Provider Relief Fund Improvement Act

H.R.4390 - PROTECT 340B Act of 2021 H.R.5963/S. 3611 - Provider Relief Fund Improvement Act H.R.7961 - SAVE Act HR 8576/S.4352 - Travel Nursing Agency Transparency Study Act Issues related to essential hospital designation Issues related to health equity Issues related to improving the provision of mental health care in the United States Issues related to reauthorizing the Hill-Burton program and allocating additional resources to essential hospitals Issues related to the 340B Drug Pricing program and contract pharmacies Issues related to the COVID-19 public health emergency Issues related to the health care workforce

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Public Health and Social Services Emergency Fund Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Resident Physician Shortage Act (S. 834/H.R. 2256) OSHA rule on COVID-19 Healthcare Workplace Safety No Surprises Act regulations Rural health care innovation (PA Rural Health Model and Community Health Access and Rural Transformation Model (CHART) Public Health Emergency designation COVID Data Reporting H.R.7961 - the SAVE Act Restoring Hope for Mental Health and Well-being Act Infrastructure Investment and Jobs Act Dr. Lorna Breen Health Care Provider Protection Act (HR 1667) Provider Relief Fund Improvement Act (H.R. 5963 / S. 3611) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Conrad State 30 & Physician Access Act Regulatory relief in light of coronavirus Vaccine mandate policy Healthcare Cybersecurity Act (S.3904) - collaboration between the CISA and HHS H. Res. 909 condemning violence against health care workers PREVENT Pandemics Act (S. 3799) Bipartisan Safer Communities Act (S. 2938) Health Care Capacity for Pediatric Mental Health Act Kids Mental Health Improvement Act Continuing Systems of Care for Children Act, Strengthen Kids Mental Health Now Act Cost of Mental Illness Act Community Health Center Mental Health Screening Act Greater Mental Health Access Act National Defense Authorization Act Travel Nursing Agency Transparency Study Act

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

Government targets: HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

H.R.1319, American Rescue Plan Act of 2021, To secure provider relief for assisted living and other senior congregate care communities; H.R.1799, PPP Extension Act of 2021, To extend the deadline for application of paycheck protection program loans for eligible senior living providers; H.R.842, Protecting the Right to Organize Act of 2021, To prevent legislation that would exacerbate workforce challenges among senior living providers; S.420, Protecting the Right to Organize Act of 2021, To prevent legislation that would exacerbate workforce challenges among senior living providers; H.R.1848, Leading Infrastructure for Tomorrow's America Act, To advance measures that will target national investments in the infrastructure needs of long-term care facilities; H.R.331, the Nurses CARE Act, to extend temporary nurse aide authorizations and meet care needs of seniors; H.R.4131, the Better Care Betters Jobs Act, to support investments in long-term care services specifically for home and community based services; S.2210, the Better Care Betters Jobs Act, to support investments in long-term care services specifically for home and community based services; H.R.5376, the Build Back Better Act, to support investments in long-term care services and workforce development; H.R.5823, the Pandemic Risk Insurance Act, to provide federal reinsurance for pandemic related losses and ensure availability of coverage related to pandemics; H.R.5963, he Provider Relief Fund Improvement Act, to release all available provider relief funds to reimburse expenses and losses attributed to COVID-19; H.R.6161, the Employee Retention Tax Credit Reinstatement Act, to restore eligibility for senior living providers to claim the tax credit that was ended prematurely, and help with workforce challenges; H.R.6530, the SENIOR Act of 2022, to provide targeted financial relief for senior living providers and workforce development grants to address staffing shortages; S.2415, the Long-Term Care Affordability Act, to provide additional tax-preferred savings options for Americans to plan for their long-term care needs; H.R.7107, the Long-Term Care Affordability Act, to provide additional tax-preferred savings options for Americans to plan for their long-term care needs; S.3799, PREVENT Pandemics Act, to plan for and better prepare for future pandemics and the impact on senior living operators; S.3611, the Provider Relief Fund Improvement Act, to release all available provider relief funds to reimburse expenses and losses attributed to COVID-19; S.4169, the Expanding Veterans Options for Long Term Care Act, to establish a pilot program to allow Veterans to access assisted living care services; H.R.447, the National Apprenticeship Act of 2021, to provide the DOL's Office of Apprenticeships statutory authority to address workforce shortages; H.R.3807, The Restaurant Revitalization Fund Replenishment Act of 2021, to provide supplemental relief for certain businesses impacted by COVID-19; H.R.8750, the Expanding Veterans Options for Long Term Care Act, to establish a pilot program to allow Veterans to access assisted living care services.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, White House Office

Provider Relief Fund Deadline Extension Act (S. 2493/H.R. 4735) Public Health and Social Services Emergency Fund Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Resident Physician Shortage Act (S. 834/H.R. 2256) No Surprises Act regulations Rural health care innovation (PA Rural Health Model and Community Health Access and Rural Transformation Model (CHART) Public Health Emergency designation COVID Data Reporting Dr. Lorna Breen Health Care Provider Protection Act (HR 1667) Provider Relief Fund Improvement Act (H.R. 5963 / S. 3611) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Conrad State 30 & Physician Access Act H.R. Res. 909 condemning violence against health care workers PREVENT Pandemics Act (S. 3799)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

S 464/HR 2163 Safe Step Act - implementing safe guards around step therapy (fail first) programs in ERISA regulated plans HR 1550 - PREVENT HPV Cancers Act of 2021 HR 3258 - TACT Act of 2021- improve patient access to anti-cancer oral medications HR 4385/S 3080- Cancer Drug Parity Act of 2021- oral parity HR 5801- HELP Copays Act- copay accumulator programs S 3039/HR 2503- Social Determinants Accelerator Act of 2021- SDOH HR 5030/S 2706- DIVERSE Trials Act- access to clinical trials HR 6584- DEPICT Act- access to clinical trials HR 6000- Cures 2.0 HR 5963/S 3611- Provider Relief Fund Improvement Act- extends deadlines, expands the uses of, and makes other changes pertaining to the Provider Relief Fund HR 4450/S 2352- Access to Infertility Treatment and Care Act- requires private insurance to cover fertility preservation services ARPA-H FDA User Fee Agreement policy riders: increasing diversity in clinical trials, improvements to accelerated approval pathway, expanded use of real world data, and in vitro clinical tests HR 7630/S 4120- Childhood Cancer STAR Reauthorization Act of 2022- reauthorizes the STAR Act through FY2028 S 4293- Pharmacy Benefit Manager Transparency Act of 2022- prevents unfair and deceptive acts or practices and the dissemination of false information related to pharmacy benefit management services for prescription drugs S 4430- Interagency Patent Coordination and Improvement Act of 2022- establishes an interagency taskforce between the United States Patent and Trademark Office and the FDA

Client expense: $125,406 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 3611 and H.R. 5963, the Provider Relief Fund Improvement Act, all provisions. Concerns about proposed payment rate decreases for hospitals in FY 2023 from CMS and requesting advocacy with the agency.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.4390 - PROTECT 340B Act of 2021 H.R.5963/S. 3611 - Provider Relief Fund Improvement Act H.R.7961 - SAVE Act Issues related to allocating additional resources to support safety net hospitals and their workforce responding to COVID-19 Issues related to health equity Issues related to improving the provision of mental health care in the United States Issues related to reauthorizing the Hill-Burton program and allocating additional resources to essential hospitals Issues related to the 340B Drug Pricing program and contract pharmacies Issues related to the COVID-19 public health emergency Issues related to the health care workforce Issues related to the Healthy Future Task Force S.4352 - Travel Nursing Agency Transparency Study Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

