Accountable Care in Rural America Act

Support H.R. 315,Medicare Sequester COVID Moratorium Act, a bill to amend the Coronavirus Aid, Relief, and Economic Security Act to extend the temporary suspension of Medicare sequestration; Support H.R. 1332 and S.368,Telehealth Modernization Act, a bill to amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency; Discussion with the Center for Medicare and Medicaid Innovation (CMMI) about the Radiation Oncology Alternative Payment Model; Support H.R. 1868, a bill that, among other health care provisions, would eliminate the 2% across-the-board cut to all Medicare payments, known as sequestration, until the end of 2021; Support H.R. 2455, The Resetting the Impact Act (TRIA), a bill to amend the IMPACT Act of 2014 to reset data collection and the development of a payment system technical prototype for post-acute care providers under the Medicare program to take into account the effects of COVID-19; Support H.R. 3173/ S.3018, Improving Seniors Timely Access to Care Act of 2021, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, and for other purposes; Support H.R. 1887/ S. 4009, Rural Hospital Support Act, a bill to make permanent the Medicare Dependent Hospital (MDH) and Low-volume Adjustment programs and rebases the MDH and Sole Community Hospital programs; Support relief for Medicare advanced payments; Discussion with CMMI about the priorities for alternative payment models; Support HR 4587, Value in Health Care Act of 2021, a bill to direct the Secretary of Health and Human Services to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage participation in such program, and for other purposes; Support HR 3746, Accountable Care in Rural America Act, a bill to amend title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program; Support H.R. 5425/ S. 1988, Protecting Rural Telehealth Access Act, a bill to amend title XVIII of the Social Security Act to protect access to telehealth services under the Medicare program; Letter asking Congress to address two important issues by the end of the year: an extension of the moratorium on Medicare sequester cuts, as well as preventing the Statutory Pay-As-You-Go (PAYGO) sequester from taking effect; Letter urging Congress to remove the reductions to the Medicaid disproportionate share hospital (DSH) program and uncompensated care pools from the Build Back Better Act; Support H.R. 5674/ S. 3061Medicare Mental Health Inpatient Equity Act of 2021, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Letter to the HHS secretary asking for PHE extension and urging HHS to extend the declaration for at least 90 days; Letter to the HHS secretary asking to renew the COVID-19 PHE; Letter to CMS urging changes to MA prior authorization requirements for PHE; Letter expressing our disappointment that Congress is adjourning for April recess without addressing the needs of hospitals and health systems and urging Congress to act to ensure health care providers have the critical relief, including but not limited to extending the Medicare sequester relief, adding more PRF dollars, and providing flexibility in the repayment terms for Medicare accelerated and advance repayments; Provide comments in response to the (CMS) request for information regarding access to coverage and care in the Medicaid and Childrens Health Insurance Program (CHIP) programs. The critical components for a comprehensive access and coverage strategy for Medicaid and CHIP should include: Robust outreach and enrollment efforts to secure and maintain coverage for eligible individuals and families, as well as ensure beneficiary knowledge of how to use this coverage, Standards to ensure timely and equitable access to quality care, and Provider payments that are sufficient to enable beneficiaries' access to quality care; Provide comments in response to the Department of Homeland Securitys (DHS) proposed rule to codify standards and clarify policies that govern public charge determinations. Public charge determinations assess how likely it is that an individual will become dependent on government assistance (public benefits) for support and subsistence. These policy clarifications are intended to help immigrants and their family members better understand when the use of certain public benefits could impact their future immigration status and address the chilling effects of the now-repealed 2019 public charge final rule. The AHA supports DHSs efforts to clarify policies regarding how public charge determinations are made to help reverse the damaging effects of the repealed 2019 public charge rule; A bill to amend title XIX of the Social Security Act to expand the availability of mental, emotional, and behavioral health services under the Medicaid program; Letter urging Congress to halt further cuts to hospital payments. Need to stop a harmful Medicare payment cut to providers that will go into effect July 1 without congressional action. Specifically, a 1% Medicare sequester cut took effect April 1, and that cut will increase to 2% on July 1 if Congress does not act. This will result in billions of dollars being cut from hospitals and health systems by the end of the year; Submitted comment letter regarding Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2023 and Updates to the IRF Quality Reporting Program. We note that the proposed IRF PPS labor-related share would only modestly shift upward from 72.9% in FY 2022 to 73.2% in FY 2022. AHA is concerned that these changes neither align regarding massive cost growth in recent months and years; Provide Comments on the Medicare Program - Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities and Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023 which stated the Proposed FY 2023 Payment Update warrants closer examination and we urge CMS to discuss in the final rule how the agency will account for these increased costs. The timing of this proposed net decrease in payments could not be worse, given the well-documented impact of the COVID-19 public emergency (PHE) on the SNF and nursing home field; Letter sent to the bipartisan, bicameral Leadership of the House and Senate, urging Congress to act to prevent further Medicare sequester cuts scheduled to take effect on July 1; Submitted comment letter about inpatient and long-term care hospital prospective payment system proposed rule for fiscal year 2023. Concerned that CMS is proposing policies and payment adjustment that do not take into account the current the COVID-19 public health emergency (PHE) and its atypical market forces and pandemic-driven aberrations affecting the utilization and cost of providing LTCH services. Specifically, we are concerned by proposals for an inadequate market basket update and an untenable spike in the high-cost outlier threshold; Letter urges Congress to call on CMS to make changes to the hospital inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2023 in order to ensure that Medicare payments for acute care services more accurately reflect the cost of providing hospital care to patients and communities; Support the bipartisan Dear Colleague letters that ask CMS to make critical changes to the hospital inpatient prospective payment system proposed rule for fiscal year (FY) 2023 to more accurately reflect the cost of providing hospital care to patients; Support HR 8487/ S 3173 Improving Seniors Timely Access to Care Act of 2022, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans; Support HR 8747 Assistance for Rural Community Hospitals Act of 2022 or the ARCH Act of 2022, a bill to amend title XVIII of the Social Security Act to extend Medicare-dependent hospital and Medicare low-volume hospital payments; Oppose HR 1330/ S 4130 Patient Access to Higher Quality Health Care Act of 2022, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 8188/ S4449 Saving Access to Laboratory Services Act, a bill to amend title XVIII of the Social Security Act to improve the accuracy of market-based Medicare payment for clinical diagnostic laboratory services, to reduce administrative burdens in the collection of data, and for other purposes; Letter urged Congress to prevent the Statutory Pay-As-You-Go Act of 2010 (Statutory PAYGO) sequester from taking effect at the end of this session of Congress. Failure to waive Statutory PAYGO sequester cuts would result in $38 billion in Medicare cuts in fiscal year 2023 which would have a devastating impact on the health care field, destabilizing health care access; Letter expressing opportunities to increase participation, enhance efficacy of Medicare Access and CHIP Reauthorization Act (MACRA) programs, and further transition our health care system from volume to value; Letter to provide feedback on the cybersecurity policy proposals released in Senator Warner report. Hospitals and health systems have prioritized protecting patients and defending their networks from cyberattacks. However, they need support from the federal government as the field continues to face targets from sophisticated cyber adversaries and nation-states; Letter to leadership encouraging Congress to take steps to provide relief to those seeking and administering behavioral health care; Support HR 7744, Building Americas Health Care Workforce Act, a bill to amend title XI of the Social Security Act to extend beyond the COVID-19 emergency period, with certain modifications, the Emergency Declaration Blanket Waiver relating to training and certification of nurse aides to alleviate burdens imposed on staff of skilled nursing facilities and nursing facilities.

Client expense: $6,950,000 · Firm income: Not reported

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

Issue: Support policies to close the Medicaid coverage gap, including through ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. Issue: Support programs and funds for safety-net providers. Educate Congress about the impact of Section 203 of the Consolidated Appropriations Act, 2021 and its changes to the Medicaid DSH cap calculation methodology on academic medical centers. P.L. 117-328, Consolidated Appropriations Act, 2023 Division FF Issue: Support increased Medicare funding for graduate medical education, including 200 new Medicare-supported GME slots included in the Consolidated Appropriations Act, 2023. H.R. 2256 / S. 834, Resident Physician Shortage Reduction Act of 2021 H.R. 5376, Build Back Better Act Issue: Support increased Medicare funding for graduate medical education S. 1438 Opioid Workforce Act H.R. 3441 Substance Use Disorder Workforce Act Issue: Support targeted Medicare funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs S.1893 / H.R. 8508, Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals Issue: Provide feedback to CMS on its proposed distribution of the 1,000 new GME slots authorized be the Consolidated Appropriations Act, 2021 as described in the 2022 Inpatient Prospective Payment System (IPPS) proposed rule. Support CMS adopting alternative 2 with modifications to allow for more than 1.0 FTE per hospital. Support policy to ensure each qualifying hospital that applies for CAA, 2021 GME positions would receive at least 1 (or a fraction of 1) of the positions before any qualifying hospital receives more than 1 of such positions Issue: Support Medicare Graduate Medical Education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital, physician, and provider cuts. H.R. 8850, Fair Access In Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. Issue: Oppose overly burdensome Medicaid GME transparency language. Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives H.R.3173 / S.3018, Improving Seniors Timely Access to Care Act Issue: Protecting patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs. Draft Medicare Part D benefit re-design legislation Issue: Support policies to reduce prescription drug prices Issue: Support implementation of the 21st Century Cures Act (Cures) interoperability and health data sharing provisions. Issue: Support changes and improvements to the Medicare Shared Savings Program. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Issue: Educate Congress and policymakers on the financial challenges facing teaching hospitals, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Support expansion of Medicaid and CHIP coverage during the postpartum period. S. 610, Protecting Medicare and American Farmers from Sequester Cuts Act H.R. 315, Medicare Sequester COVID Moratorium Act S. 748, Medicare Sequester Relief Act H.R. 1868, To prevent across-the-board direct spending cuts, and for other purposes. Issue: Support extension of Medicare sequester moratorium. P.L. 117-328, Consolidated Appropriations Act, 2023 Issue: Support clearing the PAYGO scorecard to avoid another Medicare sequester due to the use of reconciliation to pass the American Rescue Plan Act. Issue: Oppose use of extended Medicare sequester and repurposing of unused Provider Relief Fund. P.L. 117-328, Consolidated Appropriations Act, 2023 Division FF H.R.8800, Supporting Medicare Providers Act of 2022 Issue: Support a 4.42% increase in the Medicare physician fee schedule that Congress provided in the Consolidated Appropriations Act, 2021 to avoid payment cuts due to budget neutrality requirements. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support making permanent the interim final rule that allows hospitals that unknowingly trigger their Medicare GME caps and per resident amounts to not have that happen and instead retain the ability to build a new resident cap / PRA so long as the cap / PRA is not above a minimum amount. Issue: Oppose aspects of CMS hospital price transparency rule. Issue: Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Oppose finalizing proposed rule for Medicare Coverage of Innovative Technology (MCIT) and definition of reasonable and necessary. Issue: Oppose enforcement of linking Medicare Conditions of Participation (CoP) compliance with requiring that hospitals report 38 COVID-19 related measures. Issue: Support continuation of the 3-Day Skilled Nursing Facility (SNF) Stay waiver after the conclusion of the COVID-19 public health emergency. Issue: Oppose policy of incorporating revenue distinctions into the Medicare Shared Savings Program. P.L. 117-328, Consolidated Appropriations Act, 2023 Division FF Issue: Support permanent extension of Medicare telehealth waivers, including removing patient location restrictions and rural site requirements, allowing payment for audio-only services, and reimbursing providers for telehealth services as services delivered in-person. Support 2 year or permanent extension of the waivers. P.L. 117-328, Consolidated Appropriations Act, 2023 Division FF H.R. 7053 / S. 3792, Hospital Inpatient Services Modernization Act Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support permanent extension of current Covid telehealth flexibilities HR 1332, the Telehealth Modernization Act Issue: Support efforts to expand patient access to telehealth HR 1397, the Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP Issue: Support efforts to improve access to childrens mental health care H.R. 4040 Advancing Telehealth Beyond COVID-19 Act of 2021 Issue: Support extension of COVID-19 telehealth waivers for two years beyond the end of the COVID-19 public health emergency. H.R. 7961 - Safety from Violence for Healthcare Employees Act (SAVE Act)Issue: Support funding for hospital-based violence intervention programs and community violence interventions Issue: Support increased access to behavioral health and substance use disorder treatment services under Medicare and Medicaid. Support expanded Medicare reimbursement for integrated behavioral health Medicare payment codes. Support the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). S. 2061 Telemental Health Care Access Act Issue: Support policy to remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create IME payments for outpatient services while remaining budget neutral. Issue: Support efforts to reverse cuts in Medicare OPPS reimbursements to hospitals for drugs acquired under the 340B program. H.R. 4547, Value in Health Care Act Issue: Support changes to alternative payment models (APMs) to increase participation in value-based health programs and promote quality care and improved health outcomes. P.L. 117-328, Consolidated Appropriations Act, 2023 Issue: Support extension of alternative payment model (APM) bonus. H.R. 3746, Accountable Care in Rural America Act Issue: Support improving 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. H.R. 4970, Rural Medical Residency Expansion Act of 2021 Issue: Support providing funds for rural teaching hospitals to expand their residency programs. Issue: Support efforts to investigate nurse-staffing agencies conduct during the COVID-19 pandemic.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, White House Office

