infrastructure. Monitoring and outreach on legislative and administrative activity related to reconciliation and the congressional budget resolution. H.R. 4432 - Department of Defense Appropriations Act, FY2022. Senate Draft, Department of Defense Appropriations Act, FY2022 P.L. 116-136, CARES Act P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act P.L. 117-2, American Rescue Plan Act of 2021 H.R. 3684 - Infrastructure Investment and Jobs Act S. 464 - Safe Step Act H.R. 2163 - Safe Step Act H.R. 1319 - American Rescue Plan Act of 2021 S. 834 - Resident Physician Shortage Reduction Act of 2021 H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R. 1868 - To prevent across-the-board direct spending cuts, and for other purposes H.R. 315 - Medicare Sequester COVID Moratorium Act S. 368 - Telehealth Modernization Act H.R. 1332 - Telehealth Modernization Act H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 S. 1024 - Healthcare Workforce Resilience Act H.R. 2255 - Healthcare Workforce Resilience Act H.R. 1819 - Pharmacy Benefit Manager Accountability Study Act H.R. 3107 - The Improving Seniors Timely Access to Care Act H.R. 3517 - Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act H.R. 315 - The Medicare Sequester COVID Moratorium Act S. 748 - Medicare Sequester Relief Act H.R. 5067 - Preserving Patient Access to Home Infusion Act S. 2652 - Preserving Patient Access to Home Infusion Act H.R. 3541 - Conrad State 30 and Physician Access Reauthorization Act S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 5376 - Build Back Better Act S. 3314 - Supporting Medicare Providers Act H.R. 6020 - Supporting Medicare Providers Act H.R. 5801 - Help Ensure Lower Patient (HELP) Copays Act S. 4408 Health and Location Data Protection Act of 2022 H.R. 4122 - Resident Education Deferred Interest Act or the REDI Act S. 3658 - Resident Education Deferred Interest Act or the REDI Act H.R.8800 - Supporting Medicare Providers Act of 2022 FY2023 Labor Health and Human Services Appropriations content Draft House, Department of Defense Appropriations Act, FY2023 Draft Senate, Department of Defense Appropriations Act, FY2023

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. Monitoring and outreach on legislative and administrative activity related to infrastructure. Monitoring and outreach on legislative and administrative activity related to reconciliation and the congressional budget resolution. H.R. 4432 - Department of Defense Appropriations Act, FY2022. Senate Draft, Department of Defense Appropriations Act, FY2022 P.L. 116-136, CARES Act P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act P.L. 117-2, American Rescue Plan Act of 2021 H.R. 3684 - Infrastructure Investment and Jobs Act S. 464 - Safe Step Act H.R. 2163 - Safe Step Act H.R. 1319 - American Rescue Plan Act of 2021 S. 834 - Resident Physician Shortage Reduction Act of 2021 H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R. 1868 - To prevent across-the-board direct spending cuts, and for other purposes H.R. 315 - Medicare Sequester COVID Moratorium Act S. 368 - Telehealth Modernization Act H.R. 1332 - Telehealth Modernization Act H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 S. 1024 - Healthcare Workforce Resilience Act H.R. 2255 - Healthcare Workforce Resilience Act H.R. 1819 - Pharmacy Benefit Manager Accountability Study Act H.R. 3107 - The Improving Seniors Timely Access to Care Act H.R. 3517 - Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act H.R. 315 - The Medicare Sequester COVID Moratorium Act S. 748 - Medicare Sequester Relief Act H.R. 5067 - Preserving Patient Access to Home Infusion Act S. 2652 - Preserving Patient Access to Home Infusion Act H.R. 3541 - Conrad State 30 and Physician Access Reauthorization Act S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 5376 - Build Back Better Act S. 3314 - Supporting Medicare Providers Act H.R. 6020 - Supporting Medicare Providers Act H.R. 5801 - Help Ensure Lower Patient (HELP) Copays Act S. 4408 Health and Location Data Protection Act of 2022 H.R. 4122 - Resident Education Deferred Interest Act or the REDI Act S. 3658 - Resident Education Deferred Interest Act or the REDI Act H.R.8800 - Supporting Medicare Providers Act of 2022 FY2023 Labor Health and Human Services Appropriations content Draft House, Department of Defense Appropriations Act, FY2023 Draft Senate, Department of Defense Appropriations Act, FY2023

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. Monitoring and outreach on legislative and administrative activity related to infrastructure. Monitoring and outreach on legislative and administrative activity related to reconciliation and the congressional budget resolution. H.R. 4432 - Department of Defense Appropriations Act, FY2022. Senate Draft, Department of Defense Appropriations Act, FY2022 P.L. 116-136, CARES Act P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act P.L. 117-2, American Rescue Plan Act of 2021 H.R. 3684 - Infrastructure Investment and Jobs Act S. 464 - Safe Step Act H.R. 2163 - Safe Step Act H.R. 1319 - American Rescue Plan Act of 2021 S. 834 - Resident Physician Shortage Reduction Act of 2021 H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R. 1868 - To prevent across-the-board direct spending cuts, and for other purposes H.R. 315 - Medicare Sequester COVID Moratorium Act S. 368 - Telehealth Modernization Act H.R. 1332 - Telehealth Modernization Act H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 S. 1024 - Healthcare Workforce Resilience Act H.R. 2255 - Healthcare Workforce Resilience Act H.R. 1819 - Pharmacy Benefit Manager Accountability Study Act H.R. 3107 - The Improving Seniors Timely Access to Care Act H.R. 3517 - Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act H.R. 315 - The Medicare Sequester COVID Moratorium Act S. 748 - Medicare Sequester Relief Act H.R. 5067 - Preserving Patient Access to Home Infusion Act S. 2652 - Preserving Patient Access to Home Infusion Act H.R. 3541 - Conrad State 30 and Physician Access Reauthorization Act S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 5376 - Build Back Better Act S. 3314 - Supporting Medicare Providers Act H.R. 6020 - Supporting Medicare Providers Act H.R. 5801 - Help Ensure Lower Patient (HELP) Copays Act S. 4408 Health and Location Data Protection Act of 2022 H.R. 4122 - Resident Education Deferred Interest Act or the REDI Act S. 3658 - Resident Education Deferred Interest Act or the REDI Act H.R.8800 - Supporting Medicare Providers Act of 2022 FY2023 Labor Health and Human Services Appropriations content Draft House, Department of Defense Appropriations Act, FY2023 Draft Senate, Department of Defense Appropriations Act, FY2023

