Rural Medical Residency Expansion Act of 2021

Issues related to Graduate Medical Education including H.R. 2256/ S. 834, Issues related to price transparency. Issues related to coronavirus, including funding and regulatory flexibility for providers. Issues related to the HHS Provider Relief Fund. Issues related to training of rural physicians including H.R. 4970. Issues related to extension of Medicare sequester. Issues related to telehealth. Issues related to lab-developed tests in academic medical centers.

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

Government targets: 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.

Rural Medical Residency Expansion Act of 2021 (H.R. 4970) Dr. Lorna Breen Health Care Provider Protection Act (S. 610/H.R. 1667) Medical Student Education Authorization Act (S. 3497/H.R. 6397) PREVENT Pandemics Act (S. 3799) Student Assisted Vaccination Effort (SAVE) Act (S. 2114 / H.R. 5699) Medicare-Graduate Medical Education National Health Service Corps Public Health Infrastructure and Emergency Preparedness Mental and Behavioral Health Funding for Health Professions NIH Approaches to Diversity, Equity, and Inclusion HRSA THCGME Program MedPAC Advisory Committee on Training in Primary Care Medicine and Dentistry NIH Interagency Pain Research Coordinating Committee Opioid Workforce Act (S. 1438) Substance Use Disorder Act (H.R. 3441) Rural Physician Workforce Production Act (S. 1893/H.R 8508) Doctors of Community (DOC) Act (S. 1958/H.R. 3671) Strengthening America's Health Care Readiness Act (S. 54) Graduate Medical Education Parity for DOs Improving Access to Health Care in Rural and Underserved Areas (S. 201/H.R. 7383) Public Readiness and Emergency Preparedness (PREP) Act Initiative to Strengthen Primary Health Care CMS FY23 Inpatient Prospective Payment Services Proposed Rule Physicians for Underserved Areas Act (S. 4234/H.R. 8692) Advisory Committee on Community-based Linkages (ACICBL) NIH Osteopathic Representation National Osteopathic Education Week (S. Res.595) Fair Access in Residency Act (H.R. 8850)

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

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.

Issues related to Graduate Medical Education including H.R. 2256/ S. 834, Issues related to price transparency. Issues related to coronavirus, including funding and regulatory flexibility for providers. Issues related to the HHS Provider Relief Fund. Issues related to training of rural physicians including H.R. 4970. Issues related to extension of Medicare sequester. Issues related to telehealth. Issues related to lab-developed tests in academic medical centers.

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

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

Rural Medical Residency Expansion Act of 2021 (H.R. 4970) Medical Student Education Authorization Act (S. 3497/H.R. 6397) PREVENT Pandemics Act (S. 3799) Student Assisted Vaccination Effort (SAVE) Act (S. 2114 / H.R. 5699) Medicare-Graduate Medical Education National Health Service Corps Public Health Infrastructure and Emergency Preparedness Mental and Behavioral Health Funding for Health Professions NIH Approaches to Diversity, Equity, and Inclusion HRSA THCGME Program MedPAC Advisory Committee on Training in Primary Care Medicine and Dentistry NIH Interagency Pain Research Coordinating Committee Opioid Workforce Act (S. 1438) Substance Use Disorder Act (H.R. 3441) Rural Physician Workforce Production Act (S. 1893) Doctors of Community (DOC) Act (S. 1958/H.R. 3671) Strengthening America's Health Care Readiness Act (S. 54) Graduate Medical Education Parity for DOs Improving Access to Health Care in Rural and Underserved Areas (S. 201/H.R. 7383) Public Readiness and Emergency Preparedness (PREP) Act Initiative to Strengthen Primary Health Care CMS FY23 Inpatient Prospective Payment Services Proposed Rule Physicians for Underserved Areas Act (S. 4234) Advisory Committee on Community-based Linkages (ACICBL) NIH Osteopathic Representation National Osteopathic Education Week (S. Res.595)

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

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.

Issues related to Graduate Medical Education including H.R. 2256/ S. 834, Issues related to price transparency. Issues related to coronavirus, including funding and regulatory flexibility for providers. Issues related to the HHS Provider Relief Fund. Issues related to training of rural physicians including H.R. 4970. Issues related to extension of Medicare sequester. Issues related to telehealth.