H.R. 8800, Supporting Medicare Providers Act of 2022, all provisions H.R. 3434, Territories Health Equity Act of 2021, all provisions H.R. 4406, Supporting Medicaid in the U.S. Territories Act of 2021, all provisions H.R. 1332, Telehealth Modernization Act, all provisions S. 368, Telehealth Modernization Act, all provisions H.R. 2903, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, all provisions S. 1512, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, all provisions H.R. 366, Protecting Access to Post-COVID-19 Telehealth Act of 2021, all provisions H.R. 7051, Access to Prescription Digital Therapeutics Act of 2022, provisions relating to COVID-19 flexibilities, and telemental health S. 3791, Access to Prescription Digital Therapeutics Act of 2022, provisions relating to COVID-19 flexibilities, and telemental health S. 610, Protecting Medicare and American Farmers from Sequester Cuts Act, all provisions H.R. 4040, Advancing Telehealth Beyond COVID-19 Act of 2022, all provisions H.R. 2654, Chiropractic Medicare Coverage Modernization Act of 2021, all provisions H.R. 7213, Equitable Community Access to Pharmacist Services Act, all provisions H.R. 6087, Improving Access to Workers Compensation for Injured Federal Workers Act of 2022, all provisions H.R. 5067, Preserving Patient Access to Home Infusion Act, provisions relating to scope of practice S. 2652, Preserving Patient Access to Home Infusion Act, provisions relating to scope of practice H.R. 8812, Improving Care and Access to Nurses (I CAN) Act, all provisions S. 5212, Improving Care and Access to Nurses (I CAN) Act, all provisions H.R. 9577, Increasing Mental Health Options Act of 2022, all provisions S. 5272, Increasing Mental Health Options Act of 2022, all provisions H.R. 3173, Improving Seniors Timely Access to Care Act of 2021, all provisions S. 3018, Improving Seniors Timely Access to Care Act of 2021, all provisions H.R. 8487, Improving Seniors' Timely Access to Care Act of 2022, all provisions H.R. 3259, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions S. 586, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions H.R. 1438, Opioid Workforce Act of 2021, all provisions S. 1438, Opioid Workforce Act of 2021, all provisions H.R. 3441, Substance Use Disorder Workforce Act, all provisions H.R. 3407, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, provisions relating to Medicaid and CHIP, and maternal and infant mortality S. 411, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, provisions relating to Medicaid and CHIP, and maternal and infant mortality H.R. 925, Data to Save Moms Act, all provisions H.R. 959, Black Maternal Health Momnibus Act of 2021, all provisions S. 346, Black Maternal Health Momnibus Act of 2021, all provisions H.R. 3746, Accountable Care in Rural America Act, all provisions H.R. 4587, Value in Health Care Act of 2021, all provisions H.R. 4755, Seniors Chronic Care Management Improvement Act of 2021, all provisions H.R. 6308, ACO Assignment Improvement Act of 2021, all provisions S. 5249, Preserving Patient Access to Value-Based Care Act, all provisions H.R. 8879, Inpatient Psychiatric Facility Improvement Act, all provisions H.R. 8878, To amend title XVIII of the Social Security Act to ensure adequate coverage of outpatient mental health services under the Medicare program, all provisions H.R. 432, Mental Health Access Improvement Act of 2021, all provisions H.R. 8910, Behavioral Health Integration Awareness Act of 2022, all provisions H.R. 8884, Medicare Opioid Use Disorder Outreach Act, all provisions H.R. 8890, Physician Wellness Program Act of 2022, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 19, Lower Costs, More Cures Act of 2021, all provisions H.R. 4058, Telemental Health Care Access Act of 2021, all provisions S. 2061, Telemental Health Care Access Act of 2021, all provisions S. 801, Connected Maternal Online Monitoring Act, all provisions H.R. 1738, Stabilize Medicaid and CHIP Coverage Act, all provisions H.R. 1025, Kids Access to Primary Care Act of 2021, all provisions H.R. 2256, Resident Physician Shortage Reduction Act of 2021, all provisions S. 834, Resident Physician Shortage Reduction Act of 2021, all provisions H.R. 7995, Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act of 2022, all provisions H.R. 955, Medicaid Reentry Act of 2021, all provisions S. 285, Medicaid Reentry Act of 2021, all provisions H.R. 4128, Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2021, all provisions S. 2209, Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2021, all provisions H.R. 6000, Cures 2.0 Act, all provisions H.R. 4043, Ensuring Patient Access to Critical Breakthrough Products Act of 2021, all provisions S. 2416, New Opportunities for Value that Extend Lives (NOVEL) Act of 2021, all provisions S. 2938, Bipartisan Safer Communities Act, all provisions H.R. 8594, Restore Protections for Dialysis Patients Act, all provisions S. 4750, Restore Protections for Dialysis Patients Act, all provisions H.R. 4014, Physician Shortage GME Cap Flex Act of 2021, all provisions S. 2094, Physician Shortage GME Cap Flex Act of 2021, all provisions H.R. 9378, Sunshine Act of 2022, all provisions H.R. 6576, Small Practice, Underserved, and Rural Support Program (SURS) Extension Act of 2022, all provisions Medicare program: Medicare and CHIP Reauthorization Act (MACRA) broad reform Medicare program: MACRA implementation Medicare program: MACRA burdens Medicare program: 21st Century Cures Act implementation Medicare program: Enhancing the Mental Health Workforce Medicare program: Improvement to Medicare Inpatient Psychiatric Facility Improvement Act Medicare program: Medicare program improvement/Physician Services and Education Medicare program: Accountable Care Organizations Medicare program: Medicare Economic Index (MEI)/inflation updates Medicare program: 2% Medicare sequester moratorium Medicare program: 4.5% payment rates reduction Medicare program: Medicare Physician Fee Schedule Conversion Factor/3% increase extension Medicare program: Global and Professional Direct Contracting alternative payment model/REACH ACOs Medicare program: Medicare physician payment Medicare program: Merit-based Incentive Payment Program (MIPS) improvement Medicare program: Alternative Payment Models (APMs) Medicare program: Medicare Physician Payment Reform/primary care/specialties Medicare program: Provider Enrollment, Chain, and Ownership System (PECOS)/Revalidation Medicare program: Recovery plan for Americas Physicians Medicare program: Physician-Owned Hospitals/Medicare Moratorium Medicare program: Health IT burdens Medicare program: EHR certification Medicare program: Provider Compliance/Regulatory Relief Medicare program: Quality Payment Program/physician burdens Medicare program: National provider directory Medicare program: Self-measured blood pressure (SMBP) devices/benefit category Medicare program: Information blocking Medicare program: Coding Medicare program: Skilled nursing facilities (SNF) Medicare and Medicaid programs: Cybersecurity Medicare and Medicaid programs: Puerto Rico/Medicaid caps/FMAP Medicaid program: Improving Access to Physical and Mental Health Care for Children and Youth Under Medicaid and CHIP Medicaid program: Ensuring Access to Telemental Health Services Medicaid program: Ensuring Access to Telemental Health Services Medicaid program: Enhancing the Mental Health Workforce Medicaid program: Improving Integration, Coordination, and Access to Care Medicaid program: Maternal mortality and morbidity/Equity

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, White House Office

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

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

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

H.R. 5487 - Value in Health Care Act of 2021 S. 2652 / H.R. 5067 - Preserving Patient Access to Home Infusion Act S.308 / H.R.1436 - PPE in America Act S.1260 - United States Innovation and Competition Act of 2021 S. 936 / H.R. 5502 - INFORM Consumers Act S. 2648 - Rural ACO Improvement Act S. 1574 / H.R.5632 - Long-Term Care Pharmacy Definition Act S. 834 / H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R.3173 / S 3018 - Improving Seniors Timely Access to Care Act of 2021 H.R. 3746 - Accountable Care in Rural America Act H.R. 959 / S. 364 - Black Maternal Health Momnibus Act of 2021 H.R. 4387 / S. 1675 - Maternal Health Quality Improvement Act of 2021 S. 168 / H.R. 708 - Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act S. 150 - Ensuring Parity in MA for Audio Only-Telehealth Act S. 3146 - The Protecting Patients from Counterfeit Medical Devices Act S. 3799 - The PREVENT Pandemics Act H.R. 6520 - The Medical and Health Stockpile Accountability Act of 2022, automated data collection infrastructure for healthcare supply chain S. 3416 - The Protecting Patients from Counterfeit Medical Devices Act S. 3493 - Drug Shortages Shelf Life Extension Act H.R. 4521 - America COMPETES Act of 2022 S.610 - Protecting Medicare and American Farmers from Sequester Cuts Act H.R.3684 - Infrastructure Investment and Jobs Act H.R. 4735 / S. 2493 - The Provider Relief Extension Act H.R. 3589 - Better Way for Providers To Repay Act of 2021 H.R. 3203 / S. 773 - To allow hospitals that were participating in or applied for the 340B drug discount program before the public health emergency to temporarily maintain eligibility H.R. 7961 - Safety from Violence for Healthcare Employees (SAVE) Act H.R. 7410 - The American Made Medicine Act H.R. 7053/S. 3792 - Hospital Inpatient Services Modernization Act H.R. 8747 - Assistance for Rural Community Hospitals (ARCH) Act H.R. 8800 - Supporting Medicare Providers Act of 2022 H.R. 4040 - Advancing Telehealth Beyond COVID-19 Act FY 2022 Omnibus Appropriations Bill S. 5249 - Preserving Patient Access to Value-Based Care Act 340B Drug Discount Program eligbility Incentivize Domestic Manufacturing Hospital Infrastructure Support FDA User Fee Reauthorization Bills Healthcare workforce (Graduate medical education , health professional training programs, recruitment and retension incentives) Medicare provider payment cuts (Medicare sequestration cuts, physician fee schedule 3.75% reduction due to evaluation & management code increases/budget neturality adjustment, Pay-as-You-Go reductions due to American Rescue Plan) Climate change healthcare impact HHS FY 2023 appropriations - Removal of a ban on using federal funds for implementing a unique patient identification system (Section 510) and fuding for Childrens Hospitals Graduate Medical Education (CHGME) Program ACO Assignment Bill NQF/Quality Measurement funding authorization Preparing for the next pandemic and supply chain resiliency

Client expense: $240,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Value in Healthcare Act HR.4587 Accountable Care in Rural America Act H.R.3746 ACO Assignment Improvement Act of 2021 H.R.6308 Promoting Health Care Quality Act of 2022 H.R.8201 Legislation related to drug prices, telehealth, and accountable care

Client expense: $120,000 · 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. 315,Medicare Sequester COVID Moratorium Act, a bill to amend the Coronavirus Aid, Relief, and Economic Security Act to extend the temporary suspension of Medicare sequestration; Support H.R. 1332 and S.368,Telehealth Modernization Act, a bill to amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency; Discussion with the Center for Medicare and Medicaid Innovation (CMMI) about the Radiation Oncology Alternative Payment Model; Support H.R. 1868, a bill that, among other health care provisions, would eliminate the 2% across-the-board cut to all Medicare payments, known as sequestration, until the end of 2021; Support H.R. 2455, The Resetting the Impact Act (TRIA), a bill to amend the IMPACT Act of 2014 to reset data collection and the development of a payment system technical prototype for post-acute care providers under the Medicare program to take into account the effects of COVID-19; Support H.R. 3173/ S.3018, Improving Seniors Timely Access to Care Act of 2021, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, and for other purposes; Support H.R. 1887/ S. 4009, Rural Hospital Support Act, a bill to make permanent the Medicare Dependent Hospital (MDH) and Low-volume Adjustment programs and rebases the MDH and Sole Community Hospital programs; Support relief for Medicare advanced payments; Discussion with CMMI about the priorities for alternative payment models; Support HR 4587, Value in Health Care Act of 2021, a bill to direct the Secretary of Health and Human Services to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage participation in such program, and for other purposes; Support HR 3746, Accountable Care in Rural America Act, a bill to amend title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program; Support H.R. 5425/ S. 1988, Protecting Rural Telehealth Access Act, a bill to amend title XVIII of the Social Security Act to protect access to telehealth services under the Medicare program; Letter asking Congress to address two important issues by the end of the year: an extension of the moratorium on Medicare sequester cuts, as well as preventing the Statutory Pay-As-You-Go (PAYGO) sequester from taking effect; Letter urging Congress to remove the reductions to the Medicaid disproportionate share hospital (DSH) program and uncompensated care pools from the Build Back Better Act; Support H.R. 5674/ S. 3061Medicare Mental Health Inpatient Equity Act of 2021, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Letter to the HHS secretary asking for PHE extension and urging HHS to extend the declaration for at least 90 days; Letter to the HHS secretary asking to renew the COVID-19 PHE; Letter to CMS urging changes to MA prior authorization requirements for PHE; Letter expressing our disappointment that Congress is adjourning for April recess without addressing the needs of hospitals and health systems and urging Congress to act to ensure health care providers have the critical relief, including but not limited to extending the Medicare sequester relief, adding more PRF dollars, and providing flexibility in the repayment terms for Medicare accelerated and advance repayments; Provide comments in response to the (CMS) request for information regarding access to coverage and care in the Medicaid and Childrens Health Insurance Program (CHIP) programs. The critical components for a comprehensive access and coverage strategy for Medicaid and CHIP should include: Robust outreach and enrollment efforts to secure and maintain coverage for eligible individuals and families, as well as ensure beneficiary knowledge of how to use this coverage, Standards to ensure timely and equitable access to quality care, and Provider payments that are sufficient to enable beneficiaries' access to quality care; Provide comments in response to the Department of Homeland Securitys (DHS) proposed rule to codify standards and clarify policies that govern public charge determinations. Public charge determinations assess how likely it is that an individual will become dependent on government assistance (public benefits) for support and subsistence. These policy clarifications are intended to help immigrants and their family members better understand when the use of certain public benefits could impact their future immigration status and address the chilling effects of the now-repealed 2019 public charge final rule. The AHA supports DHSs efforts to clarify policies regarding how public charge determinations are made to help reverse the damaging effects of the repealed 2019 public charge rule; A bill to amend title XIX of the Social Security Act to expand the availability of mental, emotional, and behavioral health services under the Medicaid program; Letter urging Congress to halt further cuts to hospital payments. Need to stop a harmful Medicare payment cut to providers that will go into effect July 1 without congressional action. Specifically, a 1% Medicare sequester cut took effect April 1, and that cut will increase to 2% on July 1 if Congress does not act. This will result in billions of dollars being cut from hospitals and health systems by the end of the year; Submitted comment letter regarding Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2023 and Updates to the IRF Quality Reporting Program. We note that the proposed IRF PPS labor-related share would only modestly shift upward from 72.9% in FY 2022 to 73.2% in FY 2022. AHA is concerned that these changes neither align regarding massive cost growth in recent months and years; Provide Comments on the Medicare Program - Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities and Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023 which stated the Proposed FY 2023 Payment Update warrants closer examination and we urge CMS to discuss in the final rule how the agency will account for these increased costs. The timing of this proposed net decrease in payments could not be worse, given the well-documented impact of the COVID-19 public emergency (PHE) on the SNF and nursing home field; Letter sent to the bipartisan, bicameral Leadership of the House and Senate, urging Congress to act to prevent further Medicare sequester cuts scheduled to take effect on July 1; Submitted comment letter about inpatient and long-term care hospital prospective payment system proposed rule for fiscal year 2023. Concerned that CMS is proposing policies and payment adjustment that do not take into account the current the COVID-19 public health emergency (PHE) and its atypical market forces and pandemic-driven aberrations affecting the utilization and cost of providing LTCH services. Specifically, we are concerned by proposals for an inadequate market basket update and an untenable spike in the high-cost outlier threshold; Letter urges Congress to call on CMS to make changes to the hospital inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2023 in order to ensure that Medicare payments for acute care services more accurately reflect the cost of providing hospital care to patients and communities; Support the bipartisan Dear Colleague letters that ask CMS to make critical changes to the hospital inpatient prospective payment system proposed rule for fiscal year (FY) 2023 to more accurately reflect the cost of providing hospital care to patients; Support HR 8487/ S 3173 Improving Seniors Timely Access to Care Act of 2022, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans; Support HR 8747 Assistance for Rural Community Hospitals Act of 2022 or the ARCH Act of 2022, a bill to amend title XVIII of the Social Security Act to extend Medicare-dependent hospital and Medicare low-volume hospital payments; Oppose HR 1330/ S 4130 Patient Access to Higher Quality Health Care Act of 2022, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 8188/ S4449 Saving Access to Laboratory Services Act, a bill to amend title XVIII of the Social Security Act to improve the accuracy of market-based Medicare payment for clinical diagnostic laboratory services, to reduce administrative burdens in the collection of data, and for other purposes.