H.R.1319, American Rescue Plan Act of 2021, To secure provider relief for assisted living and other senior congregate care communities; H.R.1799, PPP Extension Act of 2021, To extend the deadline for application of paycheck protection program loans for eligible senior living providers; H.R.842, Protecting the Right to Organize Act of 2021, To prevent legislation that would exacerbate workforce challenges among senior living providers; S.420, Protecting the Right to Organize Act of 2021, To prevent legislation that would exacerbate workforce challenges among senior living providers; H.R.1848, Leading Infrastructure for Tomorrow's America Act, To advance measures that will target national investments in the infrastructure needs of long-term care facilities; H.R.331, the Nurses CARE Act, to extend temporary nurse aide authorizations and meet care needs of seniors; H.R.4131, the Better Care Betters Jobs Act, to support investments in long-term care services specifically for home and community based services; S.2210, the Better Care Betters Jobs Act, to support investments in long-term care services specifically for home and community based services; H.R.5376, the Build Back Better Act, to support investments in long-term care services and workforce development; H.R.5823, the Pandemic Risk Insurance Act, to provide federal reinsurance for pandemic related losses and ensure availability of coverage related to pandemics; H.R.5963, he Provider Relief Fund Improvement Act, to release all available provider relief funds to reimburse expenses and losses attributed to COVID-19; H.R.6161, the Employee Retention Tax Credit Reinstatement Act, to restore eligibility for senior living providers to claim the tax credit that was ended prematurely, and help with workforce challenges; H.R.6530, the SENIOR Act of 2022, to provide targeted financial relief for senior living providers and workforce development grants to address staffing shortages; S.2415, the Long-Term Care Affordability Act, to provide additional tax-preferred savings options for Americans to plan for their long-term care needs; H.R.7107, the Long-Term Care Affordability Act, to provide additional tax-preferred savings options for Americans to plan for their long-term care needs; S.3799, PREVENT Pandemics Act, to plan for and better prepare for future pandemics and the impact on senior living operators; S.3611, the Provider Relief Fund Improvement Act, to release all available provider relief funds to reimburse expenses and losses attributed to COVID-19; S.4169, the Expanding Veterans Options for Long Term Care Act, to establish a pilot program to allow Veterans to access assisted living care services; H.R.447, the National Apprenticeship Act of 2021, to provide the DOL's Office of Apprenticeships statutory authority to address workforce shortages; H.R.3807, The Restaurant Revitalization Fund Replenishment Act of 2021, to provide supplemental relief for certain businesses impacted by COVID-19.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

S 464/HR 2163 Safe Step Act - implementing safe guards around step therapy (fail first) programs in ERISA regulated plans HR 1550 - PREVENT HPV Cancers Act of 2021 HR 3258 - TACT Act of 2021- improve patient access to anti-cancer oral medications HR 4385/S 3080- Cancer Drug Parity Act of 2021- oral parity HR 5801- HELP Copays Act- copay accumulator programs S 3039/HR 2503- Social Determinants Accelerator Act of 2021- SDOH HR 5030/S 2706- DIVERSE Trials Act- access to clinical trials HR 6584- DEPICT Act- access to clinical trials HR 6000- Cures 2.0 HR 5963/S 3611- Provider Relief Fund Improvement Act- extends deadlines, expands the uses of, and makes other changes pertaining to the Provider Relief Fund HR 4450/S 2352- Access to Infertility Treatment and Care Act- requires private insurance to cover fertility preservation services ARPA-H FDA User Fee Agreement Reauthorization

Client expense: $155,610 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 3611 and H.R. 5963, the Provider Relief Fund Improvement Act, all provisions. Concerns about proposed payment rate decreases for hospitals in FY 2023 from CMS possible advocacy with the agency. Concerns about the methodology payment that CMS has applied for the Medicare Shared Savings Program (MSSP).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Provider Relief Fund Deadline Extension Act (S. 2493/H.R. 4735) Build Back Better Act (H.R. 5376) Public Health and Social Services Emergency Fund Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Resident Physician Shortage Act (S. 834/H.R. 2256) OSHA rule on COVID-19 Healthcare Workplace Safety No Surprises Act regulations Rural health care innovation (PA Rural Health Model and Community Health Access and Rural Transformation Model (CHART) Public Health Emergency designation COVID Data Reporting H.R.7961 - the SAVE Act Restoring Hope for Mental Health and Well-being Act Infrastructure Investment and Jobs Act Dr. Lorna Breen Health Care Provider Protection Act (HR 1667) Provider Relief Fund Improvement Act (H.R. 5963 / S. 3611) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Conrad State 30 & Physician Access Act Regulatory relief in light of coronavirus Vaccine mandate policy Healthcare Cybersecurity Act (S.3904) - collaboration between the CISA and HHS Blood shortages H. Res. 909 condemning violence against health care workers PREVENT Pandemics Act (S. 3799) Bipartisan Safer Communities Act (S. 2938)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Provider Relief Fund Deadline Extension Act (S. 2493/H.R. 4735) Infrastructure Investment and Jobs Act Build Back Better Act (H.R. 5376) Dr. Lorna Breen Health Care Provider Protection Act (HR 1667) Provider Relief Fund Improvement Act (H.R. 5963 / S. 3611) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Conrad State 30 & Physician Access Act Public Health and Social Services Emergency Fund Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Resident Physician Shortage Act (S. 834/H.R. 2256) OSHA rule on COVID-19 Healthcare Workplace Safety No Surprises Act regulations Rural health care innovation (PA Rural Health Model and Community Health Access and Rural Transformation Model (CHART) Public Health Emergency designation PREVENT Pandemics Act (S. 3799)