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

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

Support H.R. 526, Ensuring Coverage in Public Health Emergencies Act of 2021, a bill to provide for special enrollment periods during public health emergencies; Letter urging Congress to provide additional funds to the Provider Relief Fund and for vaccine distribution and administration, which will allow for continued support of hospitals' COVID-19-related lost revenues, as well as additional expenses incurred due to purchasing supplies and equipment, staffing, establishing emergency testing and vaccination centers and constructing and retrofitting facilities; Support H.R. 708 and S. 168, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, a bill to provide temporary licensing reciprocity for telehealth and interstate health care treatment; Support H.R. 1306 and S. 412, National Coronavirus Commission Act of 2021, a bill to establish the Commission on the Coronavirus Pandemic in the United States; Support S. 610/ H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act, a bill to address behavioral health and well-being among health care professionals; Support S. 773 a bill 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; Support S.834, Resident Physician Shortage Reduction Act of 2021, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose H.R. 1195, Workplace Violence Prevention for Health Care and Social Service Workers Act, a bill to direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan and urge the Committee on Education and Labor not to report it favorably; Support S.924 and H.R. 2130, Rural America Health Corps Act, a bill to establish a demonstration program to provide payments on eligible loans for individuals who are eligible for the National Health Service Corps Loan Repayment Program; Discussions with ASPR about COVID-19 related medical supply and personnel shortages; Discussions with FEMA about COVID-19 public assistance funding policies; Letter asking Congress to consider an infrastructure proposal that you prioritize hospital and health system needs to ensure our nations health care system is well positioned to meet the opportunities and challenges that lie ahead; Support S.1512/H.R. 2903, CONNECT for Health Act of 2021, a bill to amend title XVIII of the Social Security Act to expand access to telehealth services; Support H.R. 2255/ S 1024, Healthcare Workforce Resilience Act, a bill to enhance our Nations nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas; Support S.1568, Technical Reset to Advance the Instruction of Nurses (TRAIN) Act, a bill to amend title XVIII of the Social Security Act to provide a waiver of the cap on annual payments for nursing and allied health education payments; Support H.R. 3203, a bill 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; Statement to Senate Committee on Homeland Security and Governmental Affairs hearing on "COVID-19 Part II: Evaluating the Medical Supply Chain and Pandemic Response Gaps" urges Congress to take steps to strengthen the nations medical supply chain; Statement to Senate Committee on Finance hearing on COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned stating that these flexibilities can continue to drive significant improvements in patient care long after the public health emergency (PHE) ends and given the beneficial impact of those specific flexibilities urges Congress and the Administration to make them permanent. In addition, a second group of flexibilities will remain critically important for some time following the PHE and will require a carefully crafted phase-out plan to ensure enough time is provided for a necessary transition. Without action from Congress and the Administration prior to the termination of the PHE, we are concerned that much of the progress made because of the implementation of many of these flexibilities may be unnecessarily halted or even lost; Letter urges Senate HELP Committee to consider recommendations and prioritize programs that support the health care workforce needs of the country in the wake of the COVID-19 pandemic and into the future; Support H.R. 769/S. 1491, Rural Maternal and Obstetric Modernization of Services Act or the Rural MOMS Act, a bill to amend the Public Health Service Act to improve obstetric care in rural areas; Support for S.1675/ H.R. 4387, Maternal Health Quality Improvement Act, a bill to improve maternal health; Support 1438, Opioid Workforce Act of 2021, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis; Support HR 3441,Substance Use Disorder Workforce Act, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the substance use disorder crisis; Support S.1810 / H.R.3541, Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities; Statement to the Senate Judiciary Subcommittee on Competition Policy, Antitrust, and Consumer Rights for the hearing on Antitrust Applied: Hospital Consolidation Concerns and Solutions expressing that integration helps to ensure every community, whether rural, urban or suburban, has access to the same high standard of affordable, evidenced based care; discussions to ensure that H.R. 2547s limits on unfair practice under FDCPA for debt collectors does not inappropriately interfere with or restrict the ability of hospitals to be able to obtain payment for care provided; Support for revising/repealing changes to the Rural Health Clinic (RHC) Program that reduced reimbursement for provider-based RHCs; Hill outreach expressing concerns with United Healths retroactive denial of coverage for emergency-level care in facilities; Hill outreach expressing concern about CMS mid-build audit denials; Senate outreach on prior authorization legislation; Urge support for legislation/administrative action to extend the deadline to use PRF money; Urged HRSA to ensure that the drug companies that denied 340B Statute appropriate discounts make the impacted hospitals whole for the benefit of the vulnerable communities they serve; Support S. 2304 Drug-Price Transparency for Competition Act of 2021 (DTC Act of 2021), a bill to amend title XI of the Social Security Act to require that direct-to-consumer advertisements for prescription drugs and biological products include an appropriate disclosure of pricing information; Support S.246/H.R.851 Future Advancement of Academic Nursing Act or the FAAN Act, a bill to amend the Public Health Service Act to authorize grants to support schools of nursing in program enhancement and infrastructure modernization, increasing the number of nursing faculty and students, and for other purposes; Support S. 1568/HR 4407Technical Reset to Advance the Instruction of Nurses Act or the TRAIN Act, a bill to amend title XVIII of the Social Security Act to provide a waiver of the cap on annual payments for nursing and allied health education payments; Comment letter to the Occupational Safety and Health Administration (OSHA) recommending the withdrawal of the COVID-19 Emergency Temporary Standard for occupational exposure to COVID-19; Meeting with Department of Labor staff to discuss our concerns about the OSHA COVID-19 Emergency Temporary Standard for occupational exposure to COVID-19; Discussion with ASPR staff overseeing the Strategic National Stockpile about their intent to procure supplies of surgical masks; Call with Senator Cassidys staff to discuss concerns about impact of FEMA COVID-19 funding of traveling nurse agencies on hospital nursing shortages; Oppose S 2428, False Claims Amendments Act of 2021A bill to amend title 31, United States Code, to modify False Claims Act procedures, and for other purposes; Discussions about Provider Relief Fund - reporting on past disbursements and urging HHS to disburse remaining PRF money; Discussions about the challenges that teaching hospitals have with training the physician workforce, residency caps that limit funding for training programs, a shortage of residents pursuing primary care specialties, a growing patient pool due to the newly insured and aging of the population; Discussions about the hospital and health system priorities for infrastructure and reconciliation bills; Letter urging Congress to maintain the current legal and regulatory framework for evaluating mergers and acquisitions; Hill outreach to discuss the benefits of health care integration; Hill outreach about the negative impact of potentially anticompetitive conduct by nurse-staffing agencies; Support HR 5035/ S 2982 Child Suicide Prevention and Lethal Means Safety Act, a bill to authorize the Secretary of Health and Human Services to award grants to establish or expand programs to implement evidence-aligned practices in health care settings for the purpose of reducing the suicide rates of covered individuals, and for other purposes; Support H.R.5376 Build Back Better Act, this bill provides funding, establishes programs, and otherwise modifies provisions relating to a broad array of areas, including education, labor, child care, health care, taxes, immigration, and the environment; Discussions with members of congress about the implementation of Rural Emergency Hospital payment designation; Discussions on the No Surprises Act Implementation (surprise billing) and urging federal regulators to restore the independence of the independent dispute resolution process in the No Surprises Act Part 2 regulations; Support HR 5699 Student Assisted Vaccination Effort (SAVE) Act, a bill to expand the definition of qualified persons for purposes of the Public Readiness and Emergency Preparedness Act to include health professional students; Support S 2873 Preventing and Addressing Trauma with Health Services Act (PATHS Act), a bill to require the Secretary of Health and Human Services to award grants to establish or expand programs and activities to increase access to high-quality culturally competent trauma support and mental health care; Letter urging HRSA to delay proposals to withdraw certain HPSAs; Support S 3497 and HR 6397, Medical Student Education Authorization Act of 2022, a bill to amend the Public Health Service Act to establish a grant program to award grants to public institutions of higher education located in a covered State; Support HR 6279 and S 3629, Opioid Treatment Access Act of 2022, a bill to authorize a study on certain exemptions for treatment of opioid use disorder through opioid treatment programs during the COVID-19 public health emergency; Support HR 5703 and S 3677, Post-Disaster Mental Health Response Act, a bill to amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act to authorize the President to provide professional counseling services to victims of emergencies declared under such Act; Submitted a statement on the hearing for Pandemic Profiteers: Legislation to Stop Corporate Price Gouging regarding concerns about anticompetitive conduct on the part of health care staffing agencies, some of which have been exploiting the severe shortage of health care providers during the COVID-19 pandemic; Submitted a statement on the hearing for Americas Mental Health Crisis and supports additional approaches to help ensure improved access to needed comprehensive, affordable and quality behavioral health services; Provide comments to the Affordability Subcommittee of the Healthy Future Task Force expressing our shared focus with Congress on providing relief from the pandemic, ensuring a smooth recovery and rebuilding a better health care system for the future, all while continuing to support efforts to promote greater affordability and value to patients and the health care system; Submitted statement on the hearing for Recruiting, Revitalizing & Diversifying: Examining the Health Care Workforce Shortage about the challenges ahead and the need to examine Americas health care workforce shortage. We must work together to solve these issues so that our nations hospitals and health systems can continue to care for the patients and communities they serve; Submitted statement on the hearing for Protecting Youth Mental Health: Part II - Identifying and Addressing Barriers to Care examines ways to protect the mental health of our nations youth; Submitted statement on the hearing for Exploring Pathways to Affordable, Universal Health Coverage Care expressing the need to build upon and improve our existing system to increase access to coverage of comprehensive health benefits; Submitted a letter to provide information regarding the challenges facing Americas health care workforce as the country enters the third year of the COVID-19 pandemic; Provided comments to the Modernization Subcommittee of the Healthy Future Task Force urging Congress to consider how to ensure the telehealth flexibilities could remain in place for patients and health care providers beyond the PHE; Support HR 7053 and S 3792, Hospital Inpatient Services Modernization Act, a bill to amend title XVIII of the Social Security Act to extend acute hospital care at home waiver flexibilities; Support resolution, H. Res. 909, Expressing support for healthcare personnel and condemning assaults on healthcare personnel as the U.S. healthcare system faces unprecedented staffing shortages and increased workplace-related stressors; Letter urges Congress to provide immediate additional support for hospitals and health systems serving their communities during this unprecedented public health crisis. While the support Congress has provided during the last two years of the COVID-19 pandemic has helped hospitals care for their patients and communities, there is still a significant need for financial support and relief as COVID-19 challenges persist; Support S 3904, Healthcare Cybersecurity Act of 2022, a bill to enhance the cybersecurity of the Healthcare and Public Health Sector; Letter urging OSHA to extend the comment deadline for the rule making on the occupational exposure to COVID-19 in healthcare settings by at least an additional 30 days, through May 23; Meeting with the Office of the Assistant Secretary of Health (OASH) at HHS to discuss the widespread blood shortages in the U.S. and next steps; Stakeholder calls with HHS ASPR regarding the distribution/administration of COVID-19 therapeutics; Discussions on S 571, Public Health Funding Prevents Pandemics Act, a bill to fully fund the Prevention and Public Health Fund and reaffirm the importance of prevention in the United States healthcare system; Regular calls with ASPR and other stakeholders participating in the Health Care and Public Health (HPH) Sector Joint Supply Chain Resilience Working Group (Joint SCRWG), a formal Working Group under the authority of the Critical Infrastructure Partnership Advisory Council (CIPAC) to support the Presidents vision for a resilient public health supply chain; Monthly calls with ASPRs Hospital Preparedness Program (HPP) to discuss updates on the hospital association COVID-19 funding program; Call with ASPR Healthcare and Public Health Government Coordinating Council leadership and other hospital associations to provide feedback on the COVID-19 hospital data guidance update; Provide comment letter to OSHA on the re-opening of comments on the Occupational Exposure to COVID-19 Rulemaking in which we urge OSHA not to finalize its rule for occupational exposure to COVID-19. In our comments, we indicate that we continue to oppose establishing new regulations that are not fully aligned with the Centers for Disease Control and Preventions evolving evidence-based guidance. With the constantly evolving, science-based CDC guidance and recommendations, CMS vaccination requirement and existing OSHA general standards, we strongly believe that an inconsistent and overly strict OSHA COVID-19 health care standard is not necessary, would cause confusion and will ultimately lower hospital employees morale and worsen unprecedented personnel shortages in hospitals. It is essential to a well-functioning health care system that only one set of science-based standards be applied to health care providers, and that these standards be aligned across federal agencies; Letter urging Congress to make the expanded tax credits permanent, ensuring millions of low- and middle-income families continue to have access to affordable coverage in 2023 and beyond; Express concerns with the letter to CMS from Congressman Murphy that makes a number of requests for data surrounding the COVID-19 add on payments for hospitals. We are concerned about the questions as they do not take into account the continued needs of the nations hospitals and health systems. Hospitals continue to face numerous challenges, including increased labor and supply costs and workforce shortages. These additional payments have helped to address some but not all of the high costs associated with COVID-19 patient care. The complexity of care is still higher than pre-pandemic levels as measured by length of stay, which further indicates that its still more resource intensive to treat COVID inpatients. In addition, the high costs associated personal protective equipment, isolation measures, and other additional resources are necessary when treating all patients, unless and until it is determined they do not have COVID-19; Submitted a letter to Ways and Means per their request for information on the health care industry and climate change. We support the sustainability efforts while acknowledging that for a variety of reasons, many hospitals and health systems face challenges and barriers to implementing this work, especially while responding to a pandemic; Letter urging HHS to maintain the COVID-19 public health emergency (PHE) until it is clear that the global pandemic has receded and the capabilities authorized by the PHE are no longer necessary. This will help prevent any future surges from threatening the health and safety of patients and the ability of health care professionals to care for them; Long COVID Best Clinical Practices Discussion with the White House Policy Advisor, Office of the COVID-19 Response; Submitted comment letter to the Federal Trade Commission outlining the impact pharmacy benefit managers (PBMs) practices have on the field. Specifically, urging the FTC to increase scrutiny on insured-mandated white bagging policies, as well as the impact of PBM-negotiated rebates and other business practices on the 340B drug discount pricing program and overall drug prices and drug price increases; Submit a comment letter to the Internal Revenue Service for their proposed rule amending how employer coverage affordability would be measured for family members of employees. We advocated for a fix to the current methodology for assessing affordability of employer coverage for family members, often referred to as the family glitch, which is estimated to affect about 5 million individuals. We commend the IRS on proposing to revise the regulation and improve access to health insurance coverage for millions of American families; Concerns S.4348, Food and Drug Administration Safety and Landmark Advancements Act of 2022 or the FDASLA Act of 2022, a bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs, medical devices, generic drugs, and biosimilar biological product; Comment letter on CMS Radiation Oncology (RO) Model proposed rule. We strongly supports CMS efforts to transform the delivery of cancer care. We also support the original intent of the RO Model, which was to protect access to care by ensuring fair, predictable payment for radiation oncologists. However, this important goal of the original RO Model has been marred by the incorporation of significant payment cuts and substantial administrative burdens for those participating in this mandatory model. As such, the AHA supports CMSs proposal to delay the start date of the RO model from Jan. 1, 2023 to a date to be determined through future rulemaking; Support S. 4352,Travel Nursing Agency Transparency Study Act, a bill to require a study on the effects of travel nurse agencies on the health industry during the COVID-19 pandemic; Letter in response to CMS request for guidance on implementing the regulatory requirement for convening providers and facilities exchange information with co-providers and co-facilities to create a comprehensive good faith estimate as part of the implementation of the No Surprises Act. Due to the lack of currently available automated solutions, this process would require a significant manual effort by providers, which would undoubtedly result in the convening provider being unable to meet the short statutory timeframes for delivering good faith estimates to the patients and could also lead to inadvertent errors. AHA has requested an extension in enforcement direction until a technical solution has been identified and implemented; Support HR 7691, Safety From Violence for Healthcare Employees Act or the SAVE Act, a bill to protect hospital personnel from violence, and for other purposes; Letter requesting that HHS, HRSA, and OIG take immediate enforcement action against the now 17 companies that are refusing to honor their obligations under the 340B program; Letter sent to HHS Secretary to discuss how best to ensure prompt repayment to 340B hospitals without penalizing the rest of the hospital field after the U.S. Supreme Court unanimously agreed that HHS outpatient payment cuts to hospitals in the 340B Drug Pricing Program were unlawful. The Courts decision did not determine a remedy for the unlawful payment cuts, instead, it remanded the case to the lower courts to address the proper remedy; Support HR 7084/ S 3983, Protecting and Transforming Cyber Health Care Act of 2022 or the PATCH Act of 2022, a bill to amend the Federal Food, Drug, and Cosmetic Act to require, for purposes of ensuring cybersecurity, the inclusion in any premarket submission for a cyber device of information to demonstrate a reasonable assurance of safety and effectiveness throughout the lifecycle of the cyber device, and for other purposes; Submit Comment letter of support for CMS continued focus on strengthening health insurance coverage and ensuring ease of enrollment and limited gaps in coverage, including proposed updates to Medicare enrollment and eligibility rules; Submit letter for oversight hearing on Medicare Advantage (MA) plans expressing concerns about some MA plans inappropriate restrictions on beneficiary access to medically necessary care, including those highlighted in a recent report issued by the Department of Health and Human Services Office of Inspector General (HHS-OIG), and urge Congress to increase its oversight of these plans; Provided feedback on the Senate Finance Committees discussion draft addressing mental health care and telehealth. AHA supports allowing Medicare beneficiaries who seek treatment for mental health disorders to receive their care through audio-only services, removing the requirement for Medicare patients to receive an in-person visit prior to receiving mental health services through telehealth, and expanding beyond physicians and limited non-physician practitioners the types of providers who can deliver and bill for telehealth services; Support HR 8576/ S 4352 Travel Nursing Agency Transparency Study Act, a bill to require a study on the effects of travel nurse agencies on the health industry during the COVID-19 pandemic; Support HR 8806 Healthcare Cybersecurity Act of 2022, a bill to enhance the cybersecurity of the Healthcare and Public Health Sector; Submitted a statement for the record for the Senate Judiciary Subcommittee hearing on Flatlining Care: Why Immigrants Are Crucial to Bolstering Our Health Care Workforce. This hearing examines the importance of improving the immigration process in order to help alleviate Americas health care workforce shortage. We encourage Congress to help address domestic health care workforce shortage.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, White House Office