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

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

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

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

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

H.R. 1332, Telehealth Modernization Act, all provisions S. 368, Telehealth Modernization Act, all provisions H.R. 3259, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions S. 586, NOPAIN Act, all provisions H.R. 2903, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, all provisions S. 1512, CONNECT for Health Act of 2021, all provisions H.R. 2256, Resident Physician Shortage Reduction Act of 2021, all provisions S. 834, Resident Physician Shortage Reduction Act of 2021, all provisions H.R. 7995, Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act of 2022, all provisions H.R. 3407, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions S. 411, MOMMAs Act, all provisions H.R. 3173, Improving Seniors Timely Access to Care Act of 2021, all provisions S. 3018, Improving Seniors Timely Access to Care Act of 2021, all provisions H.R. 8487, Improving Seniors Timely Access to Care Act of 2022, all provisions H.R. 4058, Telemental Health Care Access Act of 2021, all provisions S. 2061, Telemental Health Care Access Act of 2021, all provisions H.R. 3441, Substance Use Disorder Workforce Act, all provisions S. 1438, Substance Use Disorder Workforce Act, all provisions H.R. 955, Medicaid Reentry Act of 2021, all provisions S. 285, Medicaid Reentry Act of 2021, all provisions H.R. 2654, Chiropractic Medicare Coverage Modernization Act of 2021, provisions related to scope of practice H.R. 6020, Supporting Medicare Providers Act of 2021, all provisions S. 3314, Supporting Medicare Providers Act of 2021, all provisions H.R. 4587, Value in Health Care Act of 2021, all provisions S. 2938, Bipartisan Safer Communities Act, all provisions H.R. 8800, Supporting Medicare Providers Act of 2022, all provisions H.R. 4040, Advancing Telehealth Beyond COVID-19 Act of 2022, all provisions H.R. 8850, Fair Access In Residency (FAIR) Act, all provisions S. 2173, Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies (PREVENT DIABETES) Act, all provisions S. 4873, Improving Access to Advance Care Planning Act, all provisions H.R. 4014, Physician Shortage GME Cap Flex Act of 2021, all provisions S. 2094, Physician Shortage GME Cap Flex Act of 2021, all provisions H.R. 7213, Equitable Community Access to Pharmacist Services Act, all provisions H.R. 8594, Restore Protections for Dialysis Patients Act, all provisions S. 4750, Restore Protections for Dialysis Patients Act, all provisions H.R. 8188, Saving Access to Laboratory Services Act (SALSA), all provisions S. 4449, SALSA Act, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 19, Lower Costs, More Cures Act of 2021, all provisions H.R. 1868, To prevent across-the-board direct spending cuts, and for other purposes, all provisions H.R. 315, Medicare Sequester COVID Moratorium Act, all provisions S. 610, Protecting Medicare and American Farmers from Sequester Cuts Act, all provisions H.R. 6048, Medicare Stability for Patients and Providers Act, all provisions H.R. 3434, Territories Health Equity Act of 2021, all provisions H.R. 4406, Supporting Medicaid in the U.S. Territories Act of 2021, all provisions S. 801, Connected Maternal Online Monitoring Act, all provisions S. 346, Black Maternal Health Momnibus Act of 2021, all provisions H.R. 1738, Stabilize Medicaid and CHIP Coverage Act, all provisions H.R. 1025, Kids Access to Primary Care Act of 2021, all provisions H.R. 66, Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act, all provisions S. 748, Medicare Sequester Relief Act, all provisions H.R. 6000, Cures 2.0 Act, all provisions H.R. 4043, Ensuring Patient Access to Critical Breakthrough Products Act of 2021, all provisions S. 2416, New Opportunities for Value that Extend Lives (NOVEL) Act of 2021, all provisions H.R. 7666, Restoring Hope for Mental Health and Well-Being Act of 2022, all provisions H.R. 3746, Accountable Care in Rural America Act, all provisions H.R. 4755, Seniors Chronic Care Management Improvement Act of 2021, all provisions H.R. 6308, ACO Assignment Improvement Act of 2021, all provisions H.R. 366, Protecting Access to Post-COVID-19 Telehealth Act of 2021, all provisions H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021, all provisions H.R. 2228, Rural Behavioral Health Access Act of 2021, all provisions H.R. 3447, Permanency for Audio-Only Telehealth Act, all provisions H.R. 7051, Access to Prescription Digital Therapeutics Act of 2022, all provisions S. 3791, Access to Prescription Digital Therapeutics Act of 2022, all provisions H.R. 7573, Telehealth Extension and Evaluation Act, all provisions S. 3593, Telehealth Extension and Evaluation Act, all provisions H.R. 7878, Kidney Health Connect Act of 2022, all provisions S. 4307, Kidney Health Connect Act of 2022, all provisions H.R. 6202, Telehealth Extension Act of 2021, all provisions H.R. 7053, Hospital Inpatient Services Modernization Act, all provisions S. 3792, Hospital Inpatient Services Modernization Act, all provisions H.R. 7116, 9-8-8 Implementation Act of 2022, all provisions H.R. 8879, Inpatient Psychiatric Facility Improvement Act, all provisions H.R. 8878, To amend title XVIII of the Social Security Act to ensure adequate coverage of outpatient mental health services under the Medicare program, all provisions H.R. 432, Mental Health Access Improvement Act of 2021, all provisions H.R. 8910, Behavioral Health Integration Awareness Act of 2022, all provisions H.R. 8884, To direct the Secretary of Health and Human Services to provide outreach and reporting on opioid use disorder treatment services furnished by opioid treatment programs under the Medicare program, all provisions S. 987, CARA 3.0 Act of 2021, all provisions H.R. 925, Data to Save Moms Act, all provisions H.R. 7475, Mamas First Act, all provisions H.R. 5067, Preserving Patient Access to Home Infusion Act, all provisions S. 2652, Preserving Patient Access to Home Infusion Act, all provisions H.R. 8812, To amend titles XVIII and XIX of the Social Security Act and the Bipartisan Budget Act of 2018 to increase access to services provided by advanced practice registered nurses under the Medicare and Medicaid programs, and for other purposes, provisions related to scope of practice Medicare program: 21st Century Cures Act/implementation Medicare program: EHR Certification Medicare program: Medicare and CHIP Reauthorization Act (MACRA) Reform Medicare program: MACRA implementation Medicare program: Laboratory testing/Diagnostics/PAMA Medicare program: Merit-based Incentive Payment System (MIPS) quality/cost/improvement activities/promoting interoperability Medicare program: Merit-based Value Pathway Medicare program: Physician Fee Schedule (PFS) inflation updates/budget neutrality rules Medicare program: 2023 Medicare Physician Fee Schedule/4.5% cut Medicare program: Accountable specialty care/payments Medicare program: Alternative Payment Models/incentive payments Medicare program: Telehealth/COVID flexibilities Medicare program: Health IT burdens Medicare program: Self-measured blood pressure devices/benefit category Medicare program: Coding Medicare program: Primary Care First models Medicare program: Appropriate Use Criteria Medicare program: Opioids Medicare program: Medicare Shared Savings Program (MSSP) Medicare program: Dental benefits Medicaid program: Uninsured and healthcare coverage/COVID-19 Medicare program: Provider Enrollment, Chain, and Ownership System (PECOS)/revalidation Medicare program: Open Payments Medicaid program: Special Enrollment Period Medicaid program: Sickle Cell Disease Medicaid program: Improving Access to Physical and Mental Health Care for Children and Youth Under Medicaid and CHIP/draft Medicare program: Provider compliance and regulatory relief Medicare program: Medicare Administrative Contractors (MACs)/Downcoding Medicare and Medicaid programs: Health Equity Medicare and Medicaid programs: Modifier 25, Impossible Day Medicare and Medicaid programs: Connected health technologies Medicare and Medicaid programs: Diabetes

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

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

Issue: Support policies to close the Medicaid coverage gap, including through ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. Issue: Support programs and funds for safety-net providers. Educate Congress about the impact of Section 203 of the Consolidated Appropriations Act, 2021 and its changes to the Medicaid DSH cap calculation methodology on academic medical centers. Support legislative efforts to address concerns. H.R. 2256 / S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: Support increased Medicare funding for graduate medical education S. 1438 Opioid Workforce Act H.R. 3441 Substance Use Disorder Workforce Act Issue: Support targeted Medicare funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs S.1893 / H.R. 8508, Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals Issue: Provide feedback to CMS on its proposed distribution of the 1,000 new GME slots authorized be the Consolidated Appropriations Act, 2021 as described in the 2022 Inpatient Prospective Payment System (IPPS) proposed rule. Support CMS adopting alternative 2 with modifications to allow for more than 1.0 FTE per hospital. Issue: Support Medicare Graduate Medical Education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts. H.R. 8850 Fair Access In Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. Issue: Oppose overly burdensome Medicaid GME transparency language. Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives H.R.3173 / S.3018, Improving Seniors Timely Access to Care Act Issue: Protecting patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs. Draft Medicare Part D benefit re-design legislation Issue: Support policies to reduce prescription drug prices Issue: Support implementation of the 21st Century Cures Act (Cures) interoperability and health data sharing provisions. Issue: Support changes and improvements to the Medicare Shared Savings Program. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Issue: Support expansion of Medicaid and CHIP coverage for postpartum women. S. 610 Protecting Medicare and American Farmers from Sequester Cuts Act H.R. 315 Medicare Sequester COVID Moratorium Act S. 748 Medicare Sequester Relief Act H.R. 1868 To prevent across-the-board direct spending cuts, and for other purposes. Issue: Support extension of Medicare sequester moratorium. Issue: Support clearing the PAYGO scorecard to avoid another Medicare sequester due to the use of reconciliation to pass the American Rescue Plan Act. Issue: Oppose use of extended Medicare sequester and repurposing of unused Provider Relief Fund. H.R.8800 - Supporting Medicare Providers Act of 2022 Issue: Support a 4.42% increase in the Medicare physician fee schedule that Congress provided in the Consolidated Appropriations Act, 2021 to avoid payment cuts due to budget neutrality requirements. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support making permanent the interim final rule that allows hospitals that unknowingly trigger their Medicare GME caps and per resident amounts to not have that happen and instead retain the ability to build a new resident cap / PRA so long as the cap / PRA is not above a minimum amount. Issue: Oppose aspects of CMS hospital price transparency rule. Issue: Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Oppose finalizing proposed rule for Medicare Coverage of Innovative Technology (MCIT) and definition of reasonable and necessary. Issue: Oppose enforcement of linking Medicare Conditions of Participation (CoP) compliance with requiring that hospitals report 38 COVID-19 related measures. Issue: Support continuation of the 3-Day Skilled Nursing Facility (SNF) Stay waiver after the conclusion of the COVID-19 public health emergency. Issue: Oppose policy of incorporating revenue distinctions into the Medicare Shared Savings Program. Issue: Support permanent extension of Medicare telehealth waivers, including removing patient location restrictions and rural site requirements, allowing payment for audio-only services, and reimbursing providers for telehealth services as services delivered in-person. Support 2 year or permanent extension of the waivers. H.R. 7053 / S. 3792, Hospital Inpatient Services Modernization Act Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support permanent extension of current Covid telehealth flexibilities HR 1332, the Telehealth Modernization Act Issue: Support efforts to expand patient access to telehealth HR 1397, the Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP Issue: Support efforts to improve access to childrens mental health care H.R. 4040 Advancing Telehealth Beyond COVID-19 Act of 2021 Issue: Support extension of COVID-19 telehealth waivers for two years beyond the end of the COVID-19 public health emergency. Issue: Support funding for hospital-based violence intervention programs and community violence interventions S. 2061 Telemental Health Care Access Act Issue: Support policy to remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services H.R. 3173/Sr. 3018 Improving Seniors Timely Access to Care Act of 2022 Issue: Support policy that would implement an electronic prior authorization program in Medicare Advantage that would simplify processes and save time for both providers and patients. Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create IME payments for outpatient services while remaining budget neutral. Issue: Support efforts to reverse cuts in Medicare OPPS reimbursements to hospitals for drugs acquired under the 340B program. Draft Value in Health Care Act Issue: Support changes to alternative payment models (APMs) to increase participation in value-based health programs and promote quality care and improved health outcomes. H.R. 3746 Accountable Care in Rural America Act Issue: Support improving 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. H.R. 4970 Rural Medical Residency Expansion Act of 2021 Issue: Support providing funds for rural teaching hospitals to expand their residency programs. Issue: Support efforts to investigate nurse-staffing agencies conduct during the COVID-19 pandemic.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, White House Office

H.R. 5487 - Value in Health Care Act of 2021 S. 2652/H.R. 5067 - Preserving Patient Access to Home Infusion Act H.R. 6520 - The Medical and Health Stockpile Accountability Act of 2022, automated data collection infrastructure for healthcare supply chain S.308 / H.R.1436 - PPE in America Act S.1260 - United States Innovation and Competition Act of 2021 S. 936 / H.R. 5502 - INFORM Consumers Act S. 2648 - Rural ACO Improvement Act S. 1574/H.R.5632 - Long-Term Care Pharmacy Definition Act H.R. 7053/S. 3792 - Hospital Inpatient Services Modernization Act S. 834 / H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R.3173 / S 3018 - Improving Seniors Timely Access to Care Act of 2021 H.R. 3746 - Accountable Care in Rural America Act H.R. 959 / S. 364 - Black Maternal Health Momnibus Act of 2021 H.R. 4387 / S. 1675 - Maternal Health Quality Improvement Act of 2021 S. 168 / H.R. 708 - Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act S. 150 - Ensuring Parity in MA for Audio Only-Telehealth Act S. 3799 - The PREVENT Pandemics Act S. 3416 - The Protecting Patients from Counterfeit Medical Devices Act S. 3493 - Drug Shortages Shelf Life Extension Act H.R. 4521 - America COMPETES Act of 2022 S.610 - Protecting Medicare and American Farmers from Sequester Cuts Act H.R.3684 - Infrastructure Investment and Jobs Act H.R. 4735/S. 2493 - The Provider Relief Extension Act H.R. 3589 - Better Way for Providers To Repay Act of 2021 H.R. 3203 / S. 773 - To allow hospitals that were participating in or applied for the 340B drug discount program before the public health emergency to temporarily maintain eligibility H.R. 7961 - Safety from Violence for Healthcare Employees (SAVE) Act H.R. 7410 - The American Made Medicine Act Hospital Infrastructure Support FDA User Fee Reauthorization Bills Healthcare workforce (Graduate medical education , health professional training programs, recruitment and retention incentives) Medicare provider payment cuts (Medicare sequestration cuts, physician fee schedule 3% reduction due to evaluation & management code increases/budget neutrality adjustment, Pay-as-You-Go reductions due to American Rescue Plan) HHS FY 2023 appropriations - Removal of a ban on using federal funds for implementing a unique patient identification system (Section 510) and funding for Childrens Hospitals Graduate Medical Education (CHGME) Program NQF/Quality Measurement funding authorization

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Value in Healthcare Act HR.4587 Accountable Care in Rural America Act H.R.3746 ACO Assignment Improvement Act of 2021 H.R.6308 Promoting Health Care Quality Act of 2022 H.R.8201 Legislation related to drug prices, telehealth, and accountable care