Client expense: $260,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Area Wage Index - New Brunswick-Lakewood CBSA; Radiation Oncology Model; Surprise Billing - Qualified Payment Amount; Site-neutral payment/BBA 2015 Sec. 603; Build Back Better Act (H.R. 5376); Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610); Protecting the American Taxpayer and Medicare Act (S. 3344); Supporting Health Care Providers During the COVID-19 Pandemic Act (H.R. 6143); Supporting Medicare Providers Act of 2021 (S. 3314); Infrastructure Investment and Jobs Act (H.R. 3684); Resident Physician Shortage Reduction Act of 2021 (S.834); Accelerating Access to Critical Therapies for ALS Act (H.R. 3537/S. 1813); Comprehensive Addiction Resources Emergency Act of 2021 (H.R. 6311/S. 3418); Expanding Medical Education Act (H.R. 801/S. 3422); Opioid Treatment Access Act of 2022 (H.R. 6279); Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667); Capping Prescription Costs Act of 2021 (H.R. 6228/S. 3339); No COVID-19 Vaccination Mandate Act of 2021 (H.R. 6170); Cures 2.0 Act (H.R. 6000); Respecting Our Frontline Workers Act (S. 3225); Provider Relief Fund Improvement Act (H.R. 5963); Inpatient Opioid Safety Act of 2021 (H.R. 5932); LOCAL HEALTH Act (H.R. 5898); Keeping Our COVID-19 Heroes Employed Act (H.R. 5860); Expanded Telehealth Access Act (H.R. 2168/S. 3193); Healthy Competition for Better Care Act (S. 3139); Hospital Revitalization Act of 2021 (S. 3105); Choose Home Care Act of 2021 (H.R. 5514/S. 2562); Good Samaritan Health Professionals Act of 2021 (H.R. 5239/S. 2941); 340B Accountability Act of 2021 (S. 2837).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Area Wage Index - New Brunswick-Lakewood CBSA; Radiation Oncology Model; Surprise Billing - Qualified Payment Amount; Site-neutral payment/BBA 2015 Sec. 603; Build Back Better Act (H.R. 5376); Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610); Protecting the American Taxpayer and Medicare Act (S. 3344); Supporting Health Care Providers During the COVID-19 Pandemic Act (H.R. 6143); Supporting Medicare Providers Act of 2021 (S. 3314); Infrastructure Investment and Jobs Act (H.R. 3684); Resident Physician Shortage Reduction Act of 2021 (S.834); Accelerating Access to Critical Therapies for ALS Act (H.R. 3537/S. 1813); Comprehensive Addiction Resources Emergency Act of 2021 (H.R. 6311/S. 3418); Expanding Medical Education Act (H.R. 801/S. 3422); Opioid Treatment Access Act of 2022 (H.R. 6279); Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667); Capping Prescription Costs Act of 2021 (H.R. 6228/S. 3339); No COVID-19 Vaccination Mandate Act of 2021 (H.R. 6170); Cures 2.0 Act (H.R. 6000); Respecting Our Frontline Workers Act (S. 3225); Provider Relief Fund Improvement Act (H.R. 5963); Inpatient Opioid Safety Act of 2021 (H.R. 5932); LOCAL HEALTH Act (H.R. 5898); Keeping Our COVID-19 Heroes Employed Act (H.R. 5860); Expanded Telehealth Access Act (H.R. 2168/S. 3193); Healthy Competition for Better Care Act (S. 3139); Hospital Revitalization Act of 2021 (S. 3105); Choose Home Care Act of 2021 (H.R. 5514/S. 2562); Good Samaritan Health Professionals Act of 2021 (H.R. 5239/S. 2941); 340B Accountability Act of 2021 (S. 2837).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Area Wage Index - New Brunswick-Lakewood CBSA; Radiation Oncology Model; Surprise Billing - Qualified Payment Amount; Site-neutral payment/BBA 2015 Sec. 603; Build Back Better Act (H.R. 5376); Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610); Protecting the American Taxpayer and Medicare Act (S. 3344); Supporting Health Care Providers During the COVID-19 Pandemic Act (H.R. 6143); Supporting Medicare Providers Act of 2021 (S. 3314); Infrastructure Investment and Jobs Act (H.R. 3684); Resident Physician Shortage Reduction Act of 2021 (S.834); Accelerating Access to Critical Therapies for ALS Act (H.R. 3537/S. 1813); Comprehensive Addiction Resources Emergency Act of 2021 (H.R. 6311/S. 3418); Expanding Medical Education Act (H.R. 801/S. 3422); Opioid Treatment Access Act of 2022 (H.R. 6279); Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667); Capping Prescription Costs Act of 2021 (H.R. 6228/S. 3339); No COVID-19 Vaccination Mandate Act of 2021 (H.R. 6170); Cures 2.0 Act (H.R. 6000); Respecting Our Frontline Workers Act (S. 3225); Provider Relief Fund Improvement Act (H.R. 5963); Inpatient Opioid Safety Act of 2021 (H.R. 5932); LOCAL HEALTH Act (H.R. 5898); Keeping Our COVID-19 Heroes Employed Act (H.R. 5860); Expanded Telehealth Access Act (H.R. 2168/S. 3193); Healthy Competition for Better Care Act (S. 3139); Hospital Revitalization Act of 2021 (S. 3105); Choose Home Care Act of 2021 (H.R. 5514/S. 2562); Good Samaritan Health Professionals Act of 2021 (H.R. 5239/S. 2941); 340B Accountability Act of 2021 (S. 2837).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Area Wage Index - New Brunswick-Lakewood CBSA; Radiation Oncology Model; Surprise Billing - Qualified Payment Amount; Site-neutral payment/BBA 2015 Sec. 603; Build Back Better Act (H.R. 5376); Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610); Protecting the American Taxpayer and Medicare Act (S. 3344); Supporting Health Care Providers During the COVID-19 Pandemic Act (H.R. 6143); Supporting Medicare Providers Act of 2021 (S. 3314); Infrastructure Investment and Jobs Act (H.R. 3684); Resident Physician Shortage Reduction Act of 2021 (S.834); Accelerating Access to Critical Therapies for ALS Act (H.R. 3537/S. 1813); Comprehensive Addiction Resources Emergency Act of 2021 (H.R. 6311/S. 3418); Expanding Medical Education Act (H.R. 801/S. 3422); Opioid Treatment Access Act of 2022 (H.R. 6279); Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667); Capping Prescription Costs Act of 2021 (H.R. 6228/S. 3339); No COVID-19 Vaccination Mandate Act of 2021 (H.R. 6170); Cures 2.0 Act (H.R. 6000); Respecting Our Frontline Workers Act (S. 3225); Provider Relief Fund Improvement Act (H.R. 5963); Inpatient Opioid Safety Act of 2021 (H.R. 5932); LOCAL HEALTH Act (H.R. 5898); Keeping Our COVID-19 Heroes Employed Act (H.R. 5860); Expanded Telehealth Access Act (H.R. 2168/S. 3193); Healthy Competition for Better Care Act (S. 3139); Hospital Revitalization Act of 2021 (S. 3105); Choose Home Care Act of 2021 (H.R. 5514/S. 2562); Good Samaritan Health Professionals Act of 2021 (H.R. 5239/S. 2941); 340B Accountability Act of 2021 (S. 2837).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Area Wage Index - New Brunswick-Lakewood CBSA; Radiation Oncology Model; Surprise Billing - Qualified Payment Amount; Site-neutral payment/BBA 2015 Sec. 603; Build Back Better Act (H.R. 5376); Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610); Protecting the American Taxpayer and Medicare Act (S. 3344); Supporting Health Care Providers During the COVID-19 Pandemic Act (H.R. 6143); Supporting Medicare Providers Act of 2021 (S. 3314); Infrastructure Investment and Jobs Act (H.R. 3684); Resident Physician Shortage Reduction Act of 2021 (S.834); Accelerating Access to Critical Therapies for ALS Act (H.R. 3537/S. 1813); Comprehensive Addiction Resources Emergency Act of 2021 (H.R. 6311/S. 3418); Expanding Medical Education Act (H.R. 801/S. 3422); Opioid Treatment Access Act of 2022 (H.R. 6279); Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667); Capping Prescription Costs Act of 2021 (H.R. 6228/S. 3339); No COVID-19 Vaccination Mandate Act of 2021 (H.R. 6170); Cures 2.0 Act (H.R. 6000); Respecting Our Frontline Workers Act (S. 3225); Provider Relief Fund Improvement Act (H.R. 5963); Inpatient Opioid Safety Act of 2021 (H.R. 5932); LOCAL HEALTH Act (H.R. 5898); Keeping Our COVID-19 Heroes Employed Act (H.R. 5860); Expanded Telehealth Access Act (H.R. 2168/S. 3193); Healthy Competition for Better Care Act (S. 3139); Hospital Revitalization Act of 2021 (S. 3105); Choose Home Care Act of 2021 (H.R. 5514/S. 2562); Good Samaritan Health Professionals Act of 2021 (H.R. 5239/S. 2941); 340B Accountability Act of 2021 (S. 2837).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Area Wage Index - New Brunswick-Lakewood CBSA; Radiation Oncology Model; Surprise Billing - Qualified Payment Amount; Site-neutral payment/BBA 2015 Sec. 603; Build Back Better Act (H.R. 5376); Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610); Protecting the American Taxpayer and Medicare Act (S. 3344); Supporting Health Care Providers During the COVID-19 Pandemic Act (H.R. 6143); Supporting Medicare Providers Act of 2021 (S. 3314); Infrastructure Investment and Jobs Act (H.R. 3684); Resident Physician Shortage Reduction Act of 2021 (S.834); Accelerating Access to Critical Therapies for ALS Act (H.R. 3537/S. 1813); Comprehensive Addiction Resources Emergency Act of 2021 (H.R. 6311/S. 3418); Expanding Medical Education Act (H.R. 801/S. 3422); Opioid Treatment Access Act of 2022 (H.R. 6279); Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667); Capping Prescription Costs Act of 2021 (H.R. 6228/S. 3339); No COVID-19 Vaccination Mandate Act of 2021 (H.R. 6170); Cures 2.0 Act (H.R. 6000); Respecting Our Frontline Workers Act (S. 3225); Provider Relief Fund Improvement Act (H.R. 5963); Inpatient Opioid Safety Act of 2021 (H.R. 5932); LOCAL HEALTH Act (H.R. 5898); Keeping Our COVID-19 Heroes Employed Act (H.R. 5860); Expanded Telehealth Access Act (H.R. 2168/S. 3193); Healthy Competition for Better Care Act (S. 3139); Hospital Revitalization Act of 2021 (S. 3105); Choose Home Care Act of 2021 (H.R. 5514/S. 2562); Good Samaritan Health Professionals Act of 2021 (H.R. 5239/S. 2941); 340B Accountability Act of 2021 (S. 2837).