H.R. 4521, America COMPETES Act (W Visa and STEM graduate student provisions) S. 2828/H.R. 5498, Preserving Employment Visas Act S. 1810/H.R.3541, the Conrad State 30 and Physician Access Reauthorization Act H.R. 4288, Workforce for an Expanding Economy Act S.1024 / H.R. 2255, Healthcare Workforce Resilience Act S. 3628, Keep STEM Talent Act of 2022 H.R. 7441, Acute Labor Shortage Solutions Act of 2022 OPM Skilled Immigration and Skills-Based Hiring Proposals Proposed Changes to Form I-9, Employment Eligibility Verification - DHS Extension of flexibilities on Form I-9 Compliance Requirements - DHS Expansion and implementation of employment-based visas and addressing visa case processing issues - DHS

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

Government targets: HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE

S. 1810/ H.R. 3541 - "The Conrad State 30 and Physician Access Reauthorization Act" - Expand healthcare workforce. S. 1024/ H.R. 2255 - Healthcare Workforce Resilience Act - Reduce green card backlogs and prioritize health care.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3541, Conrad State 30 and Physician Access Reauthorization Act, all provisions S. 1810, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 2255, Healthcare Workforce Resilience Act, all provisions S. 1024, Healthcare Workforce Resilience Act, all provisions H.R. 6, American Dream and Promise Act of 2021, all provisions H.R. 6617, Further Additional Extending Government Funding Act, provisions relating to Conrad State 30 H.R. 2471, Consolidated Appropriations Act, 2022, provisions relating to immigration H.R. 4521, America COMPETES Act of 2022, provisions relating to Section 80303, Doctoral STEM Programs H.R. 8019, Professionals Access To Health Workforce Integration Act of 2022, all provisions H.R. 8021, Immigrants in Nursing and Allied Health Act of 2022, all provisions H.R. 8022, International Medical Graduates Assistance Act of 2022, all provisions H.R. 6833, Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023, provisions relating to Section 101 and Conrad 30 extension

Client expense: $4,360,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE

H.R. 6, American Dream and Promise Act of 2021 H.R. 78, Legal Workforce Act H.R. 206/S. 4813, Paperwork Reduction for Farmers and H-2A Modernization Act H.R. 401, Landscaping Workforce Act of 2021 H.R. 427, Moving H-2A to United States Department of Agriculture Act of 2021 H.R. 865, American Jobs First Act of 2021 H.R. 1037, Better Agriculture Resources Now (BARN) Act H.R. 1177/S. 348, U.S. Citizenship Act H.R. 1571, Dairy H-2A Eligibility Act H.R. 1603, Farm Workforce Modernization Act of 2021 H.R. 2064, TPS and DED Protection Act of 2021 H.R. 2086, Agricultural Guest Worker Reform Initiative Act of 2021 H.R. 2255/S. 1024, Healthcare Workforce Resilience Act H.R. 2298, Accountability Through Electronic Verification Act H.R. 2839/S. 1358, Bipartisan Border Solutions Act of 2021 H.R. 2901/S. 831, EB-5 Reform and Integrity Act of 2021 H.R. 3215, Temporary Family Visitation Act H.R. 3237, Emergency Security Supplemental Appropriations Act, 2021 H.R. 3385/S. 2083, HOPE for Afghan SIVs Act of 2021 H.R. 3513/S. 2032, Afghan Allies Protection Act of 2021 H.R. 3541, Conrad State 30 and Physician Access Reauthorization Act H.R. 3648, Equal Access to Green cards for Legal Employment (EAGLE) Act of 2021 H.R. 3897, H-2B Returning Worker Exception Act of 2021 H.R. 4288, Workforce for an Expanding Economy Act H.R. 4331, Americas Cultivation of Hope and Inclusion for Long-term Dependents Raised and Educated Natively Act of 2021 (Americas CHILDREN Act of 2021) H.R. 4521, America Creating Opportunities for Manufacturing, Pre-Eminence in Technology, and Economic Strength (America COMPETES) Act of 2022 H.R. 4578, Relief for Seasonal Businesses Act of 2021 H.R. 4681, Let Immigrants Kickstart Employment (LIKE) Act of 2021 H.R. 4856, Canadian Snowbird Visa Act H.R. 5498, Preserving Employment Visas Act H.R. 5887/S. 3134, Keep Food Local and Affordable Act of 2021 H.R. 5924, Keep STEM Talent Act of 2021 H.R. 6206, American Tech Workforce Act of 2021 H.R. 6637, Dignity for Immigrants while Guarding our Nation to Ignite and Deliver the American Dream (DIGNIDAD Dignity) Act H.R. 7239, Essential Workers for Economic Advancement Act H.R. 7441, Acute Labor Shortage Solutions Act of 2022 H.R. 7549, Seasonal Worker Solidarity Act of 2022 H.R. 7900/S. 4543, National Defense Authorization Act for Fiscal Year 2023 H.R. 8257/S. 4679, Department of Homeland Security Appropriations Act, 2023 H.R. 8295/S. 4659, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2023 H.R. 8433, Renewing Immigration Provisions of the Immigration Act of 1929 H.R. 8685/S. 4787, Afghan Adjustment Act H. Res. 901, Expressing the sense of the House of Representatives that BridgeUSA exchange programs are vital to the economy and national interests of the United States, and that Congress should prioritize robust support to ensure equitable opportunities for Americans and people from other countries S. 71, Accountability Through Electronic Verification Act S. 264, Dream Act of 2021 S. 306, Safe Environment from Countries Under Repression and Emergency (SECURE) Act S. 418, E-Verify Act S. 478, Higher Wages for American Workers Act of 2021 S. 495, Prioritizing Help to Businesses Act S. 959, Secure and Protect Act of 2021 S. 970, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement (BELIEVE) Act S. 1810, Conrad State 30 and Physician Access Reauthorization Act S. 1861, Partner with Korea Act S. 2207, A bill to temporarily increase the availability of temporary nonimmigrant nonagricultural workers for the purposes of restoring American forests, and for other purposes S. 2443, A bill to expand the definition of H-2A nonimmigrant for purposes of the Immigration and Nationality Act to include aliens engaged in seafood processing, horticultural commodities, or the care of horses S. 2753, Protecting Children of Long-term Visa Holders Act of 2021 S. 2828, Preserving Employment Visas Act S. 3638, Keep STEM Talent Act of 2022 S. 3720, H-1B and L-1 Visa Reform Act of 2022 S. 3721, Resolving Extended Limbo for Immigrant Employees and Families (RELIEF) Act S. 3850, Securing America's Ports of Entry Act of 2022 S. 3869, A bill to add Ireland to the E-3 nonimmigrant visa program S. 4659, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2023 Various issues relating to visa waiver program; H-1B Visa Program; H-1B registration rule; H-1B reform; H-2 Visa Program and temporary rule; H-2A Visa Program; H-4 rule; L-1 Visa Program; J-1 BridgeUSA program; EB-5 Visa Program; EB-5 regional center program; E-Verify program; nonimmigrant workers in temporary or seasonal nonagricultural employment; Customs and Border Protection staffing at U.S. ports of entry; border security; immigration policy and reforms; guest worker programs; legalization concepts; visa reform; customs trade facilitation and enforcement; Deferred Action for Childhood Arrivals (DACA) program; extension of temporary protected status (TPS) designations for El Salvador, Honduras, and Haiti; administrative-regulatory efforts related to public charge, notice to appear, H-4 & OPT; delays in H-4 and L-2 Status Extensions and Employment Authorization Documents (EADs); FY22 funding for Customs and Border Protection staffing; restarting routine visa processing during the COVID-19 pandemic; high-skilled immigration; lesser skilled immigration; temporary agricultural guest workers; temporary non-agricultural guest workers; optional practical training program; size and administration of employment-based immigrant visa categories; size and administration of family-based immigrant visa categories; size and administration of employment-based nonimmigrant visa categories; expansion of the use of the E-Verify system; I-9 employment verification; interior enforcement; temporary suspension of entry of nationals from certain countries; increased vetting of visa applicants; unfair immigration related employment practices; international travel; trusted traveler programs; biometric entry-exit; increasing the number of ICE officers, border patrol agents and Customs and Border Protection officers; aerial security enhancements; temporary DHS guidance for the I-9 employment verification process in the wake of COVID-19; State Department policy extending consular interview waiver eligibility; temporary United States Citizenship and Immigration Services (USCIS) procedures to provide flexibility with regard to filing deadlines, and temporary USCIS guidelines providing flexibility to wet-ink signatures on USCIS forms and documents; United States Citizenship and Immigration Services (USCIS) funding shortfalls and extending premium processing capability for the adjudication of various immigration forms; regulatory proposals that would restrict applicant eligibility for the H-1B program; regulatory proposals that would drastically change how prevailing wage levels are determined for the purposes of obtaining certain employment nonimmigrant and immigrant visas; proposals that would significantly change how cap-subject H-1B petitions will be chosen in the future; regulatory proposals that would change how the period of admission for student visa holders and exchange visa holders is determined; regulatory proposals that will temporarily raise the annual quota for H-2B visas; enhanced COVID-19 testing protocols for international air travel; creation/use of digital passports; reopening and expanding consular operations; fully reinstituting routine visa processing at U.S. embassies and consulates abroad; rescinding or reforming current travel restrictions at land ports of entry; rescinding or reforming current travel restrictions for international air travel; recapturing unused immigrant visas from prior years; creating exemptions to the current immigrant visa caps; proposals that would expand consular interview waivers for prospective immigrant and nonimmigrant visa applicants abroad; implementation of the EB-5 Reform and Integrity Act of 2022, P.L. 117-103, Division BB; proposals that would provide relief for Afghan refugees; granting temporary protected status and special student relief to Ukrainian nationals; ensuring Ukrainian applicants for refugee/asylee status have access; potential Reinstitution of Stateside Visa Revalidation Services; implementation of electronic visa foils in passports; consular service delays; USCIS processing delays

Client expense: $23,940,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), White House Office

H.R. 6, The American Dream and Promise Act of 2021 S. 264, Dream Act of 2021 Issue: Support policies allowing undocumented students to attend U.S. medical schools and graduate medical education. Support Dreamer eligibility for federal student loans. Issue: Support retention of DACA Executive Action H.R. 3541/ S. 1810, Conrad State 30 and Physician Access Reauthorization Act Issue: Support reauthorization and expansion of the Conrad 30 program, and improvements to physician immigration Issue: Support policies to ensure timely and predictable processing for immigration of academic medicine community H.R. 2255/ S. 1024, Healthcare Workforce Resilience Act Issue: Support reduction of green card backlogs for health professionals

Client expense: $912,077 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS), White House Office

Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023 (H.R. 6833) Inflation Reduction Act of 2022 (H.R. 5376) Restoring Hope for Mental Health and Well-Being Act of 2022 (HR 7666) Healthcare Workforce Resilience Act of 2021 Maternal health: MOMMAs Act S. 411/HR 3407; Black Maternal Health Omnibus Act of 2021 S. 346/H.R. 959; Data to Save Moms Act S. 347/HR 925; IMPACT to Save Moms Act S 1675/HR 4387; Maternal Health Quality Improvement Act S. 1675/H.R. 4387 Conrad State 30 & Physician Access Reauthorization Act S. 1810/H.R. 3541 Public Health and Social Services Emergency Fund Regulatory relief in light of coronavirus Transparency (No Surprises Act regulations; public posting of hospital charges) 340B Drug Pricing Program Strengthening Americas Health Care Readiness Act (S. 54) Social Determinants Accelerator Act (H.R. 2503), Leveraging Integrated Networks in Communities (LINC) to Address Social Needs Act (S. 509) No Surprises Act regulations Protecting Providers Everywhere in America Act (S. 308/H.R. 1436) Behavioral health reimbursement and policies (Child Suicide Prevention and Lethal Means Safety Act - H.R. 5035; Childrens Mental Health Infrastructure Act - H.R. 4945; Helping Kids Cope Act - H.R. 4944; Restoring Hope for Mental Health and Well-Being Act of 2022 (HR 7666)) Public health emergency designation FAAN Future Advancement of Academic Nursing (FAAN) Act of 2022

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

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

H.R. 432 - Mental Health Access Improvement Act H.R. 1358 - Mental Health Parity Justice Act of 2021 H.R. 1475/ S. 1795 - Pursuing Equity in Mental Health Act H.R. 2754 - COVID-19 Long Haulers Act H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 H.R. 3467 - Improving Data Collection for Adverse Childhood Experiences (ACES) Act H.R. 3541 / S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 3753/ S. 1962 - Parity Implementation Assistance Act H.R. 4058 / S. 2061 - Telemental Health Care Access Act H.R. 4122 / S. 3658 - Resident Education Deferred Interest (REDI) Act H.R. 4040 - Advancing Telehealth Beyond COVID-19 Act H.R. 4770 - Evaluating Disparities and Outcomes of Telehealth (EDOT) Act of 2021 H.R. 5218 - Collaborate in an Orderly and Cohesive Manner Act H.R. 6000 - Cures 2.0 Act H.R. 7116 - 988 Implementation Act of 2022 H.R. 7180 / S. 4014 - Brycen Gray and Bren Price COVID-19 Cognitive Research Act H.R. 7232 - 988 and Parity Assistance Act of 2022 H.R. 7254 - Mental Health Justice and Parity Act of 2022 H.R. 7482 / S. 4015 - TREAT Act H.R. 7649 - To direct the Secretary of Health and Human Services to open a public docket for the submission of public comments regarding factors that should be taken into consideration when reviewing a proposed modification to an approved risk evaluation and mitigation strategy, and for other purposes. H.R. 7666 - Restoring Hope for Mental Health and Well-Being Act of 2022 H.R. 7667 - Food and Drug Amendments of 2022 H.R. 8180 - Undertaking Needed Investments in Therapy, Education, and De-Escalation (UNITED) Act of 2022 H.R. 8229 - Telemental Health Parity Act H.R. 8391 - CONNECT Act H.R. 8487 - Improving Seniors Timely Access to Care Act of 2022 H.R. 8512 - Behavioral Health Coverage Transparency Act H.R. 8542 - Mental Health Justice Act of 2022 H.R. 8637/ S. 4003 - Law Enforcement De-Escalation Training Act of 2022 H.R. 8800 - Supporting Medicare Providers Act of 2022 H.R. 8878 - Intensive Outpatient Policy H.R. 8879 - Inpatient Psychiatric Facility Improvement Act H.R. 8881 - Mental Health Transparency Act H.R. 8884 - Medicare Opioid Use Disorder Outreach Act H.R. 8885 - Better Health Care Directories Act H.R. 8886 - Promoting Clarity in Mental Health and Substance Use Disorder Treatment Act H.R. 8889 - RICE (Readable Insurance Coverage Enhancement) Act H.R. 8890 - Physician Wellness Program Act H.R. 8891 - No Surprises for Survivors Act H.R. 8892 - Access to Mental Health Services Act H.R. 8908 - Fighting Stimulant and other Substance Use Disorders Act H.R. 8910 - Behavioral Health Integration Awareness Act H.R. 9201 - Community Mental Wellness and Resilience Act S. 2086 - RISE from Trauma Act S. 2938 - Bipartisan Safer Communities Act S. 3726 - CARE for Long COVID Act S. 4132 - Womens Health Protection Act S. 4170 - Mental Health Reform Reauthorization Act of 2022 S. 4306 - Improving Access to Behavioral Health Integration Act S. 4348 - Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act of 2022 S. 4448 - Suicide Prevention Act S. 4461 - Expanding Access to Mental Health Training Act S. 4472 - Health Care Capacity for Pediatric Behavioral Health Act S. 4804 - Parity Enforcement Act of 2022 S. 4839 - State Opioid Response Grant Authorization Act S.5041 - A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions in psychiatry and subspecialties S.5042 - A bill to amend title XVIII of the Social Security Act to expand eligibility for incentives under the Medicare health professional shortage area bonus program to practitioners furnishing mental health and substance use disorder services S.5043 - A bill to require the Secretary of Health and Human Services to issue guidance to States on strategies under Medicaid and CHIP to increase mental health and substance use disorder care provider education, training, recruitment, and retention S.5061 - A bill to amend title XVIII of the Social Security Act to provide for Medicare coverage and coding for qualified psychologist services furnished by advanced psychology trainees S.5062 - A bill to amend title XVIII of the Social Security Act to increase access to mental health programs for physicians

Client expense: $192,727 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

Stopping Doctors Shortages Act (S.311), work to ensure eligibility of Texas physicians to the Public Service Loan Forgiveness Program. Conrad State 30 and Physician Access Reauthorization Act (S. 1810/H.R. 3541), allows international physicians trained in the United States to stay in country if they practice in underserved areas. Safety from Violence for Healthcare Employees, SAVE Act (HR 7961), establish legal penalties for assaulting or intimidating hospital employees.

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

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

The Affordable Care Act (P.L. 111-148, P.L. 111-152): Continued advocacy with Congress in support of expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Advocated against a December 2018 ruling by a federal judge in Texas that the entire Affordable Care Act (ACA) is unconstitutional. Access to Primary Care (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Medicare Payments to Physicians: Urged that Congress provide incentives to physicians who transform their practices into Advanced Alternative Payment Models and continue to provide stability for physicians in the MIPS program. Specifically, Congress should extend the five percent Qualified Alternative Payment Model participant bonus beyond the 2022 performance year, replace the zero percent baseline payment updates under Medicare with positive updates. Urged congressional committees with jurisdiction over Medicare to exercise their oversight authority and urge CMS to expedite approval of more Advanced APMS, particularly those that work for small and specialty practices and to simplify the scoring structure and reporting requirements under the Merit-Based Incentive Payment System (MIPS) in order to fulfill Congress intent of a more streamlined program that reduces burdens on physicians; Supported S.2648, the Rural ACO Improvement Act, amends title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program (MSSP) to ensure that all ACOs have an equal opportunity to share in savings regardless of their geographic location; Provided recommendations to CMS on the Merit-based Incentive Payment System Value Pathway (MVP), which aims to reduce reporting burden and complexity within MIPS while improving the accuracy and effectiveness of performance measurement. The College noted specifically that a robust, multi-year transition period will be critical to the success of the MVP, that it does not support making the MVP mandatory, that CMS should continue to support numerous reporting mechanisms, including qualified registries and clinical data registries, which have been instrumental in developing specialty-specific performance measures, among other things. Urged that any legislation to hold some Medicare physician payment codes harmless from budget neutrality do so for just one year and to allow evaluation and management increases. Regarding CMS Medicare Physician Fee Schedule and Quality Payment Program (QPP) rules, expressed support for extending some of the services and increased flexibility for telehealth through the end of 2023, namely some audio-only services that were allowed during the COVID-19 public health emergency (PHE), support for collecting additional data on health equity issues to analyze disparities that occur across their programs, support for including chronic care management as one of the seven MIPS Value Pathways (MVPs) for 2023. Urged CMS to discontinue its split/shared visits policy and not move forward with the transition set to take effect in 2023. Urged Congress to support inclusion in must-pass legislation this year provisions to provide financial stability through a baseline positive annual update to the physician fee schedule reflecting inflation in practice costs, and eliminate, replace or revise budget neutrality requirements to allow for appropriate changes in spending growth; Extend the moratoriums on sequester and PAYGO cuts that were approved by Congress at the end of last year. FY2023 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Preventions programs in the FY 2023 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ). COVID-19: Urged congressional appropriators to provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the virus that is commensurate with the public health emergency that the virus represents. Expressed support to Congress and the administration for a variety of COVID-related bills from the 116th Congress as follows: the Families First Coronavirus Response Act, H.R. 6201, and other stimulus reforms related to COVID-19 including: Emergency paid leave benefits, paid sick days for public health emergencies, coverage of testing for COVID-19, waiving of cost sharing under Medicare, Medicare Advantage, Medicaid, and CHIP, increasing the federal FMAP under Medicaid, providing reimbursement for CPT codes 99441 - 99443, which are telephone evaluation and management services, expediting entrance of international medical graduates who are citizens of other nations (non-US IMGs) into the country and ensuring that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic, funding for physician practices under the Public Health and Social Service Emergency Fund (PHSSEF), providing tax relief, grants, and loans to small and medium size practices impacted by COVID-19, increasing funding for personal protective equipment (PPE), ensuring Medicaid pay parity with Medicare for primary care services; Urged support for H.R. 7059, the Coronavirus Provider Protection Act, which extend liability protections to those who provide care in good faith during the COVID-19 public health emergency (plus a reasonable time, such as 60 days, after the emergency declaration ends), and not in situations of gross negligence or willful misconduct. The College also urged that pay parity between telephone claims and in-person visits and between all telehealth and in-person visits be maintained after the PHE is lifted. Urged congress to mitigate the impact of covid across racial and ethnic minority populations by collect covid-19 and racial disparity data, equitably distribute covid-19 vaccines and treatments, protect essential workers, permanently expand access to family and medical leave, address environmental and social drivers of health, integrate primary care and behavioral health, improve mental health parity with increased federal oversight and enforcement, make naloxone more available to prevent overdose, expand medication-assisted treatment (mat) for physicians, establish a national prescription drug monitoring program (PDMP); urged support for administering COVID-19 vaccinations to all eligible immigrants in Customs and Border Protection (CBP) custody. Urged CMS to support increasing COVID-19 vaccine uptake by ensuring clinicians are appropriately paid for vaccine counseling for beneficiaries of Medicaid and Medicare. Urged that telehealth services should remain in place for at least two years after the end of the PHE to ensure that our physicians are able to continue to use this modality to enhance patient care. Urged Congress to support the concept of a congressionally-mandated bipartisan commission to examine the U.S. preparations for and response to the COVID-19 pandemic, in order to inform future public policy and health systems preparedness. Urged that any uses of technology in the U.S. in the context of the pandemic should be demonstrated to be effective, be temporary, and ensure that safeguards for privacy and confidentiality are in place. Womens Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Urged support for mandatory, permanent extension of postpartum Medicaid coverage, from 60 days to 12 months after delivery. Urged support for the Womens Health Protection Act of 2021 and 2022 (H.R. 3755/S. 1975), bills that would protect a persons ability to determine whether to continue or end a pregnancy and to protect the health care clinicians ability to provide abortion services free from medically unnecessary restrictions such as waiting periods, biased counselling and admitting privilege requirements for clinicians. Access to Care: Urged members of Congress to cosponsor and pass H.R. 340, the Incentivizing Medicaid Expansion Act of 2021, to expand federal matching assistance for states that choose to expand Medicaid, regardless of when such expansion takes place: Cosponsor and pass H.R. 369, the Health Care Affordability Act of 2021, to permanently expand eligibility for higher premium tax credits under the Affordable Care Act. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2256/S. 834, the Resident Physician Reduction Shortage Act of 2021, to increase the number of GME slots to 14,000 over seven years for specialties facing shortages, including internal medicine; Cosponsor and pass S. 1024, the Healthcare Workforce Resilience Act, to recapture 40,000 unused visas and use them to provide additional green cards to 15,000 physicians and 25,000 professional nurses; Cosponsor and pass H.R. 3541/S. 1810, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R.4122/S.3658, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2023 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Public Health and Pandemic Preparedness: Urged members of Congress to support funding in FY2023 appropriations - $11 billion total for the CDC, $35 million for the CDCs Injury Prevention and Control, Firearm Injury and Mortality Prevention Research; $49 billion in total for the NIH, $25 million for the Office of the Director, Firearm Injury and Mortality Prevention Research; Cosponsor and pass the COVID Supplemental Appropriations Act, 2022, H.R. 7007, or a similar supplemental funding package, to provide $15.6 billion in additional funding for COVID relief; Cosponsor and pass the CONNECT for Health Act (H.R. 2903/S. 1512) and the Telehealth Extension Act of 2021 (H.R. 6202/S. 3593), to remove arbitrary restrictions on where a patient must be located to utilize telehealth services; enable patients to continue to receive telehealth services in their homes; ensure federally-qualified health centers and rural health centers can furnish telehealth services and improve data collection and analysis for at least two years. Prescription Drug Reform: Urged members of Congress to cosponsor and pass S. 898, the Fair Drug Pricing Act, to require drug companies to disclose and provide more information about imminent drug-price increases, including data about research and development costs; Cosponsor and pass S. 833, the Empowering Medicare Seniors to Negotiate Drug Prices Act of 2021, to help to reduce drug prices and out-of-pocket costs by allowing the federal government to negotiate lower drug prices on behalf of Medicare beneficiaries; Cosponsor and pass S. 464/H.R. 2163, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Telehealth Services: Urged Congress to support H.R. 2903/S. 1512, the CONNECT for Health Act, to remove arbitrary barriers to telehealth services such as geographic and site of service restrictions; S. 168/H.R. 708, the Temporary Reciprocity to Ensure Access to Treatment Act or the TREAT Act, to ensure that telehealth services can be provided across states lines after the public health emergency ends; H.R. 8487, the Improving Seniors Timely Access to Care Act that would help protect patients from unnecessary delays in care and reduce administrative burdens on physicians by standardizing and streamlining the prior authorization approval process in the Medicare Advantage (MA) program. Mental and Behavioral Health: Urged members of Congress to cosponsor and pass H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act, to provide grants through the Department of Health and Human Services to primary care physicians who choose to deliver behavioral health care through the Collaborate Care Model (CoCM); Support enhanced reimbursement for CoCM payment codes under Medicare to more appropriately reflect the value of services provided to patients with mental health and substance use disorder needs.