Client expense: $35,000 · 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. 315,Medicare Sequester COVID Moratorium Act, a bill to amend the Coronavirus Aid, Relief, and Economic Security Act to extend the temporary suspension of Medicare sequestration; Support H.R. 1332 and S.368,Telehealth Modernization Act, a bill to amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency; Discussion with the Center for Medicare and Medicaid Innovation (CMMI) about the Radiation Oncology Alternative Payment Model; Support H.R. 1868, a bill that, among other health care provisions, would eliminate the 2% across-the-board cut to all Medicare payments, known as sequestration, until the end of 2021; Support H.R. 2455, The Resetting the Impact Act (TRIA), a bill to amend the IMPACT Act of 2014 to reset data collection and the development of a payment system technical prototype for post-acute care providers under the Medicare program to take into account the effects of COVID-19; Support H.R. 3173/ S.3018, Improving Seniors Timely Access to Care Act of 2021, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, and for other purposes; Support H.R. 1887/ S. 4009, Rural Hospital Support Act, a bill to make permanent the Medicare Dependent Hospital (MDH) and Low-volume Adjustment programs and rebases the MDH and Sole Community Hospital programs; Support relief for Medicare advanced payments; Discussion with CMMI about the priorities for alternative payment models; Support HR 4587, Value in Health Care Act of 2021, a bill to direct the Secretary of Health and Human Services to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage participation in such program, and for other purposes; Support HR 3746, Accountable Care in Rural America Act, a bill to amend title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program; Support H.R. 5425/ S. 1988, Protecting Rural Telehealth Access Act, a bill to amend title XVIII of the Social Security Act to protect access to telehealth services under the Medicare program; Letter asking Congress to address two important issues by the end of the year: an extension of the moratorium on Medicare sequester cuts, as well as preventing the Statutory Pay-As-You-Go (PAYGO) sequester from taking effect; Letter urging Congress to remove the reductions to the Medicaid disproportionate share hospital (DSH) program and uncompensated care pools from the Build Back Better Act; Support H.R. 5674/ S. 3061Medicare Mental Health Inpatient Equity Act of 2021, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Letter to the HHS secretary asking for PHE extension and urging HHS to extend the declaration for at least 90 days; Letter to the HHS secretary asking to renew the COVID-19 PHE; Letter to CMS urging changes to MA prior authorization requirements for PHE; Letter expressing our disappointment that Congress is adjourning for April recess without addressing the needs of hospitals and health systems and urging Congress to act to ensure health care providers have the critical relief, including but not limited to extending the Medicare sequester relief, adding more PRF dollars, and providing flexibility in the repayment terms for Medicare accelerated and advance repayments; Provide comments in response to the (CMS) request for information regarding access to coverage and care in the Medicaid and Childrens Health Insurance Program (CHIP) programs. The critical components for a comprehensive access and coverage strategy for Medicaid and CHIP should include: Robust outreach and enrollment efforts to secure and maintain coverage for eligible individuals and families, as well as ensure beneficiary knowledge of how to use this coverage, Standards to ensure timely and equitable access to quality care, and Provider payments that are sufficient to enable beneficiaries' access to quality care; Provide comments in response to the Department of Homeland Securitys (DHS) proposed rule to codify standards and clarify policies that govern public charge determinations. Public charge determinations assess how likely it is that an individual will become dependent on government assistance (public benefits) for support and subsistence. These policy clarifications are intended to help immigrants and their family members better understand when the use of certain public benefits could impact their future immigration status and address the chilling effects of the now-repealed 2019 public charge final rule. The AHA supports DHSs efforts to clarify policies regarding how public charge determinations are made to help reverse the damaging effects of the repealed 2019 public charge rule; A bill to amend title XIX of the Social Security Act to expand the availability of mental, emotional, and behavioral health services under the Medicaid program; Letter urging Congress to halt further cuts to hospital payments. Need to stop a harmful Medicare payment cut to providers that will go into effect July 1 without congressional action. Specifically, a 1% Medicare sequester cut took effect April 1, and that cut will increase to 2% on July 1 if Congress does not act. This will result in billions of dollars being cut from hospitals and health systems by the end of the year; Submitted comment letter regarding Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2023 and Updates to the IRF Quality Reporting Program. We note that the proposed IRF PPS labor-related share would only modestly shift upward from 72.9% in FY 2022 to 73.2% in FY 2022. AHA is concerned that these changes neither align regarding massive cost growth in recent months and years; Provide Comments on the Medicare Program - Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities and Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023 which stated the Proposed FY 2023 Payment Update warrants closer examination and we urge CMS to discuss in the final rule how the agency will account for these increased costs. The timing of this proposed net decrease in payments could not be worse, given the well-documented impact of the COVID-19 public emergency (PHE) on the SNF and nursing home field; Letter sent to the bipartisan, bicameral Leadership of the House and Senate, urging Congress to act to prevent further Medicare sequester cuts scheduled to take effect on July 1; Submitted comment letter about inpatient and long-term care hospital prospective payment system proposed rule for fiscal year 2023. Concerned that CMS is proposing policies and payment adjustment that do not take into account the current the COVID-19 public health emergency (PHE) and its atypical market forces and pandemic-driven aberrations affecting the utilization and cost of providing LTCH services. Specifically, we are concerned by proposals for an inadequate market basket update and an untenable spike in the high-cost outlier threshold; Letter urges Congress to call on CMS to make changes to the hospital inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2023 in order to ensure that Medicare payments for acute care services more accurately reflect the cost of providing hospital care to patients and communities.

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

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

Issue: Support policies to close the Medicaid coverage gap, including through ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. Issue: Support programs and funds for safety-net providers. Educate Congress about the impact of Section 203 of the Consolidated Appropriations Act, 2021 and its changes to the Medicaid DSH cap calculation methodology on academic medical centers. Support legislative efforts to address concerns. H.R. 2256 / S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: Support increased Medicare funding for graduate medical education S. 1438 Opioid Workforce Act H.R. 3441 Substance Use Disorder Workforce Act Issue: Support targeted Medicare funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs S.1893, Draft House bill Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals H.R. 5376, Build Back Better Act Issue: Support additional Medicare funding for graduate medical education slots. Support efforts to increase physician workforce diversification through novel, targeted scholarship programs. Support protection of the 340B Drug Pricing Program in the budget reconciliation package. Support for 12-months continuous coverage for children on Medicaid and CHIP. Support extending the enhanced ACA marketplace subsidies and addressing the Medicaid coverage gap . Support extending life of Medicare Hospital Insurance Trust Fund. Issue: Provide feedback to CMS on its proposed distribution of the 1,000 new GME slots authorized be the Consolidated Appropriations Act, 2021 as described in the 2022 Inpatient Prospective Payment System (IPPS) proposed rule. Support CMS adopting alternative 2 with modifications to allow for more than 1.0 FTE per hospital. Issue: Support Medicare Graduate Medical Education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts . Issue: Oppose overly burdensome Medicaid GME transparency language. Issue: Oppose policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Educate Congress on Consolidated Appropriations Act, 2021 (CAA Sec. 203) changes to the Medicaid shortfall calculations and the potential impact on Medicaid DSH payments Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives H.R.3173 / S.3018, Improving Seniors Timely Access to Care Act Issue: Protecting patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs. Draft Medicare Part D benefit re-design legislation Issue: Support policies to reduce prescription drug prices Issue: Support implementation of the 21st Century Cures Act (Cures) interoperability and health data sharing provisions. Issue: Support changes and improvements to the Medicare Shared Savings Program. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Issue: Support expansion of Medicaid and CHIP coverage for postpartum women. S. 610 Protecting Medicare and American Farmers from Sequester Cuts Act H.R. 315 Medicare Sequester COVID Moratorium Act S. 748 Medicare Sequester Relief Act H.R. 1868 To prevent across-the-board direct spending cuts, and for other purposes. Issue: Support extension of Medicare sequester moratorium. Issue: Support clearing the PAYGO scorecard to avoid another Medicare sequester due to the use of reconciliation to pass the American Rescue Plan Act. Issue: Oppose use of extended Medicare sequester and repurposing of unused Provider Relief Fund. Issue: Support congressional extension of 3.75% temporary increase in the Medicare physician fee schedule that Congress provided in the Consolidated Appropriations Act, 2021 to avoid payment cuts due to budget neutrality requirements. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support making permanent the interim final rule that allows hospitals that unknowingly trigger their Medicare GME caps and per resident amounts to not have that happen and instead retain the ability to build a new resident cap / PRA so long as the cap / PRA is not above a minimum amount. Issue: Oppose aspects of CMS hospital price transparency rule. Issue: Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Oppose finalizing proposed rule for Medicare Coverage of Innovative Technology (MCIT) and definition of reasonable and necessary. Issue: Oppose enforcement of linking Medicare Conditions of Participation (CoP) compliance with requiring that hospitals report 38 COVID-19 related measures. Issue: Support continuation of the 3-Day Skilled Nursing Facility (SNF) Stay waiver after the conclusion of the COVID-19 public health emergency. Issue: Oppose policy of incorporating revenue distinctions into the Medicare Shared Savings Program. Issue: Support permanent extension of Medicare telehealth waivers, including removing patient location restrictions and rural site requirements, allowing payment for audio-only services, and reimbursing providers for telehealth services as services delivered in-person. Support 2 year or permanent extension of the waivers. H.R. 7053 / S. 3792, Hospital Inpatient Services Modernization Act Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support permanent extension of current Covid telehealth flexibilities HR 1332, the Telehealth Modernization Act Issue: Support efforts to expand patient access to telehealth HR 1397, the Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP Issue: Support efforts to improve access to childrens mental health care Issue: Support funding for hospital-based violence intervention programs and community violence interventions S. 2061 Telemental Health Care Access Act Issue: Support policy to remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create IME payments for outpatient services while remaining budget neutral. Issue: Support efforts to reverse cuts in Medicare OPPS reimbursements to hospitals for drugs acquired under the 340B program. Draft Value in Health Care Act Issue: Support changes to alternative payment models (APMs) to increase participation in value-based health programs and promote quality care and improved health outcomes. H.R. 3746 Accountable Care in Rural America Act Issue: Support improving 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. H.R. 4970 Rural Medical Residency Expansion Act of 2021 Issue: Support providing funds for rural teaching hospitals to expand their residency programs. Issue: Support efforts to investigate nurse-staffing agencies conduct during the COVID-19 pandemic.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, White House Office

H.R. 4014, Physician Shortage GME Cap Flex Act of 2021, provisions relating to Graduate Medical Education S. 2094, Physician Shortage GME Cap Flex Act of 2021, provisions relating to Graduate Medical Education H.R. 1332, Telehealth Modernization Act, all provisions S. 368, Telehealth Modernization Act, all provisions H.R. 4058, Telemental Health Care Access Act of 2021, all provisions S. 2061, Telemental Health Care Access Act of 2021, all provisions H.R. 3173, Improving Seniors Timely Access to Care Act of 2021, provisions relating to Prior Authorization and attachment standards S. 3018, Improving Seniors Timely Access to Care Act of 2021, provisions relating to Prior Authorization and attachment standards H.R. 7995, Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act of 2022, all provisions H.R. 3259, Non-Opioids Prevent Addiction In the Nation (NO PAIN) Act, all provisions S. 586, Non-Opioids Prevent Addiction In the Nation (NO PAIN) Act, all provisions H.R. 4587, Value in Health Care Act of 2021, all provisions H.R. 7213, Equitable Community Access to Pharmacist Services Act, all provisions S. 748, Medicare Sequester Relief Act, all provisions H.R. 2903, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions S. 1512, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions H.R. 2256, Resident Physician Shortage Reduction Act, all provisions S. 834, Resident Physician Shortage Reduction Act, all provisions H.R. 1218, Data Mapping to Save Moms Lives Act, all provisions S. 198, Data Mapping to Save Moms Lives Act, all provisions H.R. 3407, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions S. 411, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions H.R. 3441, Substance Use Disorder Workforce Act, all provisions S. 1438, Opioid Workforce Act of 2021, all provisions H.R. 955, Medicaid Reentry Act of 2021, all provisions S. 285, Medicaid Reentry Act of 2021, all provisions H.R. 2654, Chiropractic Medicare Coverage Modernization Act of 2021, all provisions H.R. 6020, Supporting Medicare Providers Act of 2021, all provisions S. 3314, Supporting Medicare Providers Act of 2021, all provisions H.R. 6311, Comprehensive Addiction Resources Emergency Act of 2021, all provisions S. 3418, Comprehensive Addiction Resources Emergency Act of 2021, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 19, Lower Costs, More Cures Act of 2021, all provisions S. 801, Connected Maternal Online Monitoring Act, all provisions H.R. 1738, Stabilize Medicaid and CHIP Coverage Act, all provisions H.R. 1025, Kids Access to Primary Care Act of 2021, all provisions H.R. 66, Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act, all provisions S. 610, Protecting Medicare and American Farmers from Sequester Cuts Act, all provisions H.R. 6000, Cures 2.0 Act, all provisions H.R. 4043, Ensuring Patient Access to Critical Breakthrough Products Act of 2021, all provisions S. 2416, New Opportunities for Value that Extend Lives (NOVEL) Act of 2021, all provisions H.R. 7666, Restoring Hope for Mental Health and Well-Being Act of 2022, all provisions H.R. 3746, Accountable Care in Rural America Act, all provisions H.R. 4755, Seniors Chronic Care Management Improvement Act of 2021, all provisions H.R. 6308, ACO Assignment Improvement Act of 2021, all provisions H.R. 1868, To prevent across-the-board direct spending cuts, and for other purposes, all provisions H.R. 315, Medicare Sequester COVID Moratorium Act, all provisions H.R. 6048, Medicare Stability for Patients and Providers Act, all provisions H.R. 3348, SOS: Sustaining Outpatient Services Act, all provisions H.R. 366, Protecting Access to Post-COVID-19 Telehealth Act of 2021, all provisions H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021, all provisions H.R. 2228, Rural Behavioral Health Access Act of 2021, all provisions H.R. 3447, Permanency for Audio-Only Telehealth Act, all provisions H.R. 7051, Access to Prescription Digital Therapeutics Act of 2022, all provisions S. 3791, Access to Prescription Digital Therapeutics Act of 2022, all provisions H.R. 7878, Kidney Health Connect Act of 2022, all provisions S. 4307, Kidney Health Connect Act of 2022, all provisions H.R. 6202, Telehealth Extension Act of 2021, all provisions S. 987, CARA 3.0 Act of 2021, all provisions H.R. 1438, Opioid Workforce Act of 2021, all provisions H.R. 925, Data to Save Moms Act, all provisions H.R. 7475, Mamas First Act, all provisions H.R. 3746, Accountable Care in Rural America Act, all provisions H.R. 4587, Value in Health Care Act of 2021, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 3614, Menstrual Equity For All Act of 2021, provisions related to menstrual products coverage in Medicaid Medicare program: Physician Payment and Delivery Reform Medicare program: Impending Medicare payment cuts Medicare program: Medicare Evaluation and Management/budget neutrality Medicare program: Statutory PAYGO/Sequester Relief Medicare program: Accountable Care Organizations/specialty care Medicare program: Alternative Payment Models Medicare program: AMA Recovery Plan for Americas Physicians/payment reform Medicare program: Global and Professional Direct Contracting alternative payment model/REACH ACOs Medicare program: Appropriate Use Criteria and Prior Authorization Medicare program: Medicare Advantage/prior authorization regulation Medicare program: Automatic blood pressure measurement devices/coverage Medicare program: Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) Medicare program: MIPS/Promoting Interoperability/Cost/Improvement Activities Medicare program: MIPS/data sharing/transparency Medicare program: MACRA physician burdens Medicare program: Quality Payment Program Medicare program: Health IT burden Medicare program: Public Health Emergency COVID-19 /Accelerated and Advance Payments Medicare program: Primary Care First models Medicare program: Medicare Shared Savings Program (MSSP) Medicare program: Modifier 25 Medicare program: Split/shared billing Medicare program: Interoperability/data blocking/HIPAA Medicare program: Coding Medicare program: Provider compliance/Regulatory relief Medicare program: Provider Enrollment, Chain, and Ownership System (PECOS) Enrollment/Revalidation Medicare program: Open Payments Medicare program: Prescription drug pricing/Pharmacy Benefits Managers Medicare program: Step Therapy Medicare and Medicaid programs: Medicare Access and Chip Reauthorization Act (MACRA)/implementation Medicare and Medicaid programs: MACRA Oversight Medicaid program: Improving Access to Physical and Mental Health Care for Children and Youth Under Medicaid and CHIP draft Medicare and Medicaid programs: Health Equity Medicaid program: Maternal Mortality Medicaid program: Uninsured and healthcare coverage/COVID-19 Medicaid program: Special Enrollment Period Medicaid program: Sickle Cell Disease