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Area Wage Index - New Brunswick-Lakewood CBSA; Radiation Oncology Model; Surprise Billing - Qualified Payment Amount; Site-neutral payment/BBA 2015 Sec. 603; Build Back Better Act (H.R. 5376); Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610); Protecting the American Taxpayer and Medicare Act (S. 3344); Supporting Health Care Providers During the COVID-19 Pandemic Act (H.R. 6143); Supporting Medicare Providers Act of 2021 (S. 3314); Infrastructure Investment and Jobs Act (H.R. 3684); Resident Physician Shortage Reduction Act of 2021 (S.834); Accelerating Access to Critical Therapies for ALS Act (H.R. 3537/S. 1813); Comprehensive Addiction Resources Emergency Act of 2021 (H.R. 6311/S. 3418); Expanding Medical Education Act (H.R. 801/S. 3422); Opioid Treatment Access Act of 2022 (H.R. 6279); Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667); Capping Prescription Costs Act of 2021 (H.R. 6228/S. 3339); No COVID-19 Vaccination Mandate Act of 2021 (H.R. 6170); Cures 2.0 Act (H.R. 6000); Respecting Our Frontline Workers Act (S. 3225); Provider Relief Fund Improvement Act (H.R. 5963); Inpatient Opioid Safety Act of 2021 (H.R. 5932); LOCAL HEALTH Act (H.R. 5898); Keeping Our COVID-19 Heroes Employed Act (H.R. 5860); Expanded Telehealth Access Act (H.R. 2168/S. 3193); Healthy Competition for Better Care Act (S. 3139); Hospital Revitalization Act of 2021 (S. 3105); Choose Home Care Act of 2021 (H.R. 5514/S. 2562); Good Samaritan Health Professionals Act of 2021 (H.R. 5239/S. 2941); 340B Accountability Act of 2021 (S. 2837).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.5963/S. 3611 - Provider Relief Fund Improvement Act (just need to add the Senate bill #) issues related to allocating additional resources to support safety net hospitals and their workforce responding to COVID-19 issues related to extending repayments for the Medicare Advanced and Accelerated payments issues related to improving the provision of mental health care in the United States issues related to reauthorizing the Hill-Burton program and allocating additional resources to essential hospitals issues related to the COVID-19 public health emergency Issues related to the health care workforce Issues related to the Healthy Future Task Force S.3799 - PREVENT Pandemics Act H.R. 7236 - Strengthen Kids Mental Health Now Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Build Back Better Act (H.R. 5376) - Supported policies to encourage health care coverage and close the Medicaid coverage gap. Urged additional pandemic financial support for hospitals. Advocated for investments for hospitals and health care providers, including physical structure improvements, workforce and graduate medical education support. Public Health Emergency - Advocated for HHS to further extend the declared Public Health Emergency. Telehealth -Supported provisions in the Consolidated Appropriations Act, 2022 (H.R. 2471) to temporarily extend certain flexibilities after the end of the public health emergency. Supported passage of the CONNECT for Health Act (S. 1512/H.R. 2903) to make telehealth flexibilities permanent. Encouraged reimbursement parity for certain telehealth services and support for audio-only telehealth services. Health Care Workforce - Urged passage of the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act (H.R. 708; S. 168); The Health Care Workforce Resilience Act (S. 1024/H.R. 2255); The Dr. Lorna Breen Health Care Provider Protection Act (S.610/H.R. 1667); The Resident Physician Shortage Reduction Act (S.834/H.R. 2256). The Opioid Workforce Act (S. 1438/H.R. 3441). Urged administration to examine practices of health care staffing agencies. Health Care Supply Chain - Advocated for the importance of hospital group purchasing organizations, and highlighted role in supporting supply chain resiliency to secure essential, authentic medical supplies for hospitals throughout the course of the COVID-19 pandemic. Engaged to support policies to limit shortages of prescription drugs. Advocated for greater transparency in the health care supply chain for drugs and medical devices. Prepare for and Respond to Existing Viruses, Emerging New Threats, and (PREVENT) Pandemics Act (S. 3799) - monitored introduction of PREVENT Pandemics Act. Supported inclusion of provisions to improve supply chain transparency and extend shelf life of prescription drugs. Supported passage of the Integrity, Notification, Fairness in Online Retail Marketplaces (INFORM) Consumers Act (S. 963/H.R. 5502). Provider Relief Fund - Urged HHS and Congress to offer greater flexibility and extend deadlines for hospitals to utilize PRF funding and provide clear guidance on reporting expectations. Supported Provider Relief Deadline Extension Act (S. 2493) and Provider Relief Fund Improvement Act (H.R. 5963/S.3611). Drug Pricing - Reviewed options to further support modifications to the unapproved drugs initiative that would prevent or limit price increases for older, unapproved drugs. Supported changes to the 340B program and urged HHS to enforce guidance that would allow 340B Covered Entities to utilize contract pharmacies. Advocated for HHS to offer additional 340B Drug Pricing Program eligibility flexibility for hospitals that have had patient mix changed during the COVID-19 public health emergency (S. 773). Supported inclusion of provisions in Consolidated Appropriations Act, 2022 (H.R. 2471) that would extend eligibility for covered entities that may have lost eligibility during the public health emergency. Medical Device User Fee Amendments - Urged greater authorities for the FDA to promote supply chain transparency. Generic Drug User Fee Amendments - Supported rapid adoption of generic drug user fee amendments, and urged inclusion of clarifying language related to the Unapproved Drugs Initiative and the PASTUER Act (S.2076). Social Determinants of Health and Health Equity - Shared insights and offered suggestions to CMS regarding health equity measurement, indices and data collection. Supported the Social Determinants Accelerator Act (H.R. 2503; S. 3039); The LINC to Address Social Needs Act (S. 509). Antimicrobial resistance (S. 2076) - Supported passage of the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act. Supported passage of Opioid Treatment Access Act (S. 3629/H.R. 6279). Supported passage of Drug Shortage Shelf Life Extension Act (S. 3493).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Consolidated Appropriations Act (H.R. 2471) Build Back Better Act H.R 5376 (Reconciliation bill Dr. Lorna Breen Health Care Provider Protection Act S. 4349/HR 809 Provider Relief Fund Improvement Act H.R. 5963/S. 3611 Healthcare Workforce Resilience Act of 2021 Rural America Health Corps Act S.54 Maternal health: MOMMAs Act S. 411/HR 3407; Black Maternal Health Omnibus Act of 2021 S. 346/H.R. 959; Data to Save Moms Act S. 347/HR 925; IMPACT to Save Moms Act S 1675/HR 4387; Maternal Health Quality Improvement Act S. 1675/H.R. 4387 Conrad State 30 & Physician Access Reauthorization Act S. 1810/H.R. 3541 Public Health and Social Services Emergency Fund Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Rural Hospital Closure Relief Act H.R. 1639/S.644 Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885) Rural America Health Corps Act (S. 924/H.R. 2130), Strengthening Americas Health Care Readiness Act (S. 54) Social Determinants Accelerator Act (H.R. 2503), Leveraging Integrated Networks in Communities (LINC) to Address Social Needs Act (S. 509) OSHA rule on COVID-19 Healthcare Workplace Safety Drug-price Transparency for Competition (DTC) Act (S. 2304) No Surprises Act regulations Protecting Providers Everywhere in America Act (S. 308/H.R. 1436) 340B legislation (S. 773 HR 3203) Childrens Mental Health Infrastructure Act H.R. 4945; Helping Kids Cope Act H.R. 4944; Child Suicide Prevention and Lethal Means Safety Act H.R. 5035 HEALTH CARE REFORM - Discussions about addressing social determinants of health