Client expense: $302,378 · Firm income: Not reported

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

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 Affordable Care Act (P.L. 111-148, P.L. 111-152): Continued advocacy with Congress in support of expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Advocated against a December 2018 ruling by a federal judge in Texas that the entire Affordable Care Act (ACA) is unconstitutional. Access to Primary Care (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Medicare Payments to Physicians: Urged that Congress provide incentives to physicians who transform their practices into Advanced Alternative Payment Models and continue to provide stability for physicians in the MIPS program. Specifically, Congress should extend the five percent Qualified Alternative Payment Model participant bonus beyond the 2022 performance year, replace the zero percent baseline payment updates under Medicare with positive updates. Urged congressional committees with jurisdiction over Medicare to exercise their oversight authority and urge CMS to expedite approval of more Advanced APMS, particularly those that work for small and specialty practices and to simplify the scoring structure and reporting requirements under the Merit-Based Incentive Payment System (MIPS) in order to fulfill Congress intent of a more streamlined program that reduces burdens on physicians; Supported S.2648, the Rural ACO Improvement Act, amends title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program (MSSP) to ensure that all ACOs have an equal opportunity to share in savings regardless of their geographic location; Provided recommendations to CMS on the Merit-based Incentive Payment System Value Pathway (MVP), which aims to reduce reporting burden and complexity within MIPS while improving the accuracy and effectiveness of performance measurement. The College noted specifically that a robust, multi-year transition period will be critical to the success of the MVP, that it does not support making the MVP mandatory, that CMS should continue to support numerous reporting mechanisms, including qualified registries and clinical data registries, which have been instrumental in developing specialty-specific performance measures, among other things. Urged that any legislation to hold some Medicare physician payment codes harmless from budget neutrality do so for just one year and to allow evaluation and management increases. Regarding CMS Medicare Physician Fee Schedule and Quality Payment Program (QPP) rules, expressed support for extending some of the services and increased flexibility for telehealth through the end of 2023, namely some audio-only services that were allowed during the COVID-19 public health emergency (PHE), support for collecting additional data on health equity issues to analyze disparities that occur across their programs, support for including chronic care management as one of the seven MIPS Value Pathways (MVPs) for 2023. Urged CMS to discontinue its split/shared visits policy and not move forward with the transition set to take effect in 2023. Urged Congress to support inclusion in must-pass legislation this year provisions to provide financial stability through a baseline positive annual update to the physician fee schedule reflecting inflation in practice costs, and eliminate, replace or revise budget neutrality requirements to allow for appropriate changes in spending growth; Extend the moratoriums on sequester and PAYGO cuts that were approved by Congress at the end of last year. FY2023 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Preventions programs in the FY 2023 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ). COVID-19: Urged congressional appropriators to provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the virus that is commensurate with the public health emergency that the virus represents. Expressed support to Congress and the administration for a variety of COVID-related bills from the 116th Congress as follows: the Families First Coronavirus Response Act, H.R. 6201, and other stimulus reforms related to COVID-19 including: Emergency paid leave benefits, paid sick days for public health emergencies, coverage of testing for COVID-19, waiving of cost sharing under Medicare, Medicare Advantage, Medicaid, and CHIP, increasing the federal FMAP under Medicaid, providing reimbursement for CPT codes 99441 - 99443, which are telephone evaluation and management services, expediting entrance of international medical graduates who are citizens of other nations (non-US IMGs) into the country and ensuring that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic, funding for physician practices under the Public Health and Social Service Emergency Fund (PHSSEF), providing tax relief, grants, and loans to small and medium size practices impacted by COVID-19, increasing funding for personal protective equipment (PPE), ensuring Medicaid pay parity with Medicare for primary care services; Urged support for H.R. 7059, the Coronavirus Provider Protection Act, which extend liability protections to those who provide care in good faith during the COVID-19 public health emergency (plus a reasonable time, such as 60 days, after the emergency declaration ends), and not in situations of gross negligence or willful misconduct. The College also urged that pay parity between telephone claims and in-person visits and between all telehealth and in-person visits be maintained after the PHE is lifted. Urged congress to mitigate the impact of covid across racial and ethnic minority populations by collect covid-19 and racial disparity data, equitably distribute covid-19 vaccines and treatments, protect essential workers, permanently expand access to family and medical leave, address environmental and social drivers of health, integrate primary care and behavioral health, improve mental health parity with increased federal oversight and enforcement, make naloxone more available to prevent overdose, expand medication-assisted treatment (mat) for physicians, establish a national prescription drug monitoring program (PDMP); urged support for administering COVID-19 vaccinations to all eligible immigrants in Customs and Border Protection (CBP) custody. Urged CMS to support increasing COVID-19 vaccine uptake by ensuring clinicians are appropriately paid for vaccine counseling for beneficiaries of Medicaid and Medicare. Urged that telehealth services should remain in place for at least two years after the end of the PHE to ensure that our physicians are able to continue to use this modality to enhance patient care. Urged Congress to support the concept of a congressionally-mandated bipartisan commission to examine the U.S. preparations for and response to the COVID-19 pandemic, in order to inform future public policy and health systems preparedness. Urged that any uses of technology in the U.S. in the context of the pandemic should be demonstrated to be effective, be temporary, and ensure that safeguards for privacy and confidentiality are in place. Womens Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Urged support for mandatory, permanent extension of postpartum Medicaid coverage, from 60 days to 12 months after delivery. Urged support for the Womens Health Protection Act of 2021 and 2022 (H.R. 3755/S. 1975), bills that would protect a persons ability to determine whether to continue or end a pregnancy and to protect the health care clinicians ability to provide abortion services free from medically unnecessary restrictions such as waiting periods, biased counselling and admitting privilege requirements for clinicians. Access to Care: Urged members of Congress to cosponsor and pass H.R. 340, the Incentivizing Medicaid Expansion Act of 2021, to expand federal matching assistance for states that choose to expand Medicaid, regardless of when such expansion takes place: Cosponsor and pass H.R. 369, the Health Care Affordability Act of 2021, to permanently expand eligibility for higher premium tax credits under the Affordable Care Act. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2256/S. 834, the Resident Physician Reduction Shortage Act of 2021, to increase the number of GME slots to 14,000 over seven years for specialties facing shortages, including internal medicine; Cosponsor and pass S. 1024, the Healthcare Workforce Resilience Act, to recapture 40,000 unused visas and use them to provide additional green cards to 15,000 physicians and 25,000 professional nurses; Cosponsor and pass H.R. 3541/S. 1810, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R.4122/S.3658, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2023 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Public Health and Pandemic Preparedness: Urged members of Congress to support funding in FY2023 appropriations - $11 billion total for the CDC, $35 million for the CDCs Injury Prevention and Control, Firearm Injury and Mortality Prevention Research; $49 billion in total for the NIH, $25 million for the Office of the Director, Firearm Injury and Mortality Prevention Research; Cosponsor and pass the COVID Supplemental Appropriations Act, 2022, H.R. 7007, or a similar supplemental funding package, to provide $15.6 billion in additional funding for COVID relief; Cosponsor and pass the CONNECT for Health Act (H.R. 2903/S. 1512) and the Telehealth Extension Act of 2021 (H.R. 6202/S. 3593), to remove arbitrary restrictions on where a patient must be located to utilize telehealth services; enable patients to continue to receive telehealth services in their homes; ensure federally-qualified health centers and rural health centers can furnish telehealth services and improve data collection and analysis for at least two years. Prescription Drug Reform: Urged members of Congress to cosponsor and pass S. 898, the Fair Drug Pricing Act, to require drug companies to disclose and provide more information about imminent drug-price increases, including data about research and development costs; Cosponsor and pass S. 833, the Empowering Medicare Seniors to Negotiate Drug Prices Act of 2021, to help to reduce drug prices and out-of-pocket costs by allowing the federal government to negotiate lower drug prices on behalf of Medicare beneficiaries; Cosponsor and pass S. 464/H.R. 2163, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Telehealth Services: Urged Congress to support H.R. 2903/S. 1512, the CONNECT for Health Act, to remove arbitrary barriers to telehealth services such as geographic and site of service restrictions; S. 168/H.R. 708, the Temporary Reciprocity to Ensure Access to Treatment Act or the TREAT Act, to ensure that telehealth services can be provided across states lines after the public health emergency ends; H.R. 8487, the Improving Seniors Timely Access to Care Act that would help protect patients from unnecessary delays in care and reduce administrative burdens on physicians by standardizing and streamlining the prior authorization approval process in the Medicare Advantage (MA) program. Mental and Behavioral Health: Urged members of Congress to cosponsor and pass H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act, to provide grants through the Department of Health and Human Services to primary care physicians who choose to deliver behavioral health care through the Collaborate Care Model (CoCM); Support enhanced reimbursement for CoCM payment codes under Medicare to more appropriately reflect the value of services provided to patients with mental health and substance use disorder needs.