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

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

Rural Medical Residency Expansion Act of 2021 (H.R. 4970) Dr. Lorna Breen Health Care Provider Protection Act (S. 610/H.R. 1667) Medical Student Education Authorization Act (S. 3497/H.R. 6397) CMS FY22 Inpatient Prospective Payment Services Proposed Rule PREVENT Pandemics Act (S. 3799) Student Assisted Vaccination Effort (SAVE) Act (S. 2114 / H.R. 5699) Medicare-Graduate Medical Education NHSC Public Health Infrastructure and Emergency Preparedness Mental and Behavioral Health Funding for Health Professions NIH Approaches to Diversity, Equity, and Inclusion HRSA THCGME Program MedPAC Advisory Committee on Training in Primary Care Medicine and Dentistry NIH Interagency Pain Research Coordinating Committee Opioid Workforce Act (S. 1438) Substance Use Disorder Act (H.R. 3441) Rural Physician Workforce Production Act (S. 1893) Doctors of Community (DOC) Act (S. 1958/H.R. 3671) Strengthening America's Health Care Readiness Act (S. 54) Student Assisted Vaccination Effort (SAVE) Act (H.R. ?) Graduate Medical Education Parity for DOs Improving Access to Health Care in Rural and Underserved Areas (S. 201/H.R. 7383) Public Readiness and Emergency Preparedness (PREP) Act

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

Issues related to Graduate Medical Education including H.R. 2256/ S. 834, Issues related to price transparency. Issues related to coronavirus, including funding and regulatory flexibility for providers. Issues related to the HHS Provider Relief Fund. Issues related to training of rural physicians including H.R. 4970. Issues related to extension of Medicare sequester.

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

Government targets: 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. 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.

Issues related to Graduate Medical Education including H.R. 2256/ S. 834, Issues related to price transparency. Issues related to coronavirus, including funding and regulatory flexibility for providers. Issues related to the HHS Provider Relief Fund. Issues related to training of rural physicians including H.R. 4970.