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

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

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

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

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

S. 3611 and H.R. 5963, the Provider Relief Fund Improvement Act, all provisions.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provider Relief Fund Deadline Extension Act (S. 2493/H.R. 4735) Infrastructure Investment and Jobs Act Build Back Better Act (H.R. 5376) Dr. Lorna Breen Health Care Provider Protection Act (HR 1667) Provider Relief Fund Improvement Act (H.R. 5963 / S. 3611) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Conrad State 30 & Physician Access Act Public Health and Social Services Emergency Fund Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Resident Physician Shortage Act (S. 834/H.R. 2256) OSHA rule on COVID-19 Healthcare Workplace Safety No Surprises Act regulations Rural health care innovation (PA Rural Health Model and Community Health Access and Rural Transformation Model (CHART) Public Health Emergency designation COVID Data Reporting Vaccine mandate policy Healthcare Cybersecurity Act (S.3904) - collaboration between the CISA and HHS Blood shortages H. Res. 909 condemning violence against health care workers PREVENT Pandemics Act (S. 3799)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provider Relief Fund Deadline Extension Act (S. 2493/H.R. 4735) Dr. Lorna Breen Health Care Provider Protection Act (S. 4349/H.R. 8094) Provider Relief Fund Improvement Act (H.R. 5963) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Conrad State 30 & Physician Access Act Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Strengthening Americas Health Care Readiness Act (S. 54) Resident Physician Shortage Act (S. 834/H.R. 2256) No Surprises Act regulations Rural health care innovation (PA Rural Health Model and Community Health Access and Rural Transformation Model (CHART) Public Health Emergency designation Executive Order on Promoting Competition in the American Economy COVID Data Reporting Vaccine mandate policy

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1319, American Rescue Plan Act of 2021, To secure provider relief for assisted living and other senior congregate care communities; H.R.1799, PPP Extension Act of 2021, To extend the deadline for application of paycheck protection program loans for eligible senior living providers; H.R.842, Protecting the Right to Organize Act of 2021, To prevent legislation that would exacerbate workforce challenges among senior living providers; S.420, Protecting the Right to Organize Act of 2021, To prevent legislation that would exacerbate workforce challenges among senior living providers; H.R.1848, Leading Infrastructure for Tomorrow's America Act, To advance measures that will target national investments in the infrastructure needs of long-term care facilities; H.R.331, the Nurses CARE Act, to extend temporary nurse aide authorizations and meet care needs of seniors; H.R.4131, the Better Care Betters Jobs Act, to support investments in long-term care services specifically for home and community based services; S.2210, the Better Care Betters Jobs Act, to support investments in long-term care services specifically for home and community based services; H.R.5376, the Build Back Better Act, to support investments in long-term care services and workforce development; H.R.5823, the Pandemic Risk Insurance Act, to provide federal reinsurance for pandemic related losses and ensure availability of coverage related to pandemics; H.R.5963, he Provider Relief Fund Improvement Act, to release all available provider relief funds to reimburse expenses and losses attributed to COVID-19; H.R.6161, the Employee Retention Tax Credit Reinstatement Act, to restore eligibility for senior living providers to claim the tax credit that was ended prematurely, and help with workforce challenges; H.R.6530, the SENIOR Act of 2022, to provide targeted financial relief for senior living providers and workforce development grants to address staffing shortages; S.2415, the Long-Term Care Affordability Act, to provide additional tax-preferred savings options for Americans to plan for their long-term care needs; H.R.7107, the Long-Term Care Affordability Act, to provide additional tax-preferred savings options for Americans to plan for their long-term care needs; S.3799, PREVENT Pandemics Act, to plan for and better prepare for future pandemics and the impact on senior living operators; S.3611, the Provider Relief Fund Improvement Act, to release all available provider relief funds to reimburse expenses and losses attributed to COVID-19