Client expense: $68,579 · Firm income: Not reported

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

S. 1893: Rural Physician Workforce Production Act - Provide federal support for rural residency training S 1958/HR 3671:DOC Act - Permanent authorization of THCGME program HR 1319: American Rescue Plan - Expansion of ACA coverage, investments in public health workforce, funding for COVID-19 response HR 2418: Student Loan Forgiveness for Frontline Health Workers- Would forgive outstanding federal and private student loan debt for frontline physicians S.1810/H.R. 3541: Conrad 30 and Physician Access Act H.R. 4014 Physician Shortage GME Cap Flex Act No Bill No.: Congressional Primary Care Caucus;117th Congress membership in the bipartisan CPCC No Bill No.: Teaching Health Centers GME; Community Health Centers- National Health Service Corps; Special Diabetes Program; Special Diabetes Program for Indians - Increased funding and allocation of resources for teaching health center programs No Bill No.: Rural MOMS Act-Demonstration program to train physicians about maternal care in rural communities

Client expense: $746,388 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1810/H.R. 3541: Conrad 30 and Physician Access Act No Bill No.: LIFT the Bar Act

Client expense: $746,388 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2255/ S.1024-Healthcare Workforce Resilience Act; H.R. 3648, Equal Access to Green cards for Legal Employment Act of 2021 or the EAGLE Act of 2021; H.R. 3541/S. 1810, Conrad State 30 and Physician Access Reauthorization Act; H.R. 4521, America COMPETES Act of 2022; and policies contained in H.R. 5376, Build Back Better Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2255/ S.1024-Healthcare Workforce Resilience Act; H.R. 3648, Equal Access to Green cards for Legal Employment Act of 2021 or the EAGLE Act of 2021; and H.R. 3541/S. 1810, Conrad State 30 and Physician Access Reauthorization Act; policies contained in H.R. 5376, to provide for reconciliation pursuant to title II of S. Con. Res. 14.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 834/ H.R. 2256: Resident Physician Shortage Reduction Act S. 1024/H.R. 2255: Healthcare Workforce Resilience Act S. 1548/H.R. 3085: Equity in Neuroscience and Alzheimers Clinical Trials (ENACT) Act S. 1810/H.R. 3541: Conrad State 30 and Physician Access Reauthorization Act S. 3427: Neuroscience Center of Excellence Act of 2021 S.4348: FDASLA Act of 2022; section 506. H.R. 2754: COVID-19 Long Haulers Act H.R. 4122: Resident Education Deferred Interest Act of 2021 H.R. 5435: Bringing Regulatory Advances into Neuroscience (BRAIN) Act H.R. 5376: Build Back Better Act; sections 139001-139003, 139101, 139102, 139201, 139202, 31060, 137402, 137405, 30601, 30602, 137301, and 30801 Urging reforms to proposed surprise billing regulations to align with congressional intent for payment disputes. Support for creating a Neuroscience Center of Excellence at FDA. Supporting policies to address the COVID-19 public health emergency, including maintaining telemedicine coverage and ensuring access to affordable health coverage and medications. Support for funding and the reauthorization of the CDC National Neurological Conditions Surveillance System. Medical research funding related to NIH including the BRAIN Initiative, AHRQ, HEAL Initiative, and the Congressionally Directed Medical Research Programs at the Department of Defense. Support for funding for the Pediatric Subspecialty Loan Repayment Program.

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

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

Support H.R. 526, Ensuring Coverage in Public Health Emergencies Act of 2021, a bill to provide for special enrollment periods during public health emergencies; Letter urging Congress to provide additional funds to the Provider Relief Fund and for vaccine distribution and administration, which will allow for continued support of hospitals' COVID-19-related lost revenues, as well as additional expenses incurred due to purchasing supplies and equipment, staffing, establishing emergency testing and vaccination centers and constructing and retrofitting facilities; Support H.R. 708 and S. 168, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, a bill to provide temporary licensing reciprocity for telehealth and interstate health care treatment; Support H.R. 1306 and S. 412, National Coronavirus Commission Act of 2021, a bill to establish the Commission on the Coronavirus Pandemic in the United States; Support S. 610/ H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act, a bill to address behavioral health and well-being among health care professionals; Support S. 773 a bill 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; Support S.834, Resident Physician Shortage Reduction Act of 2021, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose H.R. 1195, Workplace Violence Prevention for Health Care and Social Service Workers Act, a bill to direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan and urge the Committee on Education and Labor not to report it favorably; Support S.924 and H.R. 2130, Rural America Health Corps Act, a bill to establish a demonstration program to provide payments on eligible loans for individuals who are eligible for the National Health Service Corps Loan Repayment Program; Discussions with ASPR about COVID-19 related medical supply and personnel shortages; Discussions with FEMA about COVID-19 public assistance funding policies; Letter asking Congress to consider an infrastructure proposal that you prioritize hospital and health system needs to ensure our nations health care system is well positioned to meet the opportunities and challenges that lie ahead; Support S.1512/H.R. 2903, CONNECT for Health Act of 2021, a bill to amend title XVIII of the Social Security Act to expand access to telehealth services; Support H.R. 2255/ S 1024, Healthcare Workforce Resilience Act, a bill to enhance our Nations nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas; Support S.1568, Technical Reset to Advance the Instruction of Nurses (TRAIN) Act, a bill to amend title XVIII of the Social Security Act to provide a waiver of the cap on annual payments for nursing and allied health education payments; Support H.R. 3203, a bill 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; Statement to Senate Committee on Homeland Security and Governmental Affairs hearing on "COVID-19 Part II: Evaluating the Medical Supply Chain and Pandemic Response Gaps" urges Congress to take steps to strengthen the nations medical supply chain; Statement to Senate Committee on Finance hearing on COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned stating that these flexibilities can continue to drive significant improvements in patient care long after the public health emergency (PHE) ends and given the beneficial impact of those specific flexibilities urges Congress and the Administration to make them permanent. In addition, a second group of flexibilities will remain critically important for some time following the PHE and will require a carefully crafted phase-out plan to ensure enough time is provided for a necessary transition. Without action from Congress and the Administration prior to the termination of the PHE, we are concerned that much of the progress made because of the implementation of many of these flexibilities may be unnecessarily halted or even lost; Letter urges Senate HELP Committee to consider recommendations and prioritize programs that support the health care workforce needs of the country in the wake of the COVID-19 pandemic and into the future; Support H.R. 769/S. 1491, Rural Maternal and Obstetric Modernization of Services Act or the Rural MOMS Act, a bill to amend the Public Health Service Act to improve obstetric care in rural areas; Support for S.1675/ H.R. 4387, Maternal Health Quality Improvement Act, a bill to improve maternal health; Support 1438, Opioid Workforce Act of 2021, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis; Support HR 3441,Substance Use Disorder Workforce Act, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the substance use disorder crisis; Support S.1810 / H.R.3541, Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities; Statement to the Senate Judiciary Subcommittee on Competition Policy, Antitrust, and Consumer Rights for the hearing on Antitrust Applied: Hospital Consolidation Concerns and Solutions expressing that integration helps to ensure every community, whether rural, urban or suburban, has access to the same high standard of affordable, evidenced based care; discussions to ensure that H.R. 2547s limits on unfair practice under FDCPA for debt collectors does not inappropriately interfere with or restrict the ability of hospitals to be able to obtain payment for care provided; Support for revising/repealing changes to the Rural Health Clinic (RHC) Program that reduced reimbursement for provider-based RHCs; Hill outreach expressing concerns with United Healths retroactive denial of coverage for emergency-level care in facilities; Hill outreach expressing concern about CMS mid-build audit denials; Senate outreach on prior authorization legislation; Urge support for legislation/administrative action to extend the deadline to use PRF money; Urged HRSA to ensure that the drug companies that denied 340B Statute appropriate discounts make the impacted hospitals whole for the benefit of the vulnerable communities they serve; Support S. 2304 Drug-Price Transparency for Competition Act of 2021 (DTC Act of 2021), a bill to amend title XI of the Social Security Act to require that direct-to-consumer advertisements for prescription drugs and biological products include an appropriate disclosure of pricing information; Support S.246/H.R.851 Future Advancement of Academic Nursing Act or the FAAN Act, a bill to amend the Public Health Service Act to authorize grants to support schools of nursing in program enhancement and infrastructure modernization, increasing the number of nursing faculty and students, and for other purposes; Support S. 1568/HR 4407Technical Reset to Advance the Instruction of Nurses Act or the TRAIN Act, a bill to amend title XVIII of the Social Security Act to provide a waiver of the cap on annual payments for nursing and allied health education payments; Comment letter to the Occupational Safety and Health Administration (OSHA) recommending the withdrawal of the COVID-19 Emergency Temporary Standard for occupational exposure to COVID-19; Meeting with Department of Labor staff to discuss our concerns about the OSHA COVID-19 Emergency Temporary Standard for occupational exposure to COVID-19; Discussion with ASPR staff overseeing the Strategic National Stockpile about their intent to procure supplies of surgical masks; Call with Senator Cassidys staff to discuss concerns about impact of FEMA COVID-19 funding of traveling nurse agencies on hospital nursing shortages; Oppose S 2428, False Claims Amendments Act of 2021A bill to amend title 31, United States Code, to modify False Claims Act procedures, and for other purposes; Discussions about Provider Relief Fund - reporting on past disbursements and urging HHS to disburse remaining PRF money; Discussions about the challenges that teaching hospitals have with training the physician workforce, residency caps that limit funding for training programs, a shortage of residents pursuing primary care specialties, a growing patient pool due to the newly insured and aging of the population; Discussions about the hospital and health system priorities for infrastructure and reconciliation bills; Letter urging Congress to maintain the current legal and regulatory framework for evaluating mergers and acquisitions; Hill outreach to discuss the benefits of health care integration; Hill outreach about the negative impact of potentially anticompetitive conduct by nurse-staffing agencies; Support HR 5035/ S 2982 Child Suicide Prevention and Lethal Means Safety Act, a bill to authorize the Secretary of Health and Human Services to award grants to establish or expand programs to implement evidence-aligned practices in health care settings for the purpose of reducing the suicide rates of covered individuals, and for other purposes; Support H.R.5376 Build Back Better Act, this bill provides funding, establishes programs, and otherwise modifies provisions relating to a broad array of areas, including education, labor, child care, health care, taxes, immigration, and the environment; Discussions with members of congress about the implementation of Rural Emergency Hospital payment designation; Discussions on the No Surprises Act Implementation (surprise billing) and urging federal regulators to restore the independence of the independent dispute resolution process in the No Surprises Act Part 2 regulations; Support HR 5699 Student Assisted Vaccination Effort (SAVE) Act, a bill to expand the definition of qualified persons for purposes of the Public Readiness and Emergency Preparedness Act to include health professional students; Support S 2873 Preventing and Addressing Trauma with Health Services Act (PATHS Act), a bill to require the Secretary of Health and Human Services to award grants to establish or expand programs and activities to increase access to high-quality culturally competent trauma support and mental health care; Letter urging HRSA to delay proposals to withdraw certain HPSAs; Support S 3497 and HR 6397, Medical Student Education Authorization Act of 2022, a bill to amend the Public Health Service Act to establish a grant program to award grants to public institutions of higher education located in a covered State; Support HR 6279 and S 3629, Opioid Treatment Access Act of 2022, a bill to authorize a study on certain exemptions for treatment of opioid use disorder through opioid treatment programs during the COVID-19 public health emergency; Support HR 5703 and S 3677, Post-Disaster Mental Health Response Act, a bill to amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act to authorize the President to provide professional counseling services to victims of emergencies declared under such Act; Submitted a statement on the hearing for Pandemic Profiteers: Legislation to Stop Corporate Price Gouging regarding concerns about anticompetitive conduct on the part of health care staffing agencies, some of which have been exploiting the severe shortage of health care providers during the COVID-19 pandemic; Submitted a statement on the hearing for Americas Mental Health Crisis and supports additional approaches to help ensure improved access to needed comprehensive, affordable and quality behavioral health services; Provide comments to the Affordability Subcommittee of the Healthy Future Task Force expressing our shared focus with Congress on providing relief from the pandemic, ensuring a smooth recovery and rebuilding a better health care system for the future, all while continuing to support efforts to promote greater affordability and value to patients and the health care system; Submitted statement on the hearing for Recruiting, Revitalizing & Diversifying: Examining the Health Care Workforce Shortage about the challenges ahead and the need to examine Americas health care workforce shortage. We must work together to solve these issues so that our nations hospitals and health systems can continue to care for the patients and communities they serve; Submitted statement on the hearing for Protecting Youth Mental Health: Part II - Identifying and Addressing Barriers to Care examines ways to protect the mental health of our nations youth; Submitted statement on the hearing for Exploring Pathways to Affordable, Universal Health Coverage Care expressing the need to build upon and improve our existing system to increase access to coverage of comprehensive health benefits; Submitted a letter to provide information regarding the challenges facing Americas health care workforce as the country enters the third year of the COVID-19 pandemic; Provided comments to the Modernization Subcommittee of the Healthy Future Task Force urging Congress to consider how to ensure the telehealth flexibilities could remain in place for patients and health care providers beyond the PHE; Support HR 7053 and S 3792, Hospital Inpatient Services Modernization Act, a bill to amend title XVIII of the Social Security Act to extend acute hospital care at home waiver flexibilities; Support resolution, H. Res. 909, Expressing support for healthcare personnel and condemning assaults on healthcare personnel as the U.S. healthcare system faces unprecedented staffing shortages and increased workplace-related stressors; Letter urges Congress to provide immediate additional support for hospitals and health systems serving their communities during this unprecedented public health crisis. While the support Congress has provided during the last two years of the COVID-19 pandemic has helped hospitals care for their patients and communities, there is still a significant need for financial support and relief as COVID-19 challenges persist; Support S 3904, Healthcare Cybersecurity Act of 2022, a bill to enhance the cybersecurity of the Healthcare and Public Health Sector; Letter urging OSHA to extend the comment deadline for the rule making on the occupational exposure to COVID-19 in healthcare settings by at least an additional 30 days, through May 23; Meeting with the Office of the Assistant Secretary of Health (OASH) at HHS to discuss the widespread blood shortages in the U.S. and next steps; Stakeholder calls with HHS ASPR regarding the distribution/administration of COVID-19 therapeutics; Discussions on S 571, Public Health Funding Prevents Pandemics Act, a bill to fully fund the Prevention and Public Health Fund and reaffirm the importance of prevention in the United States healthcare system; Regular calls with ASPR and other stakeholders participating in the Health Care and Public Health (HPH) Sector Joint Supply Chain Resilience Working Group (Joint SCRWG), a formal Working Group under the authority of the Critical Infrastructure Partnership Advisory Council (CIPAC) to support the Presidents vision for a resilient public health supply chain; Monthly calls with ASPRs Hospital Preparedness Program (HPP) to discuss updates on the hospital association COVID-19 funding program; Call with ASPR Healthcare and Public Health Government Coordinating Council leadership and other hospital associations to provide feedback on the COVID-19 hospital data guidance update; Provide comment letter to OSHA on the re-opening of comments on the Occupational Exposure to COVID-19 Rulemaking in which we urge OSHA not to finalize its rule for occupational exposure to COVID-19. In our comments, we indicate that we continue to oppose establishing new regulations that are not fully aligned with the Centers for Disease Control and Preventions evolving evidence-based guidance. With the constantly evolving, science-based CDC guidance and recommendations, CMS vaccination requirement and existing OSHA general standards, we strongly believe that an inconsistent and overly strict OSHA COVID-19 health care standard is not necessary, would cause confusion and will ultimately lower hospital employees morale and worsen unprecedented personnel shortages in hospitals. It is essential to a well-functioning health care system that only one set of science-based standards be applied to health care providers, and that these standards be aligned across federal agencies; Letter urging Congress to make the expanded tax credits permanent, ensuring millions of low- and middle-income families continue to have access to affordable coverage in 2023 and beyond; Express concerns with the letter to CMS from Congressman Murphy that makes a number of requests for data surrounding the COVID-19 add on payments for hospitals. We are concerned about the questions as they do not take into account the continued needs of the nations hospitals and health systems. Hospitals continue to face numerous challenges, including increased labor and supply costs and workforce shortages. These additional payments have helped to address some but not all of the high costs associated with COVID-19 patient care. The complexity of care is still higher than pre-pandemic levels as measured by length of stay, which further indicates that its still more resource intensive to treat COVID inpatients. In addition, the high costs associated personal protective equipment, isolation measures, and other additional resources are necessary when treating all patients, unless and until it is determined they do not have COVID-19; Submitted a letter to Ways and Means per their request for information on the health care industry and climate change. We support the sustainability efforts while acknowledging that for a variety of reasons, many hospitals and health systems face challenges and barriers to implementing this work, especially while responding to a pandemic; Letter urging HHS to maintain the COVID-19 public health emergency (PHE) until it is clear that the global pandemic has receded and the capabilities authorized by the PHE are no longer necessary. This will help prevent any future surges from threatening the health and safety of patients and the ability of health care professionals to care for them; Long COVID Best Clinical Practices Discussion with the White House Policy Advisor, Office of the COVID-19 Response; Submitted comment letter to the Federal Trade Commission outlining the impact pharmacy benefit managers (PBMs) practices have on the field. Specifically, urging the FTC to increase scrutiny on insured-mandated white bagging policies, as well as the impact of PBM-negotiated rebates and other business practices on the 340B drug discount pricing program and overall drug prices and drug price increases; Submit a comment letter to the Internal Revenue Service for their proposed rule amending how employer coverage affordability would be measured for family members of employees. We advocated for a fix to the current methodology for assessing affordability of employer coverage for family members, often referred to as the family glitch, which is estimated to affect about 5 million individuals. We commend the IRS on proposing to revise the regulation and improve access to health insurance coverage for millions of American families; Concerns S.4348, Food and Drug Administration Safety and Landmark Advancements Act of 2022 or the FDASLA Act of 2022, a bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs, medical devices, generic drugs, and biosimilar biological product; Comment letter on CMS Radiation Oncology (RO) Model proposed rule. We strongly supports CMS efforts to transform the delivery of cancer care. We also support the original intent of the RO Model, which was to protect access to care by ensuring fair, predictable payment for radiation oncologists. However, this important goal of the original RO Model has been marred by the incorporation of significant payment cuts and substantial administrative burdens for those participating in this mandatory model. As such, the AHA supports CMSs proposal to delay the start date of the RO model from Jan. 1, 2023 to a date to be determined through future rulemaking; Support S. 4352,Travel Nursing Agency Transparency Study Act, a bill to require a study on the effects of travel nurse agencies on the health industry during the COVID-19 pandemic; Letter in response to CMS request for guidance on implementing the regulatory requirement for convening providers and facilities exchange information with co-providers and co-facilities to create a comprehensive good faith estimate as part of the implementation of the No Surprises Act. Due to the lack of currently available automated solutions, this process would require a significant manual effort by providers, which would undoubtedly result in the convening provider being unable to meet the short statutory timeframes for delivering good faith estimates to the patients and could also lead to inadvertent errors. AHA has requested an extension in enforcement direction until a technical solution has been identified and implemented; Support HR 7691, Safety From Violence for Healthcare Employees Act or the SAVE Act, a bill to protect hospital personnel from violence, and for other purposes; Letter requesting that HHS, HRSA, and OIG take immediate enforcement action against the now 17 companies that are refusing to honor their obligations under the 340B program; Letter sent to HHS Secretary to discuss how best to ensure prompt repayment to 340B hospitals without penalizing the rest of the hospital field after the U.S. Supreme Court unanimously agreed that HHS outpatient payment cuts to hospitals in the 340B Drug Pricing Program were unlawful. The Courts decision did not determine a remedy for the unlawful payment cuts, instead, it remanded the case to the lower courts to address the proper remedy; Support HR 7084/ S 3983, Protecting and Transforming Cyber Health Care Act of 2022 or the PATCH Act of 2022, a bill to amend the Federal Food, Drug, and Cosmetic Act to require, for purposes of ensuring cybersecurity, the inclusion in any premarket submission for a cyber device of information to demonstrate a reasonable assurance of safety and effectiveness throughout the lifecycle of the cyber device, and for other purposes; Submit Comment letter of support for CMS continued focus on strengthening health insurance coverage and ensuring ease of enrollment and limited gaps in coverage, including proposed updates to Medicare enrollment and eligibility rules; Submit letter for oversight hearing on Medicare Advantage (MA) plans expressing concerns about some MA plans inappropriate restrictions on beneficiary access to medically necessary care, including those highlighted in a recent report issued by the Department of Health and Human Services Office of Inspector General (HHS-OIG), and urge Congress to increase its oversight of these plans.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, White House Office