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

H.R. 5487 - Value in Health Care Act of 2021 S. 2652/H.R. 5067 - Preserving Patient Access to Home Infusion Act S.308 / H.R.1436 - PPE in America Act S.1260 - United States Innovation and Competition Act of 2021 S. 936 / H.R. 5502 - INFORM Consumers Act S. 2648 - Rural ACO Improvement Act S. 1574/H.R.5632 - Long-Term Care Pharmacy Definition Act S. 834 / H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R.3173 / S 3018 - Improving Seniors Timely Access to Care Act of 2021 H.R. 3746 - Accountable Care in Rural America Act H.R. 959 / S. 364 - Black Maternal Health Momnibus Act of 2021 H.R. 4387 / S. 1675 - Maternal Health Quality Improvement Act of 2021 S. 168 / H.R. 708 - Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act S. 150 - Ensuring Parity in MA for Audio Only-Telehealth Act S. 3146 - The Protecting Patients from Counterfeit Medical Devices Act S. 3799 - The PREVENT Pandemics Act H.R. 6520 - The Medical and Health Stockpile Accountability Act of 2022, automated data collection infrastructure for healthcare supply chain S. 3416 - The Protecting Patients from Counterfeit Medical Devices Act S. 3493 - Drug Shortages Shelf Life Extension Act H.R. 4521 - America COMPETES Act of 2022 S.610 - Protecting Medicare and American Farmers from Sequester Cuts Act H.R.3684 - Infrastructure Investment and Jobs Act H.R. 4735/S. 2493 - The Provider Relief Extension Act H.R. 3589 - Better Way for Providers To Repay Act of 2021 H.R. 3203 / S. 773 - To allow hospitals that were participating in or applied for the 340B drug discount program before the public health emergency to temporarily maintain eligibility HHS FY 2023 appropriations - Removal of a ban on using federal funds for implementing a unique patient identification system (Section 510) and funding for Childrens Hospitals Graduate Medical Education (CHGME) Program 340B Drug Discount Program eligibility Incentivize Domestic Manufacturing Hospital Infrastructure Support FDA User Fee Reauthorization Bills Healthcare workforce (Graduate medical education , health professional training programs, recruitment and retention incentives) Medicare provider payment cuts (Medicare sequestration cuts, physician fee schedule 3.75% reduction due to evaluation & management code increases/budget neutrality adjustment, Pay-as-You-Go reductions due to American Rescue Plan)

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

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

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

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

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

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

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

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

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

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

Issue: Support policies to close the Medicaid coverage gap, including through ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. H.R. 2256 / S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: Support increased Medicare funding for graduate medical education S. 1438 Opioid Workforce Act H.R. 3441 Substance Use Disorder Workforce Act Issue: Support targeted Medicare funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs S.1893, Draft House bill Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals H.R. 5376, Build Back Better Act Issue: Support additional Medicare funding for graduate medical education slots. Support efforts to increase physician workforce diversification through novel, targeted scholarship programs. Support protection of the 340B Drug Pricing Program in the budget reconciliation package. Support for 12-months continuous coverage for children on Medicaid and CHIP. Support extending the enhanced ACA market place subsidies and addressing the Medicaid coverage gap. Issue: Provide feedback to CMS on its proposed distribution of the 1,000 new GME slots authorized be the Consolidated Appropriations Act, 2021 as described in the 2022 Inpatient Prospective Payment System (IPPS) proposed rule. Support CMS adopting alternative 2 with modifications to allow for more than 1.0 FTE per hospital. Issue: Support Medicare Graduate Medical Education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts. Issue: Oppose overly burdensome Medicaid GME transparency language. Issue: Oppose policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Educate Congress on Consolidated Appropriations Act, 2021 (CAA Sec. 203) changes to the Medicaid shortfall calculations and the potential impact on Medicaid DSH payments Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives H.R.3173 / S.3018, Improving Seniors Timely Access to Care Act Issue: Protecting patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs. Medicare Part D benefit re-design Issue: Support policies to reduce prescription drug prices Issue: Support implementation of the 21st Century Cures Act (Cures) interoperability and health data sharing provisions. Issue: Support changes and improvements to the Medicare Shared Savings Program. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Issue: Support expansion of Medicaid and CHIP coverage for postpartum women. S. 610 Protecting Medicare and American Farmers from Sequester Cuts Act H.R. 315 Medicare Sequester COVID Moratorium Act S. 748 Medicare Sequester Relief Act H.R. 1868 To prevent across-the-board direct spending cuts, and for other purposes. Issue: Support extension of Medicare sequester moratorium. Issue: Support clearing the PAYGO scorecard to avoid another Medicare sequester due to the use of reconciliation to pass the American Rescue Plan Act. Issue: Oppose use of extended Medicare sequester and repurposing of unused Provider Relief Fund. Issue: Support congressional extension of 3.75% temporary increase in the Medicare physician fee schedule that Congress provided in the Consolidated Appropriations Act, 2021 to avoid payment cuts due to budget neutrality requirements. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support making permanent the interim final rule that allows hospitals that unknowingly trigger their Medicare GME caps and per resident amounts to not have that happen and instead retain the ability to build a new resident cap / PRA so long as the cap / PRA is not above a minimum amount. Issue: Oppose aspects of CMS hospital price transparency rule. Issue: Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Oppose finalizing proposed rule for Medicare Coverage of Innovative Technology (MCIT) and definition of reasonable and necessary. Issue: Oppose enforcement of linking Medicare Conditions of Participation (CoP) compliance with requiring that hospitals report 38 COVID-19 related measures. Issue: Support continuation of the 3-Day Skilled Nursing Facility (SNF) Stay waiver after the conclusion of the COVID-19 public health emergency. Issue: Oppose policy of incorporating revenue distinctions into the Medicare Shared Savings Program. Issue: Support permanent extension of Medicare telehealth waivers, including removing patient location restrictions and rural site requirements, allowing payment for audio-only services, and reimbursing providers for telehealth services as services delivered in-person. Support 2 year or permanent extension of the waivers. H.R. 7053 / S. 3792, Hospital Inpatient Services Modernization Act Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support permanent extension of current Covid telehealth flexibilities HR 1332, the Telehealth Modernization Act Issue: Support efforts to expand patient access to telehealth HR 1397, the Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP Issue: Support efforts to improve access to childrens mental health care Issue: Support funding for hospital-based violence intervention programs and community violence interventions S. 2061 Telemental Health Care Access Act Issue: Support policy to remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create IME payments for outpatient services while remaining budget neutral. Issue: Support efforts to reverse cuts in Medicare OPPS reimbursements to hospitals for drugs acquired under the 340B program. Draft Value in Health Care Act Issue: Support changes to alternative payment models (APMs) to increase participation in value-based health programs and promote quality care and improved health outcomes. H.R. 3746 Accountable Care in Rural America Act Issue: Support improving 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. H.R. 4970 Rural Medical Residency Expansion Act of 2021 Issue: Support providing funds for rural teaching hospitals to expand their residency programs. Issue: Support efforts to investigate nurse-staffing agencies conduct during the COVID-19 pandemic.

Client expense: $874,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, White House Office

H.R. 1868, To prevent across-the-board direct spending cuts, and for other purposes, all provisions H.R. 315, Medicare Sequester COVID Moratorium Act, all provisions H.R. 6020, Supporting Medicare Providers Act of 2021, all provisions S. 3314, Supporting Medicare Providers Act of 2021, all provisions S. 610, Protecting Medicare and American Farmers from Sequester Cuts Act, all provisions H.R. 6048, Medicare Stability for Patients and Providers Act, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 19, Lower Costs, More Cures Act of 2021, all provisions H.R. 3259, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions S. 586, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions H.R. 3441, Substance Use Disorder Workforce Act, all provisions S. 1438, Opioid Workforce Act of 2021, all provisions H.R. 1332, Telehealth Modernization Act, all provisions S. 368, Telehealth Modernization Act, all provisions H.R. 2903, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, all provisions S. 1512, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, all provisions H.R. 4058, Telemental Health Care Access Act of 2021, all provisions S. 2061, Telemental Health Care Access Act of 2021, all provisions S. 801, Connected Maternal Online Monitoring Act, all provisions S. 346, Black Maternal Health Momnibus Act of 2021, all provisions H.R. 3407, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions S. 411, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions H.R. 1738, Stabilize Medicaid and CHIP Coverage Act, all provisions H.R. 1025, Kids Access to Primary Care Act of 2021, all provisions H.R. 66, Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act, all provisions H.R. 2256, Resident Physician Shortage Reduction Act of 2021, all provisions S. 834, Resident Physician Shortage Reduction Act of 2021, all provisions H.R. 3173, Improving Seniors Timely Access to Care Act of 2021, all provisions S. 3018, Improving Seniors Timely Access to Care Act of 2021, all provisions S. 748, Medicare Sequester Relief Act, all provisions H.R. 2163, Safe Step Act, all provisions S. 464, Safe Step Act, all provisions H.R. 955, Medicaid Reentry Act of 2021, all provisions S. 285, Medicaid Reentry Act of 2021, all provisions H.R. 2654, Chiropractic Medicare Coverage Modernization Act of 2021, all provisions H.R. 4587, Value in Health Care Act of 2021, all provisions H.R. 6000, Cures 2.0 Act, all provisions H.R. 4043, Ensuring Patient Access to Critical Breakthrough Products Act of 2021, all provisions S. 2416, New Opportunities for Value that Extend Lives (NOVEL) Act of 2021, all provisions H.R. 6311, Comprehensive Addiction Resources Emergency (CARE) Act of 2021, all provisions S. 3418, Comprehensive Addiction Resources Emergency (CARE) Act of 2021, all provisions H.R. 4014, Physician Shortage GME Cap Flex Act of 2021, all provisions S. 2094, Physician Shortage GME Cap Flex Act of 2021, all provisions H.R. 6202, Telehealth Extension Act of 2021, all provisions S. 3593, Telehealth Extension and Evaluation Act, all provisions H.R. 2807, Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies (PREVENT DIABETES) Act, all provisions S. 2173, Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies (PREVENT DIABETES) Act, all provisions H.R. 5804, Expanding Access to Diabetes Self-Management Training Act of 2021, all provisions S. 2203, Expanding Access to Diabetes Self-Management Training Act of 2021, all provisions S. 596, Treat and Reduce Obesity Act of 2021, all provisions H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021, all provisions H.R. 366, Protecting Access to Post-COVID-19 Telehealth Act of 2021, all provisions H.R. 2228, Rural Behavioral Health Access Act of 2021, all provisions H.R. 3447, Permanency for Audio-Only Telehealth Act, all provisions H.R. 7051, Access to Prescription Digital Therapeutics Act of 2022, all provisions S. 3791, Access to Prescription Digital Therapeutics Act of 2022, all provisions H.R. 2503, Social Determinants Accelerator Act of 2021, all provisions S. 3039, Social Determinants Accelerator Act of 2021, all provisions H.R. 987, CARA 3.0 Act of 2021, all provisions H.R. 925, Data to Save Moms Act, all provisions H.R. 3746, Accountable Care in Rural America Act, all provisions H.R. 4755, Seniors Chronic Care Management Improvement Act of 2021, all provisions H.R. 6308, ACO Assignment Improvement Act of 2021, all provisions H.R. 6583, Stop the Wait Act of 2022, all provisions S. 224, Stop the Wait Act of 2022, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 7213, Equitable Community Access to Pharmacist Services Act, all provisions Medicare program: Gold Card Act/draft Medicare program: 21st Century Cures Act Medicare program: Protecting Access to Medicare Act (PAMA)/Laboratory testing/diagnostics Medicare program: Small Practice, Underserved, and Rural Support Program (SURS) Extension Act of 2022 Medicare program: Telehealth and dialysis centers/COVID-19 flexibilities continuation Medicare program: Telehealth/telephone visit codes/equity/quality Medicare program: Physician Payment Reform Medicare program: MEDPAC Report Medicare program: 2% Medicare sequester moratorium/continuation Medicare program: 4% Medicare sequester/Statutory PAYGO Medicare program: Physician payment/inflation index Medicare program: Medicare Physician Fee Schedule Conversion Factor/extension of 3% increase Medicare program: Medicare Diabetes Prevention Program (MDPP) model Medicare program: Global and Professional Direct Contracting Model (GPDC)/Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Medicare program: Evaluation and Management (E/M)/budget neutrality Medicare program: Prior authorization Medicare program: Interoperability Medicare program: EFT fees Medicare program: Merit-based Incentive Payment System (MIPS)/Quality/Cost/Improvement activities Medicare program: MIPS Value Pathways (MVPs) Medicare program: MIPS draft cost measures/field testing extension Medicare program: Value-based care acceleration/transparency/stability Medicare program: Virtual credit cards Medicare program: Primary Care First models Medicare program: Medicare Shared Savings Program (MSSP) Medicare program: RVS Update Committee (RUC)/Current Procedural Terminology (CPT) Medicare program: Split/shared billing Medicare program: PECOS Enrollment/Revalidation Medicare program: Open Payments Medicare program: Step Therapy Medicare program: Public health emergency/accelerated and advance payments Medicare program: MACRA oversight Medicare program: MACRA/physician burdens Medicare program: Alternative payment models (APMs) Medicare and Medicaid programs: Medicare Access and CHIP Reauthorization Act (MACRA)/implementation/Accountable Care Organizations Medicare and Medicaid programs: Information blocking/Patient privacy Medicare and Medicaid programs: COVID-19 response Medicare and Medicaid programs: Mental Health Parity and Addiction Equity Act (MHPAEA)/patient protection Medicare and Medicaid programs: Health equity/COVID-19 Medicare and Medicaid programs: Drug overdose epidemic Medicare and Medicaid programs: Health IT burdens Medicaid program: Medicaid funding in US territories Medicaid program: Uninsured individuals/COVID-19 Medicaid program: Special enrollment period Medicaid program: Sickle Cell Disease

Client expense: $6,520,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Natl Drug Control Policy (NDCP), SENATE

Medicare Shared Savings Program policies; H.R. 3746, Accountable Care in Rural America Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

a. Incentivize Domestic Manufacturing b. Hospital Infrastructure Support c. H.R. 5487 - Value in health Care Act of 2021 d. S. 2652/H.R. 5067 - Preserving Patient Access to Home Infusion Act e. S.308/H.R.1436 - PPE in America Act f. S.1260 - United States Innovation and Competition Act of 2021 g. S. 936 / H.R. 5502 - INFORM Consumers Act h. S. 2648 - Rural ACO Improvement Act i. S. 1574/H.R.5632 - Long-Term Care Pharmacy Definition Act j. S. 834 / H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 k. H.R.3173 S 3018 - Improving Seniors Timely Access to Care Act of 2021 l. H.R. 3746 - Accountable Care in Rural America Act m. H.R.1319 - American Rescue Plan Act of 2021 n. H.R. 959 / S. 364 - Black Maternal Health Momnibus Act of 2021 o. H.R. 4387 / S. 1675 - Maternal Health Quality Improvement Act of 2021 p. S. 168 / H.R. 708 - Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act q. S. 150 - Ensuring Parity in MA for Audio Only-Telehealth Act r. 340B Drug Discount Program eligbility t. Healthcare workforce (Graduate medical education , health professional training programs, recruitment and retension incentives) u. Medicare provider payment cuts (Medicare sequestration cuts, physician fee schedule 3.75% reduction due to evaluation & management code increases/budget neturality adjustment, Pay-as-You-Go reductions due to American Rescue Plan) v. Automated data collection infrastructure for healthcare supply chain w. S. 3146 - The Protecting Patients from Counterfeit Medical Devices Act x. S. 3799 - The PREVENT Pandemics Act y. H.R. 650 - The Medical and Health Stockpile Accountability Act of 2022 z. S. 3416 - The Protecting Patients from Counterfeit Medical Devices Act aa. S. 3493 - Drug Shortages Shelf Life Extension Act ab. H.R. 4521 - America COMPETES Act of 2022 ac. H.R.5376 - Build Back Better Act ad. S.610 - Protecting Medicare and American Farmers from Sequester Cuts Act ae. H.R.3684 - Infrastructure Investment and Jobs Act af. H.R. 4735/S. 2493 - The Provider Relief Extension Act ag. H.R. 3589 - Better Way for Providers To Repay Act of 2021 ah. H.R. 3203 / S. 773 - To allow hospitals that were participating in or applied for the 340B drug discount program before the public health emergency to temporarily maintain eligibility ai. HHS FY 2022 appropriations - Removal of a ban on using federal funds for implementing a unique patient identification system (Section 510) aj. ACO Assignment Bill ak. NQF/Quality Measurement funding authorization al. Preparing for the next pandemic and supply chain resiliency