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Public Health Emergency Extension; HRSA Provider Relief Fund Phase 4; Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule with Comment Period (CMS-3415-IFC); Medicare GME Final Rule with Comment Period - Distribution of Residency Slots (CMS-1752-FC3); Medicare Area Wage Index - New Brunswick-Lakewood CBSA (CMS-1752-F); Surprise Billing - Qualified Payment Amount, Good Faith Estimates (CMS-9908-IFC)/No Surprises Act (P. L. 116-260); Site-neutral payment/BBA 2015 Sec. 603 (P.L. 114-74); Hospital Price Transparency Final Rule (CMS-1753-F); CY 2023 Medicare Advantage and Part D Proposed Rule - Prior Authorization for Hospital Transfers to Post-Acute Settings during PHE (CMS-4192-P); Request for Information: Electronic Prior Authorization Standards, Implementation Specifications, and Certification Criteria (RIN - 0955-AA04); FY 2022 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice and Home Health Quality Reporting Program Requirements (CMS-1754-P); Occupational Exposure to COVID-19 in Healthcare Settings - Emergency Temporary Standard (OSHA-2020-0004); Health Care Workplace Violence; HRSA Uninsured Program - Claims for Testing and Treatment for Uninsured Patients; Public Charge Ground of Inadmissibility NPRM (USCIS-2021-0013); Build Back Better Act (H.R. 5376); Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667/P.L. 117-105); Healthcare Cybersecurity Act (S. 3904); Telehealth Modernization Act (S. 368/H.R. 1332); Telehealth Extension and Evaluation Act (H.R. 6202/S. 3593); 340B Eligibility Exceptions due to COVID-19 PHE (H.R. 4390/P. L. 117-103); Further Additional Extending Government Funding Act (P.L. 117-86); Consolidated Appropriations Act, 2022 (P.L. 117-103); Medicare Sequestration; Resident Physician Shortage Reduction Act of 2021 (S. 834); Opioid Workforce Act (S. 1438); Healthcare Workforce Resilience Act (H.R. 2255/S. 1024); Anticompetitive Behavior by Nurse Staffing Agencies; Provider Relief Fund Improvement Act (H.R. 5963/S. 3611); Better Way for Providers to Repay Act (H.R. 2407); Parity Enforcement Act (H.R. 1364); Medicare Mental Health Inpatient Equity Act (H.R. 5674/S. 3061); Post-Disaster Mental Health Response Act (H.R. 5703/S. 3677); Opioid Treatment Access Act (H.R. 6279); PACE Plus Act (S. 1162); Improving Access to Medicare Coverage Act (H.R. 3650/S. 2048); Hospital Inpatient Services Modernization Act (H.R. 7053/S. 3792); PREVENT Pandemics Act (S. 3799); Supplemental Funding for COVID-19 Relief.

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

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

- Corresponded with a member of the Missouri congressional delegation regarding non-covid related concerns testing positive during admissions process in Missouri. - Corresponded with a member of the Missouri congressional delegation regarding a draft of the Health Care Safety and Nurses Protection Act. - Corresponded with a member of the Missouri congressional delegation regarding support of HR 3203. - Corresponded with a members of the Missouri congressional delegation regarding support of the Federal agency investigation of anticompetitive behavior from nurse-staffing agencies. - Corresponded with a member of the Missouri congressional delegation regarding support of letter to HHS and CMS about Alzheimers Disease treatment restrictions. - Responded to a member of the Missouri congressional delegation regarding the potentially ending the PHE when it expires in April and the affect it will have on hospitals and concerns regarding telehealth. - Corresponded with a members of the Missouri congressional delegation requesting support the extension of Medicare sequester moratorium until 12/31/22, quickly distribute unused provider relief funds (HR 5963), extend provider relief fund expenditure dates (HR 5963), and provide additional $25 billion in provider relief payments. - Convened a virtual meeting with a member of the Missouri congressional delegation regarding COVID-19, the return of provider relief payments and funding language for nursing support bill. - Provided to a member of the Missouri congressional delegation a listing of Missouri hospitals with provider type in their district.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Conrad State 30 and Physician Access Reauthorization Act Dr. Lorna Breen Health Care Provider Protection Act H.R. 4390 - PROTECT 340B Act H.R.5963 - Provider Relief Fund Improvement Act Healthcare Workforce Resilience Act HR 2503/S. 3039 - Social Determinants of Health Accelerator Act HR 379/S. 104 - Improving Social Determinants of Health Act Issues related to 340B contract pharmacies and third-party vendors Issues related to 340B drug pricing program Issues related to a public health insurance option Issues related to behavioral and mental health care Issues related to developing and sustaining the health care work force Issues related to disparities in health and health care Issues related to maternal health Issues related to prescription drug prices Issues related to social determinants of health and structural racism Issues related to telehealth Issues related to the No Surprises Act implementation Issues related to the Provider Relief Fund Skilled immigration/employment visas Value in Health Care Act Issues related to the National Quality Forum Issues related to COVID-19 Black Maternal Health Momnibus Act S. 2873 - Preventing and Addressing Trauma with Health Services Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Conrad State 30 and Physician Access Reauthorization Act Dr. Lorna Breen Health Care Provider Protection Act H.R. 4390 - PROTECT 340B Act H.R.5963 - Provider Relief Fund Improvement Act Healthcare Workforce Resilience Act HR 2503/S. 3039 - Social Determinants of Health Accelerator Act HR 379/S. 104 - Improving Social Determinants of Health Act Issues related to 340B contract pharmacies and third-party vendors Issues related to 340B drug pricing program Issues related to a public health insurance option Issues related to behavioral and mental health care Issues related to developing and sustaining the health care work force Issues related to disparities in health and health care Issues related to maternal health Issues related to prescription drug prices Issues related to social determinants of health and structural racism Issues related to telehealth Issues related to the No Surprises Act implementation Issues related to the Provider Relief Fund Skilled immigration/employment visas Value in Health Care Act Issues related to the National Quality Forum Issues related to COVID-19 Black Maternal Health Momnibus Act S. 2873 - Preventing and Addressing Trauma with Health Services Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Q4 Lobbying Report (October 1-December 31) Health Issues Provider Relief Fund Improvement Act (H.R. 5963) Provider Relief Fund Deadline Extension Act (S. 2493/H.R. 4735) Infrastructure Investment and Jobs Act (H.R. 3684) Build Back Better Act (H.R. 5376) FY 2022 Budget Resolution Public Service Loan Forgiveness program/physician federal loan forgiveness Coronavirus Provider Protection Act (H.R. 3021) Healthcare Workforce Resilience Act of 2021 Increasing Behavioral Health Treatment Act (H.R.2611) Rural America Health Corps Act (S.54) Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Conrad State 30 & Physician Access Act Public Health and Social Services Emergency Fund Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 American Rescue Plan (H.R. 1319) American Jobs Plan Leading Infrastructure for Tomorrows America Act/LIFT America Act (H.R. 1848) Rural Hospital Closure Relief Act (H.R. 1639/S.644) National Coronavirus Commission Act (S. 412) Strengthening Mental Health Supports for BIPOC Communities Act (H.R. 1331) Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885) Rural America Health Corps Act (S. 924/H.R. 2130), Strengthening Americas Health Care Readiness Act (S. 54) Resident Physician Shortage Act (S. 834/H.R. 2256) OSHA rule on COVID-19 Healthcare Workplace Safety No Surprises Act regulations Medicare/Medicaid Protecting Medicare and American Farmers from Sequester Cuts Act (S.610) Medicaid DSH Payment Adjustment Fairness Act of 2021 (H.R. 5015) Stopping Doctor Shortages Act (H.R. 1133/S. 311) Better Way for Providers to Repay Act of 2021 (H.R. 2407) Public Health Emergency designation Accelerated and Advance Payment Program repayment flexibility Rural hospital policies (Rural Health Clinic payment - H.R. 1868) Sequestration relief (H.R. 1868) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 (S. 834) Disproportionate share hospital allotment increase (technical correction) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340) Medicare for All (H.R. 1976) Resetting the Impact Act (TRIA) of 2021 (H.R. 2455) Submitted Comments SUBJECT: [Docket No. FDA-2016-D-0271], Hospital and Health System Compounding Under Section 503A of the Federal Food, Drug, and Cosmetic Act; Revised Draft Guidance for Industry; (Vol 86, No 192), October 7, 2021 Subject: CMS-9908-IFC, Requirements Related to Surprise Billing; Part II; Interim Final Rule with Comment Period, Federal Register (Vol. 86, No. 192), October 7, 2021 SUBJECT: CMS-9907-P, Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement, Federal Register (Vol. 86, No. 177), September 16, 2021 SUBJECT: [IS No. 2696-21; DHS Docket No. USCIS- 2021-0013; Public Charge Ground of Inadmissibility; Advanced Notice of Proposed Rulemaking; Federal Register (Vol. 86, No. 160), August 23, 2021