H.R. 6, The American Dream and Promise Act of 2021 H.R. 1177, S. 348 US. Citizenship Act S. 264, Dream Act of 2021 H.R. 5376, Build Back Better Act Issue: Support policies allowing undocumented students to attend U.S. medical schools and graduate medical education. Support Dreamer eligibility for federal student loans. Issue: Support retention of DACA Executive Action H.R. 3541/ S. 1810, Conrad State 30 and Physician Access Reauthorization Act Issue: Support reauthorization and expansion of the Conrad 30 program, and improvements to physician immigration Issue: Support policies to ensure timely and predictable processing for immigration of academic medicine community Issue: Oppose policies limiting entry of medical students, residents, researchers, and health professionals to the U.S. on the F-1, J-1, and H-1B visas. H.R. 2255/ S. 1024, Healthcare Workforce Resilience Act Issue: Support reduction of green card backlogs for health professionals

Client expense: $1,090,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS), White House Office

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. Monitoring and outreach on legislative and administrative activity related to infrastructure. Monitoring and outreach on legislative and administrative activity related to reconciliation and the congressional budget resolution. H.R. 4432 - Department of Defense Appropriations Act, FY2022. Senate Draft, Department of Defense Appropriations Act, FY2022 P.L. 116-136, CARES Act P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act P.L. 117-2, American Rescue Plan Act of 2021 H.R. 3684 - Infrastructure Investment and Jobs Act S. 464 - Safe Step Act H.R. 2163 - Safe Step Act H.R. 1319 - American Rescue Plan Act of 2021 S. 834 - Resident Physician Shortage Reduction Act of 2021 H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R. 1868 - To prevent across-the-board direct spending cuts, and for other purposes H.R. 315 - Medicare Sequester COVID Moratorium Act S. 368 - Telehealth Modernization Act H.R. 1332 - Telehealth Modernization Act H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 S. 1024 - Healthcare Workforce Resilience Act H.R. 2255 - Healthcare Workforce Resilience Act H.R. 1819 - Pharmacy Benefit Manager Accountability Study Act H.R. 3107 - The Improving Seniors Timely Access to Care Act H.R. 3517 - Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act H.R. 315 - The Medicare Sequester COVID Moratorium Act S. 748 - Medicare Sequester Relief Act H.R. 5067 - Preserving Patient Access to Home Infusion Act S. 2652 - Preserving Patient Access to Home Infusion Act H.R. 3541 - Conrad State 30 and Physician Access Reauthorization Act S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 5376 - Build Back Better Act S. 3314 - Supporting Medicare Providers Act H.R. 6020 - Supporting Medicare Providers Act H.R. 5801 - Help Ensure Lower Patient (HELP) Copays Act S. 4408 Health and Location Data Protection Act of 2022 H.R. 4122 - Resident Education Deferred Interest Act or the REDI Act S. 3658 - Resident Education Deferred Interest Act or the REDI Act FY2023 Labor Health and Human Services Appropriations content Draft House, Department of Defense Appropriations Act, FY2023 Draft Senate, Department of Defense Appropriations Act, FY2023

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. Monitoring and outreach on legislative and administrative activity related to infrastructure. Monitoring and outreach on legislative and administrative activity related to reconciliation and the congressional budget resolution. H.R. 4432 - Department of Defense Appropriations Act, FY2022. Senate Draft, Department of Defense Appropriations Act, FY2022 P.L. 116-136, CARES Act P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act P.L. 117-2, American Rescue Plan Act of 2021 H.R. 3684 - Infrastructure Investment and Jobs Act S. 464 - Safe Step Act H.R. 2163 - Safe Step Act H.R. 1319 - American Rescue Plan Act of 2021 S. 834 - Resident Physician Shortage Reduction Act of 2021 H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R. 1868 - To prevent across-the-board direct spending cuts, and for other purposes H.R. 315 - Medicare Sequester COVID Moratorium Act S. 368 - Telehealth Modernization Act H.R. 1332 - Telehealth Modernization Act H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 S. 1024 - Healthcare Workforce Resilience Act H.R. 2255 - Healthcare Workforce Resilience Act H.R. 1819 - Pharmacy Benefit Manager Accountability Study Act H.R. 3107 - The Improving Seniors Timely Access to Care Act H.R. 3517 - Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act H.R. 315 - The Medicare Sequester COVID Moratorium Act S. 748 - Medicare Sequester Relief Act H.R. 5067 - Preserving Patient Access to Home Infusion Act S. 2652 - Preserving Patient Access to Home Infusion Act H.R. 3541 - Conrad State 30 and Physician Access Reauthorization Act S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 5376 - Build Back Better Act S. 3314 - Supporting Medicare Providers Act H.R. 6020 - Supporting Medicare Providers Act H.R. 5801 - Help Ensure Lower Patient (HELP) Copays Act S. 4408 Health and Location Data Protection Act of 2022 H.R. 4122 - Resident Education Deferred Interest Act or the REDI Act S. 3658 - Resident Education Deferred Interest Act or the REDI Act FY2023 Labor Health and Human Services Appropriations content Draft House, Department of Defense Appropriations Act, FY2023 Draft Senate, Department of Defense Appropriations Act, FY2023