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Value in Healthcare Act HR.7791 & HR.4587 Accountable Care in Rural America Act H.R.3746 Rural Health Glitch Bill S.2648 Housing is a Human Right Act of 2020 H.R.6308

Client expense: $35,000 · Firm income: Not reported

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

Medicare Shared Savings Program policies; H.R. 3746, Accountable Care in Rural America Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support H.R. 315,Medicare Sequester COVID Moratorium Act, a bill to amend the Coronavirus Aid, Relief, and Economic Security Act to extend the temporary suspension of Medicare sequestration; Support H.R. 1332 and S.368,Telehealth Modernization Act, a bill to amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency; Letter opposing CMS interim final rule establishing a Most Favored Nation model and urging the agency to withdraw it immediately and replace it with a serious effort at drug pricing reform; Letter urging CMS to rescind its denial determinations for those hospitals that submitted mid-build exception requests due to the agencys failure to meet the required statutory deadline; Discussion with the Center for Medicare and Medicaid Innovation (CMMI) about the Radiation Oncology Alternative Payment Model; Urged CMS to exercise enforcement discretion with respect to the hospital price transparency rule until the end of the public health emergency; Support H.R. 1868, a bill that, among other health care provisions, would eliminate the 2% across-the-board cut to all Medicare payments, known as sequestration, until the end of 2021; Support H.R. 2455, The Resetting the Impact Act (TRIA), a bill to amend the IMPACT Act of 2014 to reset data collection and the development of a payment system technical prototype for post-acute care providers under the Medicare program to take into account the effects of COVID-19; Support H.R. 3173/ S.3018, Improving Seniors Timely Access to Care Act of 2021, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, and for other purposes; Support H.R. 1887, Rural Hospital Support Act, a bill to make permanent the Medicare Dependent Hospital (MDH) and Low-volume Adjustment programs and rebases the MDH and Sole Community Hospital programs; Support relief for Medicare advanced payments; Discussion with CMMI about the priorities for alternative payment models; Comment letter to CMS on the CY 2022 OPPS/ASC Proposed Rule oppose the agencys deep OPPS payment cuts to 340B hospitals and other concerns; Letter to CMS administrator on the mid-build exception audit denials requesting the agency rescind the denials or, if not, establish an informal review process to correct errors in the audit determinations. Further requesting that hospitals be allowed extra time to identify and return any overpayments; Support HR 4587, Value in Health Care Act of 2021, a bill to direct the Secretary of Health and Human Services to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage participation in such program, and for other purposes; Support HR 3746, Accountable Care in Rural America Act, a bill to amend title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program; Support H.R. 5425/ S. 1988, Protecting Rural Telehealth Access Act, a bill to amend title XVIII of the Social Security Act to protect access to telehealth services under the Medicare program; Letter asking Congress to address two important issues by the end of the year: an extension of the moratorium on Medicare sequester cuts, as well as preventing the Statutory Pay-As-You-Go (PAYGO) sequester from taking effect; Letter urging Congress to remove the reductions to the Medicaid disproportionate share hospital (DSH) program and uncompensated care pools from the Build Back Better Act; Support H.R. 5674/ S. 3061Medicare Mental Health Inpatient Equity Act of 2021, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program.

Client expense: $6,430,000 · Firm income: Not reported

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

Issue: Support policies to close the Medicaid coverage gap, including through ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. H.R. 2256 / S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: Support increased Medicare funding for graduate medical education S. 1438 Opioid Workforce Act H.R. 3441 Substance Use Disorder Workforce Act Issue: Support targeted Medicare funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs S.1893, Draft House bill Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals H.R. 5376, Build Back Better Act Issue: Support additional Medicare funding for graduate medical education slots. Issue: Support efforts to increase physician workforce diversification through novel, targeted scholarship programs. Issue: Support protection of the 340B Drug Pricing Program in the budget reconciliation package Issue: Support for 12-months continuous coverage for children on Medicaid and CHIP Issue: Support extending the enhanced ACA market place subsidies and addressing the Medicaid coverage gap Rural-Urban Physician Workforce Act Issue: Support improvements to Rural Training Track programs. Issue: Provide feedback to CMS on its proposed distribution of the 1,000 new GME slots authorized be the Consolidated Appropriations Act, 2021 as described in the 2022 Inpatient Prospective Payment System (IPPS) proposed rule. Support CMS adopting alternative 2 with modifications to allow for more than 1.0 FTE per hospital. Issue: Support Medicare Graduate Medical Education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts Issue: Oppose overly burdensome Medicaid GME transparency language. Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Educate Congress on Consolidted Appropriations Act, 2021 (CAA Sec. 203) changes to the Medicaid shortfall calculations and the potential impact on Medicaid DSH payments Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives Draft, Improving Seniors Timely Access to Care Act Issue: Support protecting patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs HHS Rebate Rule Medicare Part D benefit re-design Issue: Support policies to reduce prescription drug prices Issue: Support implementation of the 21st Century Cures Act (Cures) interoperability and health data sharing provisions. Issue: Support changes and improvements to the Medicare Shared Savings Program. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Issue: Support expansion of Medicaid and CHIP coverage for postpartum women. S. 610 Protecting Medicare and American Farmers from Sequester Cuts Act H.R. 315 Medicare Sequester COVID Moratorium Act S. 748 Medicare Sequester Relief Act H.R. 1868 To prevent across-the-board direct spending cuts, and for other purposes. Issue: Support extension of Medicare sequester moratorium. Issue: Support clearing the PAYGO scorecard to avoid another Medicare sequester due to the use of reconciliation to pass the American Rescue Plan Act. Issue: Oppose use of extended Medicare sequester and repurposing of unused Provider Relief Fund as a financing mechanism for bipartisan infrastructure package. Issue: Support congressional extension of 3.75% temporary increase in the Medicare physician fee schedule that Congress provided in the Consolidated Appropriations Act, 2021 to avoid payment cuts due to budget neutrality requirements. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support making permanent the CMS policy allowing teaching physicians to provide supervision via real-time, interactive audio/video technology to meet resident supervision requirements. Issue: Support making permanent the interim final rule that allows hospitals that unknowingly trigger their Medicare GME caps and per resident amounts to not have that happen and instead retain the ability to build a new resident cap / PRA so long as the cap / PRA is not above a minimum amount. Issue: Oppose CMS hospital price transparency rule. Issue: Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Oppose finalizing proposed rule for Medicare Coverage of Innovative Technology (MCIT) and definition of reasonable and necessary. Issue: Oppose enforcement of linking Medicare Conditions of Participation (CoP) compliance with requiring that hospitals report 38 COVID-19 related measures. Issue: Support continuation of the 3-Day Skilled Nursing Facility (SNF) Stay waiver after the conclusion of the COVID-19 public health emergency. Issue: Oppose policy of incorporating revenue distinctions into the Medicare Shared Savings Program. Issue: Support permanent extension of Medicare telehealth waivers, including removing patient location restrictions and rural site requirements, allowing payment for audio-only services, and reimbursing providers for telehealth services as services delivered in-person. Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support permanent extension of current Covid telehealth flexibilities HR 1332, the Telehealth Modernization Act Issue: Support efforts to expand patient access to telehealth HR 1397, the Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP Issue: Support efforts to improve access to childrens mental health care HR 5035, The Child Suicide Prevention and Lethal Means Safety Act Issue: Support expansion of training for health professionals to prevent self-harm or suicide Issue: Support funding to support hospital-based violence intervention programs and community violence interventions S. 2061 Telemental Health Care Access Act Issue: Support policy to remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create IME payments for outpatient services while remaining budget neutral. Issue: Support efforts to reverse cuts in Medicare OPPS reimbursements to hospitals for drugs acquired under the 340B program. Draft Value in Health Care Act Issue: Support changes to alternative payment models (APMs) to increase participation in value-based health programs and promote quality care and improved health outcomes. H.R. 3746 Accountable Care in Rural America Act Issue: Support improving 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. H.R. 4970 Rural Medical Residency Expansion Act of 2021 Issue: Support providing funds for rural teaching hospitals to expand their residency programs. Issue: Support efforts to investigate nurse-staffing agencies conduct during the COVID-19 pandemic.

Client expense: $1,020,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Medicare Payment Advisory Commission (MedPAC), Natl Economic Council (NEC), Natl Institutes of Health (NIH), Natl Science Foundation (NSF), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), Office of the Vice President of the United States, SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

H.R. 1868, To prevent across-the-board direct spending cuts, and for other purposes, all provisions H.R. 315, Medicare Sequester COVID Moratorium Act, all provisions S. 748, Medicare Sequester Relief Act, all provisions H.R. 5612, To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes, all provisions H.R. 6020, Supporting Medicare Providers Act of 2021, all provisions S. 3314, Supporting Medicare Providers Act of 2021, all provisions S. 610, Protecting Medicare and American Farmers from Sequester Cuts Act, provisions relating to averting Medicare physician fee schedule cuts H.R. 6144, Removing Waste and Protecting Medicare Act, all provisions H.R. 6048, Medicare Stability for Patients and Providers Act, all provisions H.R. 1332, Telehealth Modernization Act, provisions related to permanently lifting Medicare telehealth restrictions S. 368, Telehealth Modernization Act, provisions related to permanently lifting Medicare telehealth restrictions H.R. 2903, CONNECT for Health Act of 2021, provisions related to permanently lifting Medicare telehealth restrictions S. 1512, CONNECT for Health Act of 2021, provisions related to permanently lifting Medicare telehealth restrictions H.R. 366, Protecting Access to Post-COVID-19 Telehealth Act of 2021, all provisions H.R. 4058, Telemental Health Care Access Act of 2021, provisions related to permanently lifting Medicare telehealth restrictions S. 2061, Telemental Health Care Access Act of 2021, provisions related to permanently lifting Medicare telehealth restrictions H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021, all provisions H.R. 2228, Rural Behavioral Health Access Act of 2021, all provisions H.R. 3447, Permanency for Audio-Only Telehealth Act, all provisions H.R. 6000, Cures 2.0 Act, all provisions H.R. 2503, Social Determinants Accelerator Act of 2021, all provisions S. 3039, Social Determinants Accelerator Act of 2021, all provisions H.R. 3173, Improving Seniors Timely Access to Care Act of 2021, all provisions S. 3018, Improving Seniors Timely Access to Care Act of 2021, all provisions H.R. 2163, Safe Step Act, all provisions S. 464, Safe Step Act, all provisions H.R. 3259, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions S. 586, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions S. 987, CARA 3.0 Act of 2021, all provisions S. 1438, Opioid Workforce Act of 2021, all provisions H.R. 3441, Substance Use Disorder Workforce Act, all provisions H.R. 3407, MOMMAs Act, all provisions S. 411, MOMMAs Act, all provisions H.R. 925, Data to Save Moms Act, all provisions H.R. 3352, Midwives for MOMS Act of 2021, all provisions H.R. 2256, Resident Physician Shortage Reduction Act of 2021, all provisions S. 834, Resident Physician Shortage Reduction Act of 2021, all provisions H.R. 4014, Physician Shortage GME Cap Flex Act of 2021, all provisions S. 2094, Physician Shortage GME Cap Flex Act of 2021, all provisions H.R. 3746, Accountable Care in Rural America Act, all provisions H.R. 4587, Value in Health Care Act of 2021, all provisions H.R. 4755, Seniors Chronic Care Management Improvement Act of 2021, all provisions H.R. 6308, ACO Assignment Improvement Act of 2021, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 19, Lower Costs, More Cures Act of 2021, all provisions H.R. 4034, Ensuring Patient Access to Critical Breakthrough Products Act of 2021, all provisions S. 2416, New Opportunities for Value that Extend Lives (NOVEL) Act of 2021, all provisions H.R. 2144, Access to Genetic Counselor Services Act of 2021, provisions relating to scope of practice S. 1450, Access to Genetic Counselor Services Act of 2021, provisions relating to scope of practice H.R. 2654, Chiropractic Medicare Coverage Modernization Act of 2021, provisions relating to scope of practice H.R. 2305, Improving Access to Mental Health Act of 2021, all provisions H.R. 5218, Collaborate in an Orderly and Cohesive Manner Act, all provisions S. 801, Connected MOM Act, all provisions S. 346, Black Maternal Health Momnibus Act of 2021, all provisions H.R. 1738, Stabilize Medicaid and CHIP Coverage Act, all provisions H. R. 1025, Kids Access to Primary Care Act of 2021, all provisions H.R. 66, Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act, all provisions H.R. 955, Medicaid Reentry Act of 2021, all provisions S. 285, Medicaid Reentry Act of 2021, all provisions H.R. 6311, Comprehensive Addiction Resources Emergency Act of 2021, provisions relating to Medicare and Medicaid S. 3418, Comprehensive Addiction Resources Emergency Act of 2021, provisions relating to Medicare and Medicaid Medicare program: No Surprises Act/implementation Medicare program: CY 2021 Physician Fee Schedule/3.75% payment adjustment Medicare program: Physician Payment Reform Medicare program: 2022 physician payment Medicare program: Alternative payment models (APMs) Medicare program: Health equity Medicare program: Medicare Diabetes Prevention Program Medicare program: Prescription drug prices Medicare program: Cybersecurity Medicare program: Medicare expansion/dental, vision, hearing coverage Medicare program: Physician payment/PAYGO and sequester Medicare program: Barriers to patient care Medicare program: 2020 Physician spending/COVID-19 Impact Medicare program: Evaluation and Management (E/M)/budget neutrality Medicare program: Pharmacy Benefit Managers/Rx drug price transparency Medicare program: Merit-Based Incentive Payment System (MIPS) program Medicare program: MIPS/Value Pathways (MVPs) Medicare program: MIPS/cost, promoting interoperability, improvement activities Medicare program: Quality Payment Program (QPP) Medicare program: Health IT physician burdens Medicare program: Primary Care First models Medicare program: Medicare Shared Savings Program (MSSP) Medicare program: Open Payments Medicare program: Provider Enrollment, Chain, and Ownership System (PECOS) Enrollment/Revalidation Medicare program: Telehealth policies Medicare program: RVS Update Committee (RUC) - physician payment Medicare program: Coding - CPT Panel Medicare program: Accountable Care Organizations (ACOs)/Pre-COVID Benchmarks Medicare program: Federal Gold Carding Medicare and Medicaid programs: Medicare Access and CHIP Reauthorization Act (MACRA)/implementation/Accountable Care Organizations Medicare and Medicaid programs: MACRA Oversight Medicare and Medicaid programs: MACRA physician burdens Medicare and Medicaid programs: Prior authorization Medicare and Medicaid programs: COVID-19 public health emergency/accelerated and advance payments Medicare and Medicaid programs: Electronic funds transfer (EFT) standard/Enforcement Medicare and Medicaid programs: Provider Relief Fund Medicare and Medicaid programs: Telehealth Extension and Evaluation Act/draft Medicare and Medicaid programs: Telehealth and Dialysis centers Medicare and Medicaid programs: COVID-19 telehealth flexibilities continuation Medicare and Medicaid programs: Primary and Virtual Health Care Affordability Act Medicare and Medicaid programs: Data Privacy Medicare and Medicaid programs: Social determinants of health Medicare and Medicaid programs: Information blocking/privacy Medicare and Medicaid programs: Information blocking/privacy of adolescents Medicare and Medicaid programs: Opioids Medicaid program: Medicaid funding in U.S. Territories Medicaid program: Medicaid expansion Medicaid program: Maternal mortality Medicaid program: COVID-19/uninsured healthcare coverage Medicaid program: Medicaid Special Enrollment Period

Client expense: $4,770,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), 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), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA), White House Office