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

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

Infrastructure Investment and Jobs Act Build Back Better Act (H.R. 5376) Provider Relief Fund Improvement Act (H.R. 5963) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Conrad State 30 & Physician Access Act Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Rural America Health Corps Act (S. 924/H.R. 2130), Resident Physician Shortage Act (S. 834/H.R. 2256) No Surprises Act regulations Social Determinants Accelerator Act (H.R. 2503) Public Health Emergency designation Vaccine mandate policy

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6000, CURES 2.0 Act, all provisions H.R. 666, Anti-Racism in Public Health Act of 2021, all provisions S. 162, Anti-Racism in Public Health Act of 2021, all provisions H.R. 4217, Taskforce Recommending Improvements for Unaddressed Mental Perinatal & Postpartum Health (TRIUMPH) for New Moms Act of 2021, all provisions S. 2779, Taskforce Recommending Improvements for Unaddressed Mental Perinatal & Postpartum Health (TRIUMPH) for New Moms Act of 2021, all provisions H.R. 708, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, provisions related to fraud, waste, and abuse In telehealth S. 168, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, provisions related to fraud, waste, and abuse In telehealth H.R. 4480, Telehealth Coverage and Payment Parity Act, all provisions H.R. 6202, Telehealth Extension Act of 2021, all provisions H.R. 8, Bipartisan Background Checks Act of 2021, all provisions H.R. 1446, Enhanced Background Checks Act of 2021, all provisions H.R. 379, Improving Social Determinants of Health Act of 2021, all provisions S. 104, Improving Social Determinants of Health Act of 2021, all provisions H.R. 1306, National Coronavirus Commission Act of 2021, all provisions S. 412, National Coronavirus Commission Act of 2021, all provisions H.R. 1843, COVID-19 Hate Crimes Act, all provisions S. 937, COVID-19 Hate Crimes Act, all provisions H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act, all provisions S. 610, Dr. Lorna Breen Health Care Provider Protection Act, all provisions H.R. 3778, Nullifying Opportunities for Variants to Infect and Decimate (NOVID) Act, all provisions S. 1976, Nullifying Opportunities for Variants to Infect and Decimate (NOVID) Act, all provisions S. 2448, Health Misinformation Act of 2021, all provisions H.R. 5963, Provider Relief Fund Improvement Act, all provisions H.R. 6072, Leveraging Integrated Networks in Communities (LINC) to Address Social Needs Act of 2021, all provisions S. 509, Leveraging Integrated Networks in Communities (LINC) to Address Social Needs Act of 2021, all provisions H.R. 3614, Menstrual Equity For All Act of 2021, all provisions H.R. 1384, Mainstreaming Addiction Treatment Act of 2021, all provisions S. 445, Mainstreaming Addiction Treatment Act of 2021, all provisions H.R. 5224, Preventing Overdoses and Saving Lives Act of 2021, all provisions H.R. 3755, Women's Health Protection Act of 2021, provisions relating to parental notification and consent laws for unemancipated youth S. 1975, Women's Health Protection Act of 2021, provisions relating to parental notification and consent laws for unemancipated youth S. 253, Cannabidiol and Marihuana Research Expansion 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 S. 1675, Maternal Health Quality Improvement Act, all provisions H.R. 5248, Temporary Responders for Immediate Aid in Grave Emergencies (TRIAGE) 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 21st Century Cures Act/implementation Primary Care Physician Reentry Act COVID-19/Vaccine distributions/vaccines in physician offices COVID-19/Vaccine/Health Equity COVID-19/monoclonal antibodies/therapeutics/testing/counseling reimbursement VOCID-19/PPE/misinformation COVID-19/retail pharmacies/HIPAA Health equity/race corrections in clinical algorithms Surprise billing Electronic Health Records (EHR) Certification Maternal health/mortality Maternal health/bias Pharmacy Benefit Managers/Rx drug price transparency Drug overdose epidemic Biometrics Telemedicine/HIPAA Social determinants of health Information blocking/privacy Human cell donating/men who have had sex with men PL 115-271, Section 3204/harmful interpretation Naloxone/over-the-counter/standing orders Menstrual products/poverty/medical necessities Abortion/mandatory parent notification/consent Coding - CPT Panel Risk Evaluation and Mitigation Strategies (REMS) - Accutane Opioids Physical therapy Digital Health/AI/Digital Therapeutics Precision Medicine/Diagnostics

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

H.R.1319, American Rescue Plan Act of 2021, To secure provider relief for assisted living and other senior congregate care communities; H.R.1799, PPP Extension Act of 2021, To extend the deadline for application of paycheck protection program loans for eligible senior living providers; H.R.842, Protecting the Right to Organize Act of 2021, To prevent legislation that would exacerbate workforce challenges among senior living providers; S.420, Protecting the Right to Organize Act of 2021, To prevent legislation that would exacerbate workforce challenges among senior living providers; H.R.1848, Leading Infrastructure for Tomorrow's America Act, To advance measures that will target national investments in the infrastructure needs of long-term care facilities; H.R.331, the Nurses CARE Act, to extend temporary nurse aide authorizations and meet care needs of seniors; H.R.4131, the Better Care Betters Jobs Act, to support investments in long-term care services specifically for home and community based services; S.2210, the Better Care Betters Jobs Act, to support investments in long-term care services specifically for home and community based services; H.R.5376, the Build Back Better Act, to support investments in long-term care services and workforce development; H.R.5823, the Pandemic Risk Insurance Act, to provide federal reinsurance for pandemic related losses and ensure availability of coverage related to pandemics; H.R.5963, he Provider Relief Fund Improvement Act, to release all available provider relief funds to reimburse expenses and losses attributed to COVID-19; H.R.6161, the Employee Retention Tax Credit Reinstatement Act, to restore eligibility for senior living providers to claim the tax credit that was ended prematurely, and help with workforce challenges.