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. Monitoring and outreach on legislative and administrative activity related to infrastructure. Monitoring and outreach on legislative and administrative activity related to reconciliation and the congressional budget resolution. H.R. 4432 - Department of Defense Appropriations Act, FY2022. Senate Draft, Department of Defense Appropriations Act, FY2022 P.L. 116-136, CARES Act P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act P.L. 117-2, American Rescue Plan Act of 2021 H.R. 3684 - Infrastructure Investment and Jobs Act S. 464 - Safe Step Act H.R. 2163 - Safe Step Act H.R. 1319 - American Rescue Plan Act of 2021 S. 834 - Resident Physician Shortage Reduction Act of 2021 H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R. 1868 - To prevent across-the-board direct spending cuts, and for other purposes H.R. 315 - Medicare Sequester COVID Moratorium Act S. 368 - Telehealth Modernization Act H.R. 1332 - Telehealth Modernization Act H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 S. 1024 - Healthcare Workforce Resilience Act H.R. 2255 - Healthcare Workforce Resilience Act H.R. 1819 - Pharmacy Benefit Manager Accountability Study Act H.R. 3107 - The Improving Seniors Timely Access to Care Act H.R. 3517 - Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act H.R. 315 - The Medicare Sequester COVID Moratorium Act S. 748 - Medicare Sequester Relief Act H.R. 5067 - Preserving Patient Access to Home Infusion Act S. 2652 - Preserving Patient Access to Home Infusion Act H.R. 3541 - Conrad State 30 and Physician Access Reauthorization Act S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 5376 - Build Back Better Act S. 3314 - Supporting Medicare Providers Act H.R. 6020 - Supporting Medicare Providers Act H.R. 5801 - Help Ensure Lower Patient (HELP) Copays Act S. 4408 Health and Location Data Protection Act of 2022 H.R. 4122 - Resident Education Deferred Interest Act or the REDI Act S. 3658 - Resident Education Deferred Interest Act or the REDI Act FY2023 Labor Health and Human Services Appropriations content Draft House, Department of Defense Appropriations Act, FY2023 Draft Senate, Department of Defense Appropriations Act, FY2023

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

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

H.R. 4521, America COMPETES Act (W Visa and STEM graduate student provisions) H.R. 5498, Preserving Employment Visas Act, (Bill to allow USCIS to continue processing employment-based visa applications from fiscal years 2020 and 2021) S. 1810/ H.R.3541, the Conrad State 30 and Physician Access Reauthorization Act (Expansion of the Conrad 30 program). H.R.4288, Workforce for an Expanding Economy Act S.1024, Healthcare Workforce Resilience Act Proposed Changes to Form I-9, Employment Eligibility Verification - DHS Extension of flexibilities on Form I-9 Compliance Requirements - DHS H.R. 5376, the Build Back Better Act (Immigration provisions) Expansion and implementation of employment-based visas and addressing visa case processing issues - DHS

Client expense: $366,591 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE

H.R. 2255, Healthcare Workforce Resilience Act, all provisions S. 1024, Healthcare Workforce Resilience Act, all provisions H.R. 3541, Conrad State 30 and Physician Access Reauthorization Act, all provisions S. 1810, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 6, American Dream and Promise Act of 2021, all provisions H.R. 8019, Professionals Access To Health Workforce Integration Act of 2022, all provisions H.R. 8021, Immigrants in Nursing and Allied Health Act of 2022, all provisions H.R. 8022, International Medical Graduates Assistance Act of 2022, all provisions Conrad 30

Client expense: $4,550,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE

H.R. 6, American Dream and Promise Act of 2021 H.R. 78, Legal Workforce Act H.R. 206, Paperwork Reduction for Farmers and H-2A Modernization Act H.R. 401, Landscaping Workforce Act of 2021 H.R. 427, Moving H-2A to United States Department of Agriculture Act of 2021 H.R. 865, American Jobs First Act of 2021 H.R. 1037, Better Agriculture Resources Now (BARN) Act H.R. 1177/S. 348, U.S. Citizenship Act H.R. 1571, Dairy H-2A Eligibility Act H.R. 1603, Farm Workforce Modernization Act of 2021 H.R. 2064, TPS and DED Protection Act of 2021 H.R. 2086, Agricultural Guest Worker Reform Initiative Act of 2021 H.R. 2255/S. 1024, Healthcare Workforce Resilience Act H.R. 2298, Accountability Through Electronic Verification Act H.R. 2839/S. 1358, Bipartisan Border Solutions Act of 2021 H.R. 2901, EB-5 Reform and Integrity Act of 2021 H.R. 3215, Temporary Family Visitation Act H.R. 3237, Emergency Security Supplemental Appropriations Act, 2021 H.R. 3385/S. 2083, HOPE for Afghan SIVs Act of 2021 H.R. 3513/S. 2032, Afghan Allies Protection Act of 2021 H.R. 3541, Conrad State 30 and Physician Access Reauthorization Act H.R. 3648, Equal Access to Green cards for Legal Employment (EAGLE) Act of 2021 H.R. 3897, H-2B Returning Worker Exception Act of 2021 H.R. 4288, Workforce for an Expanding Economy Act H.R. 4331, Americas Cultivation of Hope and Inclusion for Long-term Dependents Raised and Educated Natively Act of 2021 (Americas CHILDREN Act of 2021) H.R. 4521, America Creating Opportunities for Manufacturing, Pre-Eminence in Technology, and Economic Strength (America COMPETES) Act of 2022 H.R. 4578, Relief for Seasonal Businesses Act of 2021 H.R. 4681, Let Immigrants Kickstart Employment (LIKE) Act of 2021 H.R. 4856, Canadian Snowbird Visa Act H.R. 5498, Preserving Employment Visas Act H.R. 5887/S. 3134, Keep Food Local and Affordable Act of 2021 H.R. 5924, Keep STEM Talent Act of 2021 H.R. 6206, American Tech Workforce Act of 2021 H.R. 6637, Dignity for Immigrants while Guarding our Nation to Ignite and Deliver the American Dream (DIGNIDAD Dignity) Act H.R. 7239, Essential Workers for Economic Advancement Act H.R. 7441, Acute Labor Shortage Solutions Act of 2022 H. Res. 901, Expressing the sense of the House of Representatives that BridgeUSA exchange programs are vital to the economy and national interests of the United States, and that Congress should prioritize robust support to ensure equitable opportunities for Americans and people from other countries S. 71, Accountability Through Electronic Verification Act S. 264, Dream Act of 2021 S. 306, Safe Environment from Countries Under Repression and Emergency (SECURE) Act S. 418, E-Verify Act S. 478, Higher Wages for American Workers Act of 2021 S. 495, Prioritizing Help to Businesses Act S. 831, EB-5 Reform and Integrity Act of 2021 S. 959, Secure and Protect Act of 2021 S. 970, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement (BELIEVE) Act S. 1810, Conrad State 30 and Physician Access Reauthorization Act S. 1861, Partner with Korea Act S. 2207, A bill to temporarily increase the availability of temporary nonimmigrant nonagricultural workers for the purposes of restoring American forests, and for other purposes S. 2443, A bill to expand the definition of H-2A nonimmigrant for purposes of the Immigration and Nationality Act to include aliens engaged in seafood processing, horticultural commodities, or the care of horses S. 2753, Protecting Children of Long-term Visa Holders Act of 2021 S. 2828, Preserving Employment Visas Act S. 3638, Keep STEM Talent Act of 2022 S. 3720, H-1B and L-1 Visa Reform Act of 2022 S. 3721, Resolving Extended Limbo for Immigrant Employees and Families (RELIEF) Act S. 3850, Securing America's Ports of Entry Act of 2022 S. 3869, A bill to add Ireland to the E-3 nonimmigrant visa program Draft legislation titled Making appropriations for the Department of Homeland Security for the fiscal year ending September 30, 2023, and for other purposes Various issues relating to visa waiver program; H-1B Visa Program; H-1B registration rule; H-1B reform; H-2 Visa Program and temporary rule; H-2A Visa Program; H-4 rule; L-1 Visa Program; J-1 BridgeUSA program; EB-5 Visa Program; EB-5 regional center program; E-Verify program; nonimmigrant workers in temporary or seasonal nonagricultural employment; Customs and Border Protection staffing at U.S. ports of entry; border security; immigration policy and reforms; guest worker programs; legalization concepts; visa reform; customs trade facilitation and enforcement; Deferred Action for Childhood Arrivals (DACA) program; extension of temporary protected status (TPS) designations for El Salvador, Honduras, and Haiti; administrative-regulatory efforts related to public charge, notice to appear, H-4 & OPT; delays in H-4 and L-2 Status Extensions and Employment Authorization Documents (EADs); FY22 funding for Customs and Border Protection staffing; restarting routine visa processing during the COVID-19 pandemic; high-skilled immigration; lesser skilled immigration; temporary agricultural guest workers; temporary non-agricultural guest workers; optional practical training program; size and administration of employment-based immigrant visa categories; size and administration of family-based immigrant visa categories; size and administration of employment-based nonimmigrant visa categories; expansion of the use of the E-Verify system; I-9 employment verification; interior enforcement; temporary suspension of entry of nationals from certain countries; increased vetting of visa applicants; unfair immigration related employment practices; international travel; trusted traveler programs; biometric entry-exit; increasing the number of ICE officers, border patrol agents and Customs and Border Protection officers; aerial security enhancements; temporary DHS guidance for the I-9 employment verification process in the wake of COVID-19; State Department policy extending consular interview waiver eligibility; temporary United States Citizenship and Immigration Services (USCIS) procedures to provide flexibility with regard to filing deadlines, and temporary USCIS guidelines providing flexibility to wet-ink signatures on USCIS forms and documents; United States Citizenship and Immigration Services (USCIS) funding shortfalls and extending premium processing capability for the adjudication of various immigration forms; regulatory proposals that would restrict applicant eligibility for the H-1B program; regulatory proposals that would drastically change how prevailing wage levels are determined for the purposes of obtaining certain employment nonimmigrant and immigrant visas; proposals that would significantly change how cap-subject H-1B petitions will be chosen in the future; regulatory proposals that would change how the period of admission for student visa holders and exchange visa holders is determined; regulatory proposals that will temporarily raise the annual quota for H-2B visas; enhanced COVID-19 testing protocols for international air travel; creation/use of digital passports; reopening and expanding consular operations; fully reinstituting routine visa processing at U.S. embassies and consulates abroad; rescinding or reforming current travel restrictions at land ports of entry; rescinding or reforming current travel restrictions for international air travel; recapturing unused immigrant visas from prior years; creating exemptions to the current immigrant visa caps; proposals that would expand consular interview waivers for prospective immigrant and nonimmigrant visa applicants abroad; implementation of the EB-5 Reform and Integrity Act of 2022, P.L. 117-103, Division BB; proposals that would provide relief for Afghan refugees; granting temporary protected status and special student relief to Ukrainian nationals; ensuring Ukrainian applicants for refugee/asylee status have access; potential Reinstitution of Stateside Visa Revalidation Services; implementation of electronic visa foils in passports; consular service delays; USCIS processing delays

Client expense: $15,800,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), White House Office