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

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

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

a. Incentivize Domestic Manufacturing b. Hospital Infrastructure Support c. H.R. 5487 - Value in health Care Act of 2021 d. S. 2652/H.R. 5067 - Preserving Patient Access to Home Infusion Act e. S.308/H.R.1436 - PPE in America Act f. S.1260 - United States Innovation and Competition Act of 2021 g. S. 936 / HR 5502 - INFORM Consumers Act h. S. 2648 - Rural ACO Improvement Act i. S. 1574/H.R.5632 - Long-Term Care Pharmacy Definition Act j. S. 834 / H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 k. H.R.3173 S 3018 - Improving Seniors Timely Access to Care Act of 2021 l. H.R. 3746 - Accountable Care in Rural America Act m. H.R.1319 - American Rescue Plan Act of 2021 n. H.R. 959 / S. 364 - Black Maternal Health Momnibus Act of 2021 o. H.R. 4387 / S. 1675 - Maternal Health Quality Improvement Act of 2021 p. S. 168 / H.R. 708 - Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act q. S. 150 - Ensuring Parity in MA for Audio Only-Telehealth Act r. 340B Drug Discount Program eligbility s. Healthcare workforce (Graduate medical education , health professional training programs, recruitment and retension incentives) t. Medicare provider payment cuts (Medicare sequestration cuts, physician fee schedule 3.75% reduction due to evaluation & management code increases/budget neturality adjustment, Pay-as-You-Go reductions due to American Rescue Plan) u. Automated data collection infrastructure for healthcare supply chain v. The Protecting Patients from Counterfeit Medical Devices Act (S. 3416) w. Preparing for the next pandemic and supply chain resiliency x. H.R.5376 - Build Back Better Act y. S.610 - Protecting Medicare and American Farmers from Sequester Cuts Act z. H.R.3684 - Infrastructure Investment and Jobs Act aa. H.R. 4735/S. 2493 - The Provider Relief Extension Act ab. H.R. 3589 - Better Way for Providers To Repay Act of 2021 ac. H.R. 3203 / S. 773 - To allow hospitals that were participating in or applied for the 340B drug discount program before the public health emergency to temporarily maintain eligibility ad. HHS FY 2022 appropriations - Removal of a ban on using federal funds for implementing a unique patient identification system (Section 510) ae. ACO Assignment Bill af. NQF/Quality Measurement funding authorization

Client expense: $310,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

H.R. 1330 - "Patient Access to Higher Quality Health Care Act of 2021" - Oppose legislation that would repeal current law limiting self-referral to physician-owned hospitals. H.R. 2455 - "The Resetting the IMPACT Act (TRIA) of 2021" - Support legislation to refresh the unified PAC PPS timeline and process under the IMPACT Act. S. 999/H.R. 4066 - "Save Rural Hospitals Act of 2021" - Support a national wage index floor of .85 in a non-budget neutral manner. S. 1512 - "Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021" - Advocate in support of the CONNECT Act to expand access to telehealth services. H.R. 4587 - "Value in Health Care Act of 2021" - Support ACO program reforms. S. 1568 / H.R. 4407 - "Technical Reset to Advance the Instruction of Nurses Act" - Support legislation that would direct CMS not to seek repayment from nursing and allied health programs. H.R. 1887 - "Rural Hospital Support Act" - Support rural MDH and LVH program extensions. H.R. 3746 - "Accountable Care In Rural America Act" - Support rural health ACOs. Rural - Seek introduction of legislation that would remove the current 12% DSH payment cap that currently applies to rural hospitals (with some exceptions) as well as urban hospitals under 100 beds. Urged Congress to waive Statutory PAYGO and advocated for extending the 2% Medicare sequester moratorium.

Client expense: $600,000 · Firm income: Not reported

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

Medicare Shared Savings Program policies; H.R. 3746, Accountable Care in Rural America Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support H.R. 315,Medicare Sequester COVID Moratorium Act, a bill to amend the Coronavirus Aid, Relief, and Economic Security Act to extend the temporary suspension of Medicare sequestration; Support H.R. 1332 and S.368,Telehealth Modernization Act, a bill to amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency; Letter opposing CMS interim final rule establishing a Most Favored Nation model and urging the agency to withdraw it immediately and replace it with a serious effort at drug pricing reform; Letter urging CMS to rescind its denial determinations for those hospitals that submitted mid-build exception requests due to the agencys failure to meet the required statutory deadline; Discussion with the Center for Medicare and Medicaid Innovation (CMMI) about the Radiation Oncology Alternative Payment Model; Urged CMS to exercise enforcement discretion with respect to the hospital price transparency rule until the end of the public health emergency; Support H.R. 1868, a bill that, among other health care provisions, would eliminate the 2% across-the-board cut to all Medicare payments, known as sequestration, until the end of 2021; Support H.R. 2455, The Resetting the Impact Act (TRIA), a bill to amend the IMPACT Act of 2014 to reset data collection and the development of a payment system technical prototype for post-acute care providers under the Medicare program to take into account the effects of COVID-19; Support H.R. 3173, Improving Seniors Timely Access to Care Act of 2021, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, and for other purposes; Support H.R. 1887, Rural Hospital Support Act, a bill to make permanent the Medicare Dependent Hospital (MDH) and Low-volume Adjustment programs and rebases the MDH and Sole Community Hospital programs; Support relief for Medicare advanced payments; Discussion with CMMI about the priorities for alternative payment models; Comment letter to CMS on the CY 2022 OPPS/ASC Proposed Rule oppose the agencys deep OPPS payment cuts to 340B hospitals and other concerns; Letter to CMS administrator on the mid-build exception audit denials requesting the agency rescind the denials or, if not, establish an informal review process to correct errors in the audit determinations. Further requesting that hospitals be allowed extra time to identify and return any overpayments; Support HR 4587, Value in Health Care Act of 2021, a bill to direct the Secretary of Health and Human Services to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage participation in such program, and for other purposes; Support HR 3746, Accountable Care in Rural America Act, a bill to amend title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program.

Client expense: $4,470,000 · Firm income: Not reported

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

H.R. 1868, To prevent across-the-board direct spending cuts, and for other purposes, all provisions H.R. 315, Medicare Sequester COVID Moratorium Act, all provisions H.R. 1332, Telehealth Modernization Act, all provisions S. 368, Telehealth Modernization Act, all provisions H.R. 2903, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, all provisions S. 1512, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, all provisions H.R. 366, Protecting Access to Post-COVID-19 Telehealth Act of 2021, all provisions H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021, all provisions H.R. 2228, Rural Behavioral Health Access Act of 2021, all provisions H.R. 3447, Permanency for Audio-Only Telehealth Act, all provisions H.R. 5241, Linking Seniors to Needed Legal Services Act of 2021, all provisions H.R. 3173, Improving Seniors Timely Access to Care Act of 2021, all provisions H.R. 3259, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions S. 586, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions S. 987, CARA 3.0 Act of 2021, all provisions H.R. 3441, Substance Use Disorder Workforce Act, all provisions S. 1438, Opioid Workforce Act of 2021, all provisions H.R. 3407, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions S. 411, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions H.R. 925, Data to Save Moms Act, all provisions H.R. 2256, Resident Physician Shortage Reduction Act of 2021, all provisions S. 834, Resident Physician Shortage Reduction Act of 2021, all provisions H.R. 4014, Physician Shortage GME Cap Flex Act of 2021, all provisions S. 2094, Physician Shortage GME Cap Flex Act of 2021, all provisions H.R. 3746, Accountable Care in Rural America Act, all provisions H.R. 4587, Value in Health Care Act of 2021, all provisions H.R. 4755, Seniors Chronic Care Management Improvement Act of 2021, all provisions H.R. 1330, Patient Access to Higher Quality Health Care Act of 2021, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 4043, Ensuring Patient Access to Critical Breakthrough Products Act of 2021, all provisions S. 2416, NOVEL Act of 2021, all provisions H.R. 2144, Access to Genetic Counselor Services Act of 2021, provisions relating to scope of practice S. 1450, Access to Genetic Counselor Services Act of 2021, provisions relating to scope of practice H.R. 2654, Chiropractic Medicare Coverage Modernization Act of 2021, provisions relating to scope of practice H.R. 5370, Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 202, all provisions H.R. 2807, Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies (PREVENT DIABETES) Act, all provisions S. 2173, Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies (PREVENT DIABETES) Act, all provisions S. 748, Medicare Sequester Relief Act, all provisions H.R. 955, Medicaid Reentry Act of 2021, all provisions S. 285, Medicaid Reentry Act of 2021, all provisions H.R. 19, Lower Costs, More Cures Act of 2021, provisions relating to pharmacy benefits managers and drug price transparency S. 801, Connected MOM Act, all provisions S. 346, Black Maternal Health Momnibus Act of 2021, all provisions H.R. 1738, Stabilize Medicaid and CHIP Coverage Act, all provisions H.R. 1025, Kids Access to Primary Care Act of 2021, all provisions H.R. 66, Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act, all provisions S. 2214, Promote Responsible Oversight and Targeted Employee background Check Transparency for Seniors (PROTECTS) Act, all provisions H.R. 5125, Strengthening Innovation in Medicare and Medicaid Act, all provisions H.R. 1587, Medicare Audiologist Access and Services Act of 2021, all provisions S. 2691, Strengthening the Vaccines for Children Program Act of 2021, all provisions Medicare program: No Surprises Act/implementation Medicare program: Physician payment Medicare program: 2022 Physician Fee Schedule/audio-only telehealth expansion Medicare program: Telehealth Extension and Evaluation Act Medicare program: Alternative payment models Medicare program: National Coverage Determination/self-measured blood pressure monitoring devices Medicare program: Physician payment issues/PAYGO and Sequester/3.75% Conversion Factor increase Medicare program: Evaluation and Management (E/M)/budget neutrality Medicare program: Physician-owned hospitals/hospital consolidation Medicare program: Medicare expansion/dental, vision, hearing coverage Medicare program: Diabetes Prevention Medicare program: Surprise Medical Billing/Price transparency Medicare program: Merit-Based Incentive Payment System (MIPS) program Medicare program: MIPS Value Pathways Medicare program: Quality Payment Program Medicare program: Information blocking/interoperability/data segmentation Medicare program: Cybersecurity and HIPAA Medicare program: Measure Application Partnership (MAP) Medicare program: COVID-19 Public Health Emergency/Accelerated and Advance Payments Medicare program: Primary Care First (PCF) models Medicare program: Medicare Shared Savings Program (MSSP) Medicare program: Physician payment/globals Medicare program: Provider Enrollment, Chain, and Ownership System (PECOS)/Revalidation Medicare program: Open Payments Medicare program: Prescription Drug Prices Medicare program: Chronic Care Management code Medicare program: Graduate Medical Education (GME) Medicare program: Step Therapy Medicare and Medicaid programs: Medicare Access and CHIP Reauthorization Act (MACRA)/implementation/Accountable Care Organizations Medicare and Medicaid programs: MACRA/physician burdens Medicare and Medicaid programs: Drug overdose epidemic Medicare and Medicaid programs: 21st Century Cures 2.0 Medicare and Medicaid programs: Waste, fraud, and abuse in telehealth Medicare and Medicaid programs: Prior authorization Medicare and Medicaid programs: Public Option Medicare and Medicaid programs: Electronic Health Records (EHR) certification Medicare and Medicaid programs: Physician Health IT burdens Medicare and Medicaid programs: Data privacy Medicare and Medicaid programs: Provider compliance and regulatory relief Medicaid program: COVID-19/Provider Relief Fund Medicaid program: Funding for U.S. territories Medicaid program: Medicaid expansion Medicaid program: Work requirements Medicaid program: COVID-19/Uninsured and healthcare coverage/child 12 month continuous eligibility Medicaid program: Pediatric mental health care access/behavioral health services Medicaid program: Special enrollment period Medicaid program: Proprietary Laboratory Analysis (PLA) codes

Client expense: $3,490,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Institute of Standards & Technology (NIST), Office of Science & Technology Policy (OSTP), SENATE, U.S. Customs & Border Protection, Veterans Affairs, Dept of (VA), White House Office

Issue: Support policies to close the Medicaid coverage gap, including through ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. H.R. 2256 / S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: Support additional Medicare funding for graduate medical education S. 1438 Opioid Workforce Act H.R. 3441 Substance Use Disorder Workforce Act Issue: Support additional Medicare funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs S.1893, Draft House bill Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals H.R. 5376, Build Back Better Act Issue: Support additional Medicare funding for graduate medical education slots. Issue: Support efforts to increase physician workforce diversification through novel, targeted scholarship programs. Issue: Support protection of the 340B Drug Pricing Program in the budget reconciliation package Issue: Support for 12-months continuous coverage for children on Medicaid and CHIP Issue: Support strengthening the ACA and address the Medicaid coverage gap Rural-Urban Physician Workforce Act Issue: Support improvements to Rural Training Track programs. Issue: Provide feedback to CMS on its proposed distribution of the 1,000 new GME slots authorized be the Consolidated Appropriations Act, 2021 as described in the 2022 Inpatient Prospective Payment System (IPPS) proposed rule. Support CMS adopting alternative 2 with modifications to allow for more than 1.0 FTE per hospital. Issue: Support Medicare Graduate Medical Education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts Issue: Oppose overly burdensome Medicaid GME transparency language. Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives Draft, Improving Seniors Timely Access to Care Act Issue: Support protecting patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs HHS Rebate Rule Medicare Part D benefit re-design Issue: Support policies to reduce prescription drug prices Issue: Support implementation of the 21st Century Cures Act (Cures) interoperability and health data sharing provisions. Issue: Support changes and improvements to the Medicare Shared Savings Program. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Issue: Support expansion of Medicaid and CHIP coverage for postpartum women. H.R. 315 Medicare Sequester COVID Moratorium Act S. 748 Medicare Sequester Relief Act H.R. 1868 To prevent across-the-board direct spending cuts, and for other purposes. Issue: Support extension of Medicare sequester moratorium. Issue: Support clearing the PAYGO scorecard to avoid another Medicare sequester due to the use of reconciliation to pass the American Rescue Plan Act. Issue: Oppose use of extended Medicare sequester and repurposing of unused Provider Relief Fund as a financing mechanism for bipartisan infrastructure package. Issue: Support congressional extension of 3.75% temporary increase in the Medicare physician fee schedule that Congress provided in the Consolidated Appropriations Act, 2021 to avoid payment cuts due to budget neutrality requirements. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support making permanent the CMS policy allowing teaching physicians to provide supervision via real-time, interactive audio/video technology to meet resident supervision requirements. Issue: Support making permanent the interim final rule that allows hospitals that unknowingly trigger their Medicare GME caps and per resident amounts to not have that happen and instead retain the ability to build a new resident cap / PRA so long as the cap / PRA is not above a minimum amount. Issue: Support CMS introducing new regulations to make permanent the interim final rule that ensures teaching hospitals that increased their number of inpatient beds to accommodate the surge in patients during the public health emergency to not have their Indirect Medical Education (IME) payments reduced by CMS. Issue: Oppose CMS hospital price transparency rule. Issue: Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Oppose finalizing proposed rule for Medicare Coverage of Innovative Technology (MCIT) and definition of reasonable and necessary. Issue: Oppose enforcement of linking Medicare Conditions of Participation (CoP) compliance with requiring that hospitals report 38 COVID-19 related measures. Issue: Support continuation of the 3-Day Skilled Nursing Facility (SNF) Stay waiver after the conclusion of the COVID-19 public health emergency. Issue: Oppose policy of incorporating revenue distinctions into the Medicare Shared Savings Program. Issue: Support permanent extension of Medicare telehealth waivers, including removing patient location restrictions and rural site requirements, allowing payment for audio-only services, and reimbursing providers for telehealth services as services delivered in-person. Issue: Support extension of Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support permanent extension of current Covid telehealth flexibilities HR 1332, the Telehealth Modernization Act Issue: Support efforts to expand patient access to telehealth HR 1397, the Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP Issue: Support efforts to improve access to childrens mental health care HR 5035, The Child Suicide Prevention and Lethal Means Safety Act Issue: Support expansion of training for health professionals to prevent self-harm or suicide Issue: Support funding to support hospital-based violence intervention programs and community violence interventions S. 2061 Telemental Health Care Access Act Issue: Support policy to remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create IME payments for outpatient services while remaining budget neutral. Issue: Support efforts to reverse cuts in Medicare OPPS reimbursements to hospitals for drugs acquired under the 340B program. Issue: Support extension of 24/7 nursing care waiver for Acute Hospital Care at Home program. Draft Value in Health Care Act Issue: Support changes to alternative payment models (APMs) to increase participation in value-based health programs and promote quality care and improved health outcomes. H.R. 3746 Accountable Care in Rural America Act Issue: Support improving 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.