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

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

H. Res. 349 - In support the goals of Overdose Awareness Day by lowering the United States flag to half-staff on all Federal buildings on August 31st of each year H.Res 538 - Bebe Moore Campbell BIPOC Mental Health Awareness Month H.R. 586/S. 1543- The STANDUP Act H.R. 588 - Stopping the Mental Health Pandemic Act H.R. 593 - Coronavirus Mental Health and Addiction Assistance Act of 2021 H.R. 654/S. 26 - Drug-Free Communities Pandemic Relief Act H.R. 666/ S. 162 - the Anti-Racism in Public Health Act H.R. 721/S. 1841 - Mental Health Services for Students Act H.R. 909/S. 484 - Moms Matter Act H.R. 912 - American Indian and Alaska Native Veterans Mental Health Act H.R. 925/S. 327 - Data to Save Moms Act H.R. 955/S. 285 - Medicaid Reentry Act H.R. 959/ S. 346 - the Black Maternal Health Momnibus Act H.R. 1025 - Kids Access to Primary Care Act of 2021 H.R. 1195 - the Workplace Violence Prevention for Health Care and Social Service Workers Act H.R. 1205/S. 2157 - Improving Mental Health Access from the Emergency Department Act H.R. 1324/S. 467 - Effective Suicide Screening and Assessment in the Emergency Department Act H.R. 1331 - the Strengthening Mental Health Supports for BIPOC Communities Act H.R. 1400 - the COVID-19 Health Disparities Action Act of 2021 H.R. 1475/S. 1795 - Pursuing Equity in Mental Health Act H.R. 1480 - Helping Emergency Responders Overcome (HERO) Act H.R. 1551/S.584 - Nutrition CARE Act H.R. 1554 - grants for community-based mental health and substance use disorder services H.R. 1587/S. 1731 - Medicare Audiologist Access and Services Act of 2021 H.R. 1667/S. 610 - Dr. Lorna Breen Health Care Provider Protection Act H.R. 1716/ S. 631 - the Covid-19 Mental Health Research Act H.R. 1738/S. 646 - Stabilize Medicaid and CHIP Act H.R. 2051/S. 854 - Methamphetamine Response Act of 2021 H.R. 2161/S. 971 - CAMRA Act Support Letter H.R. 2255/S. 1024 -the Healthcare Workforce Resilience Act H.R. 2256/S. 834 - the Resident Physician Shortage Reduction Act of 2021 H.R. 2264/ S. 660 - the Telemental Health Improvement Act H.R. 2364 - Synthetic Opioid Danger Awareness Act H.R. 2379 - State Opioid Response Grant Authorization Act of 2021 H.R. 2503 - Social Determinants Accelerator Act of 2021 H.R. 2591/S.957 - DUMP Opioids Act H.R. 2611 - Increasing Behavioral Health Treatment Act H.R. 2767/ S. 2144 - the Promoting Effective and Empowering Recovery Services (PEERS) in Medicare Act H.R. 2862 -the Campaign to Prevent Suicide Act H.R. 2874/S. 1576 - Behavioral Health Coverage Transparency Act of 2021 H.R. 2903/S. 1512 - the CONNECT for Health Act of 2021 H.R. 2929/ S. 157 - The Virtual Peer Support Act H.R. 2955 -the Suicide Prevention Act H.R. 2973 - the Strengthening Americas Families Act (SAFA) of 2021 H.R. 2981, the Suicide Prevention Lifeline Improvement Act of 2021 H.R. 3150/S. 1578 - the Mental Health Professionals Workforce Shortage Loan Repayment Act of 2021 H.R. 3407/S. 411 - Mothers and Offspring Mortality and Morbidity Awareness Act MOMMAs Act H.R. 3441 - The Substance Use Disorder Workforce Act of 2021 H.R. 3447 - Permanency for Audio-Only Telehealth Act H.R. 3450/S. 1727, the Medicaid Bump Act H.R. 3541/S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R.3467 - the Improving Data Collection for Adverse Childhood Experiences Act H.R. 3753/S. 1962 - Parity Implementation Assistance Act H.R. 3755/S. 1975 - the Womens Health Protection Act H.R. 3894 - Collecting and Analyzing Resources Integral and Necessary for Guidance (CARING) for Social Determinants Act of 2021 H.R. 3931 / S. 2069 - Excellence in Mental Health and Addiction Treatment Expansion Act H.R. 4026 - Social Determinants of Health Data Analysis Act of 2021 H.R. 4058/S. 2061- The Telemental Health Care Access Act H.R. 4146 - Therapeutic Fraud Prevention Act of 2021 H.R. 4151/S. 2238 - FASD Respect Act H.R.4217 - TRIUMPH for New Moms Act of 2021 H.R. 4305, the Crisis Care Enhancement Act H.R. 4351/S. 981 - CARA 3.0 Act of 2021 H.R. 4387/S. 1675 - Maternal Health Quality Improvement Act of 2021 H.R. 4406 - Supporting Medicaid in the U.S. Territories Act of 2021 H.R. 4510 - Health Enterprise Zones Act of 2021 H.R. 4554 - Care That's Fair Act H.R. 4631- Protecting Our Students by Terminating Graduate Rates that Add to Debt (POST GRAD) Act H.R. 4649 - Supporting Underserved Populations by Placing Our Resources in Trusts (SUPPORT) for Mental Health Act H.R. 4770- Evaluating Disparities and Outcomes of Telehealth During the COVID-19 Emergency Act of 2021 (EDOT Act) H.R. 4943 - the Childrens Mental Health Infrastructure Act of 2021 H.R. 4944, the Helping Kids Cope Act of 2021 H.R. 4970 - Rural Medical Residency Expansion Act of 2021 H.R. 5035 - Child Suicide Prevention and Lethal Means Safety Act H.R. 5218 - Collaborate in an Orderly and Cohesive Manner Act H.R. 5224 - Preventing Overdoses and Saving Lives Act of 2021 S. 674 - Public Health Infrastructure Saves Lives Act S. 1024 - Healthcare Workforce Resilience Act S. 1902 - Behavioral Health Crisis Services Expansion Act S. 2086/ - Resilience Investment, Support, and Expansion from Trauma Act (RISE from Trauma Act) (Bill # TBD) - LAI Buprenorphine Access Act (No legislation) Amend Section 1834(m) of the Social Security Act to ensure that the Secretary has the tools to transition following the end of the public health emergency and ensure telehealth is regulated the same as in-person services.    (No legislation)_Retain the 3.75% increase to conversion factor for FY 22 and 23 in the MPFS