Client expense: $1,068,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Economic Council (NEC), Natl Institutes of Health (NIH), Natl Science Foundation (NSF), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), Office of the Vice President of the United States, SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

a. Incentivize Domestic Manufacturing b. Hospital Infrastructure Support c. Value in health Care Act of 2021 d. Preserving Patient Access to Home Infusion Act e. S.308/H.R.1436 - PPE in America Act f. S.1260 - United States Innovation and Competition Act of 2021 g. S. 936 - INFORM Consumers Act h. S. 2648 - Rural ACO Improvement Act i. S. 1574 - Long-Term Care Pharmacy Definition Act j. S. 834 / H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 k. H.R.3173 - Improving Seniors Timely Access to Care Act of 2021 l. H.R. 3746 - Accountable Care in Rural America Act m. H.R.1319 - American Rescue Plan Act of 2021 n. H.R. 959- Black Maternal Health Momnibus Act of 2021

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Value in Healthcare Act HR.7791 Accountable Care in Rural America Act H.R.3746 Rural Health Glitch Bill S.2648

Client expense: $35,000 · 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. 1330 - "Patient Access to Higher Quality Health Care Act of 2021" - Oppose legislation that would repeal current law limiting self-referral to physician-owned hospitals. H.R. 2455 - "The Resetting the IMPACT Act (TRIA) of 2021" - Support legislation to refresh the unified PAC PPS timeline and process under the IMPACT Act. S. 999/H.R. 4066 - "Save Rural Hospitals Act of 2021" - Support a national wage index floor of .85 in a non-budget neutral manner. S. 1512 - "Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021" - Advocate in support of the CONNECT Act to expand access to telehealth services. H.R. 4587 - "Value in Health Care Act of 2021" - Support ACO program reforms. S. 1568 / H.R. 4407 - "Technical Reset to Advance the Instruction of Nurses Act" - Support legislation that would direct CMS not to seek repayment from nursing and allied health programs. H.R. 1887 - "Rural Hospital Support Act" - Support rural MDH and LVH program extensions. H.R. 3746 - "Accountable Care In Rural America Act" - Support rural health ACOs. Rural - Seek introduction of legislation that would remove the current 12% DSH payment cap that currently applies to rural hospitals (with some exceptions) as well as urban hospitals under 100 beds. Urged Congress to waive Statutory PAYGO and advocated for extending the 2% Medicare sequester moratorium.

Client expense: $570,000 · Firm income: Not reported

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

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

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

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

Medicare Shared Savings Program policies; H.R. 3746, Accountable Care in Rural America Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issue: Support policies to close the Medicaid coverage gap, including through ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. H.R. 2256 / S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: Support additional Medicare funding for graduate medical education S. 1438 Opioid Workforce Act/H.R. 3441 Substance Use Disorder Workforce Act Issue: Support additional Medicare funding for graduate medical education for addiction medicine, addiction psychiatry, and pain medicine residency programs S.1893, Draft House bill Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals Issue: Support efforts to increase physician workforce diversity through novel, targeted scholarship programs. Rural-Urban Physician Workforce Act Issue: Support improvements to Rural Training Track programs. Issue: Provide feedback to CMS on its proposed distribution of the 1,000 new GME slots authorized be the Consolidated Appropriations Act, 2021 as described in the 2022 Inpatient Prospective Payment System (IPPS) proposed rule. Support CMS adopting alternative 2 with modifications to allow for more than 1.0 FTE per hospital. Issue: Support Medicare Graduate Medical Education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts Issue: Oppose overly burdensome Medicaid GME transparency language. Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Draft, Medical Education for a Diverse America Act Issue: Ensure that time medical residents spend in unconscious bias training is counted toward the determination of FTE for Medicare GME Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives Draft, Improving Seniors Timely Access to Care Act Issue: Support protecting patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs HHS Rebate Rule Medicare Part D benefit re-design Issue: Support policies to reduce prescription drug prices Issue: Support implementation of the 21st Century Cures Act (Cures) interoperability and health data sharing provisions. Issue: Support changes and improvements to the Medicare Shared Savings Program. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Issue: Support expansion of Medicaid and CHIP coverage for postpartum women. H.R. 315 Medicare Sequester COVID Moratorium Act S. 748 Medicare Sequester Relief Act H.R. 1868 To prevent across-the-board direct spending cuts, and for other purposes. Issue: Support extension of Medicare sequester. Issue: Support clearing the PAYGO scorecard to avoid another Medicare sequester due to the use of reconciliation to pass the American Rescue Plan Act. Issue: Oppose use of extended Medicare sequester and repurposing of unused Provider Relief Fund as a financing mechanism for bipartisan infrastructure package. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support making permanent the CMS policy allowing teaching physicians to provide supervision via real-time, interactive audio/video technology to meet resident supervision requirements. Issue: Support making permanent the interim final rule that allows hospitals that unknowingly trigger their Medicare GME caps and per resident amounts to not have that happen and instead retain the ability to build a new resident cap / PRA so long as the cap / PRA is not above a minimum amount. Issue: Support CMS introducing new regulations to make permanent the interim final rule that ensures teaching hospitals that increased their number of inpatient beds to accommodate the surge in patients during the public health emergency to not have their Indirect Medical Education (IME) payments reduced by CMS. Issue: Oppose CMS hospital price transparency rule. Issue: Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Oppose finalizing proposed rule for Medicare Coverage of Innovative Technology (MCIT) and definition of reasonable and necessary. Issue: Oppose enforcement of linking Medicare Conditions of Participation (CoP) compliance with requiring that hospitals report 38 COVID-19 related measures. Issue: Support continuation of the 3-Day Skilled Nursing Facility (SNF) Stay waiver after the conclusion of the COVID-19 public health emergency. Issue: Oppose policy of incorporating revenue distinctions into the Medicare Shared Savings Program. Issue: Support permanent extension of Medicare telehealth waivers, including removing patient location restrictions and rural site requirements, allowing payment for audio-only services, and reimbursing providers for telehealth services as services delivered in-person. S. 2061 Telemental Health Care Access Act Issue: Support policy to remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create IME payments for outpatient services while remaining budget neutral. Issue: Support efforts to reverse cuts in Medicare OPPS reimbursements to hospitals for drugs acquired under the 340B program. Issue: Support extension of 24/7 nursing care waiver for Acute Hospital Care at Home program. Draft Value in Health Care Act Issue: Support changes to alternative payment models (APMs) to increase participation in value-based health programs and promote quality care and improved health outcomes. H.R. 3746 Accountable Care in Rural America Act Issue: Support improving 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. Issue: Support CMS change to the displaced residents rule, which makes the determination of when a resident is displaced consistent with the Inpatient Prospective Payment System rule.

Client expense: $1,187,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Economic Council (NEC), Natl Institutes of Health (NIH), Natl Science Foundation (NSF), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), Office of the Vice President of the United States, SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

Graduate Medical Education (GME): (1) Sent a letter to the CMS Administrator with other healthcare organizations asking to finalize certain methodology in the FY 2022 Inpatient Prospective Payment System (IPPS) proposed rule, with modifications, and increase the number of full time equivalent (FTE) slots awarded per hospital for FY 2023 and all succeeding years. (2) Sent letter with other healthcare organizations asking to support the physician workforce in the upcoming infrastructure package by increasing the number of GME positions. Accountable Care Organizations (ACO): (1) Sent a letter of support to bill sponsors of the Accountable Care In Rural America Act (H.R. 3746), which 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. (2) Sent a letter to HHS urging to extend Next Gen ACOs through 2022. CMS Administrator: Sent a letter welcoming Administrator Brooks-LaSure to CMS and outlining several MGMA administrative priorities for the year. CMMI: Sent a letter to CMMI Administrator Fowler welcoming her to CMMI and outlining recommendations for Alternative Payment Models (APMs). MSSP: Sent letter to HHS asking to delay mandatory MSSP quality reporting changes. Medicare reimbursement cuts: Sent a letter to Congress urging them to address FY 2022 Medicare cuts in the infrastructure package. Telehealth: Submitted testimony on telehealth expansion for both the W&M and E&C Committee hearings regarding telehealth. Step Therapy: Sent a letter to CMS urging for reinstatement of the step therapy prohibition on Part B drugs in MA plans. MIPS: Sent a letter to CMS urging to release MIPS cost measure benchmark data

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

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

Graduate Medical Education (GME): (1) Sent a letter to the CMS Administrator with other healthcare organizations asking to finalize certain methodology in the FY 2022 Inpatient Prospective Payment System (IPPS) proposed rule, with modifications, and increase the number of full time equivalent (FTE) slots awarded per hospital for FY 2023 and all succeeding years. (2) Sent letter with other healthcare organizations asking to support the physician workforce in the upcoming infrastructure package by increasing the number of GME positions. Accountable Care Organizations (ACO): (1) Sent a letter of support to bill sponsors of the Accountable Care In Rural America Act (H.R. 3746), which 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. (2) Sent a letter to HHS urging to extend Next Gen ACOs through 2022. CMS Administrator: Sent a letter welcoming Administrator Brooks-LaSure to CMS and outlining several MGMA administrative priorities for the year. CMMI: Sent a letter to CMMI Administrator Fowler welcoming her to CMMI and outlining recommendations for Alternative Payment Models (APMs). Provider Relief Fund (PRF): (1) Sent a letter to Secretary Becerra urging modifications to the PRF. (2) Sent a letter of support to the sponsors of Eliminating the Provider Relief Fund Tax Penalties Act (H.R. 2079), a bill which would eliminate the negative tax implications stemming from the PRF. HIPAA: Submitted comments on proposed modifications to the HIPAA Privacy Rule. MSSP: Sent letter to HHS asking to delay mandatory MSSP quality reporting changes. Medicare reimbursement cuts: Sent a letter to Congress urging them to address FY 2022 Medicare cuts in the infrastructure package. Telehealth: Submitted testimony on telehealth expansion for both the W&M and E&C Committee hearings regarding telehealth. Step Therapy: Sent a letter to CMS urging for reinstatement of the step therapy prohibition on Part B drugs in MA plans. MIPS: Sent a letter to CMS urging to release MIPS cost measure benchmark data Patient IDs: Sent a letter to Congress the reject the inclusion of rider language in the FY 2022 Labor, Health and Human Services, and Education and Related Agencies (Labor-HHS) Appropriations bill that prohibits the US Department of Health and Human Services (HHS) from spending any federal dollars to promulgate or adopt a national unique health identifier standard. OSHA COVID-19 Emergency Temporary Standard (ETS): Sent a letter to the Secretary of the Department of Labor asking to rescind or relay the OSHA healthcare ETS.

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

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

H.R. 1330, Patient Access to Higher Quality Health Care Act of 2021, all provisions H.R. 2807, PREVENT DIABETES Act, all provisions S. 2173, A bill to permit Centers for Disease Control and Prevention-recognized virtual diabetes prevention program suppliers to be included in the Medicare Diabetes Prevention Program Expanded Model conducted by the Center for Medicare and Medicaid Innovation under section 1115A of the Social Security Act (42 U.S.C. 1315a), all provisions H.R. 3447, Permanency for Audio-Only Telehealth Act, all provisions H.R. 3173, Improving Seniors Timely Access to Care Act of 2021, all provisions H.R. 3259, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions S. 586, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions H.R. 4040, To amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program, and for other purposes, all provisions H.R. 2503, Social Determinants Accelerator Act of 2021, all provisions H.R. 4014, To provide for a new building period with respect to the cap on full-time equivalent residents for purposes of payment for graduate medical education costs under the Medicare program for certain hospitals that have established a shortage specialty program, all provisions S. 2094, Physician Shortage GME Cap Flex Act of 2021, all provisions H.R. 2256, Resident Physician Shortage Reduction Act of 2021, all provisions S. 834, Resident Physician Shortage Reduction Act of 2021, all provisions H.R. 1332, Telehealth Modernization Act, all provisions S. 368, Telehealth Modernization Act, all provisions H.R. 366, Protecting Access to Post-COVID-19 Telehealth Act of 2021, all provisions H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021, all provisions H.R. 2228, Rural Behavioral Health Access Act of 2021, all provisions H.R. 2903, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, all provisions S. 1512, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, all provisions H.R. 3407, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions S. 411, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions H.R. 2347, Strengthening the Vaccines for Children Program Act of 2021, all provisions S. 801, Connected MOM Act, all provisions S. 346, Black Maternal Health Momnibus Act of 2021, all provisions H.R. 3441, Substance Use Disorder Workforce Act, all provisions S. 1438, Opioid Workforce Act of 2021, all provisions H.R. 3746, To amend title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program, all provisions H.R. 2144, Access to Genetic Counselor Services Act of 2021, all provisions S. 1450, Access to Genetic Counselor Services Act of 2021, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 19, Lower Costs, More Cures Act of 2021 H.R, 1738, Stabilize Medicaid and CHIP Coverage Act, all provisions H.R. 1025, Kids Access to Primary Care Act of 2021, all provisions H.R. 66, Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act, all provisions H.R. 3630, Lymphedema Treatment Act, all provisions S. 1315, Lymphedema Treatment Act, all provisions H.R. 1587, Medicare Audiologist Access and Services Act of 2021, all provisions Medicare program: Value in Healthcare Act Medicare program: No Surprises Act/implementation Medicare program: Physician payment issues/PAYGO and Sequester/Patient care barriers/mitigating future cuts/provider relief fund Medicare program: Medicare Access and CHIP Reauthorization Act (MACRA)/implementation/ oversight/reform Medicare program: MACRA Alternative Payment Models (APMs) Medicare program: MACRA/Accountable Care Organizations Medicare program: MACRA physician burdens Medicare program: FY22 Inpatient Prospective Payment System (IPPS)/Alternative 2 methodology Medicare program: FY22 IPPS/Medicare transplant payment policies Medicare program: FY 22 IPPS/Graduate Medical Education proposals Medicare program: Merit-based Incentive Payment System (MIPS)/Quality, Cost, Improvement Activities, Promoting Interoperability Medicare program: Digital quality measurement Medicare program: Physician self-referral Medicare program: Surprise Medical Billing Medicare program: Primary Care First model Medicare program: Appropriate Use Criteria (AUC) Medicare program: Provider compliance and regulatory relief Medicare program: Open Payments Medicare program: Medicare Shared Savings Program (MSSP)/Quality reporting changes Medicare program: Measure Application Partnership (MAP) Medicare program: Provider Enrollment, Chain, and Ownership System (PECOS)/Revalidation Medicare and Medicaid programs: E/M reimbursement changes Medicare and Medicaid programs: Remote Patient Monitoring Medicare and Medicaid programs: Health Insurance Portability and Accountability Act (HIPAA)/changes/Information Blocking Medicare and Medicaid programs: Health Equity Medicare and Medicaid programs: Coding Medicaid program: Justice for Incarcerated Moms Act Medicaid program: Funding for US territories Medicaid program: Special enrollment period Medicare program: Pediatric mental health care/access to behavioral health services Medicaid program: Medicaid program work requirements

Client expense: $4,220,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Education, Dept of, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA), White House Office