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

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

Build Back Better Act (H.R. 5376) - Supported policies to encourage health care coverage and close the Medicaid coverage gap. Urged additional pandemic financial support for hospitals. Advocated for investments for hospitals and health care providers, including physical structure improvements, workforce and graduate medical education support. Infrastructure Investment and Jobs Act (H.R. 3684) - Supported inclusion of funding to support broadband deployment needed for greater access to telehealth services. Opposed using further extension of Medicare sequestration or repurposing unused provider relief funding as offsets for bipartisan infrastructure package. Telehealth - Supported passage of the CONNECT for Health Act (S. 1512/H.R. 2903) to make telehealth flexibilities permanent. Encouraged reimbursement parity for certain telehealth services and support for audio-only telehealth services. Health Care Workforce - Urged passage of the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act (H.R. 708; S. 168); The Health Care Workforce Resilience Act (S. 1024/H.R. 2255); The Dr. Lorna Breen Health Care Provider Protection Act (S.610/H.R. 1667); The Resident Physician Shortage Reduction Act (S.834/H.R. 2256). Urged administration to examine practices of health care staffing agencies. Surprise Bills - Urged changes to the Surprise Billing Interim Final Rule Part 2 to modify its reliance on a "Qualifying Payment Amount" in an Independent Dispute Resolution process. Hospital Group Purchasing Organizations - Advocated for the importance of hospital group purchasing organizations, and highlighted role in supporting supply chain resiliency to secure essential, authentic medical supplies for hospitals throughout the course of the COVID-19 pandemic. Engaged to support policies to limit shortages of prescription drugs. Engaged with U.S. DOT Port Envoy related to shipping delays for key medical products. Advocated for greater transparency in the health care supply chain for drugs and medical devices. Supported passage of the Integrity, Notification, Fairness in Online Retail Marketplaces (INFORM) Consumers Act (S. 963/H.R. 5502). Provider Relief Fund - Urged HHS and Congress to offer greater flexibility and extend deadlines for hospitals to utilize PRF funding and provide clear guidance on reporting expectations. Supported Provider Relief Deadline Extension Act (S. 2493) and Provider Relief Fund Improvement Act (H.R. 5963). Drug Pricing - Monitored drug pricing legislation (H.R. 3, H.R. 19, H.R. 5376) with support for policies that improve market competition and makes improvements to support hospital and patient access to needed medications. Reviewed options to further support modifications to the unapproved drugs initiative that would prevent or limit price increases for older, unapproved drugs. Monitored for potential changes to the 340B program and supported HHS to enforce guidance that would allow 340B Covered Entities to utilize contract pharmacies. Advocated for HHS to offer additional 340B Drug Pricing Program eligibility flexibility for hospitals that have had patient mix changed during the COVID-19 public health emergency (S. 773). Social Determinants of Health - Engaged to offer support for policies to improve social determinants of health. Offered feedback on legislation and activity from the CMS Innovation Center to improve access and reduce health care disparities. Supported the Social Determinants Accelerator Act (H.R. 2503; S. 3039); The LINC to Address Social Needs Act (S. 509). CURES 2.0 (H.R. 6000) - Monitored the introduction of CURES 2.0 Health Care Equity - Offered feedback on legislation to improve access to care and reduce health care disparities. Rural MOMS Act (H.R. 769); Black Maternal Health Momnibus Act (H.R. 959). Antimicrobial resistance (S. 2076) - Supported passage of the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act.

Client expense: $190,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation, Dept of (DOT), U.S. Trade Representative (USTR)

Provider Relief Fund Deadline Extension Act (S. 2493/H.R. 4735) Infrastructure Investment and Jobs Act Build Back Better Act (H.R. 5376) Dr. Lorna Breen Health Care Provider Protection Act (S. 4349/H.R. 8094) Provider Relief Fund Improvement Act (H.R. 5963) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Resilience Act of 2021 Black Maternal Health Momnibus Act of 2021 (S. 346/H.R. 959) Conrad State 30 & Physician Access Act Public Health and Social Services Emergency Fund Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Leading Infrastructure for Tomorrows America Act/LIFT America Act (H.R. 1848) Rural America Health Corps Act (S. 924/H.R. 2130), Strengthening Americas Health Care Readiness Act (S. 54) Resident Physician Shortage Act (S. 834/H.R. 2256) OSHA rule on COVID-19 Healthcare Workplace Safety No Surprises Act regulations Rural health care innovation (PA Rural Health Model and Community Health Access and Rural Transformation Model (CHART) Coverage policy (H.R. 1976, Medicare for All) Social Determinants Accelerator Act (H.R. 2503) Public Health Emergency designation Executive Order on Promoting Competition in the American Economy COVID Data Reporting Vaccine mandate policy

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Extension of the Medicare sequester moratorium and the Medicare physician payment adjustment. H.R. 5963, Provider Relief Fund Improvement Act. Making permanent (or extending) certain CMS waivers provided during the Public Health Emergency.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Area Wage Index - New Brunswick-Lakewood CBSA; Radiation Oncology Model; Surprise Billing - Qualified Payment Amount; Site-neutral payment/BBA 2015 Sec. 603; Build Back Better Act (H.R. 5376); Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610); Protecting the American Taxpayer and Medicare Act (S. 3344); Supporting Health Care Providers During the COVID-19 Pandemic Act (H.R. 6143); Supporting Medicare Providers Act of 2021 (S. 3314); Infrastructure Investment and Jobs Act (H.R. 3684); Resident Physician Shortage Reduction Act of 2021 (S.834); Accelerating Access to Critical Therapies for ALS Act (H.R. 3537/S. 1813); Comprehensive Addiction Resources Emergency Act of 2021 (H.R. 6311/S. 3418); Expanding Medical Education Act (H.R. 801/S. 3422); Opioid Treatment Access Act of 2022 (H.R. 6279); Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667); Capping Prescription Costs Act of 2021 (H.R. 6228/S. 3339); No COVID-19 Vaccination Mandate Act of 2021 (H.R. 6170); Cures 2.0 Act (H.R. 6000); Respecting Our Frontline Workers Act (S. 3225); Provider Relief Fund Improvement Act (H.R. 5963); Inpatient Opioid Safety Act of 2021 (H.R. 5932); LOCAL HEALTH Act (H.R. 5898); Keeping Our COVID-19 Heroes Employed Act (H.R. 5860); Expanded Telehealth Access Act (H.R. 2168/S. 3193); Healthy Competition for Better Care Act (S. 3139); Hospital Revitalization Act of 2021 (S. 3105); Choose Home Care Act of 2021 (H.R. 5514/S. 2562); Good Samaritan Health Professionals Act of 2021 (H.R. 5239/S. 2941); 340B Accountability Act of 2021 (S. 2837).

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

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

Extension of the Medicare sequester moratorium and the Medicare physician payment adjustment H.R. 5963 Provider Relief Fund Improvement Act Making permanent(or extending) certain CMS waivers provided during the public health emergency

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

- Distributed to the Centers for Medicare and Medicaid Services a copy of the talking points from the September 9 virtual meeting regarding Medicare Advantage Sepsis Down coding and Prior Authorization. - Corresponded with a member of the Missouri congressional delegation on questions regarding HHS distribution of CARES Act General Distribution Phase 4 funds. - Corresponded with Senate members of the Missouri congressional delegation regarding the pending House Amendment to S. 610. - Responded to a member of the Missouri congressional delegations questions regarding American Rescue Plan Act rural health funding and Medicare Accelerated and Advance Payments. - Corresponded with a member of the Missouri congressional delegation regarding HHS and HRSAs distribution of American Rescue Plan Act payments to providers and suppliers who serve rural Medicaid, Childrens Health Insurance Program (CHIP) and Medicare beneficiaries. - Corresponded with a member of the Missouri congressional delegation regarding the findings of the CMS survey on regulations mandating COVID-19 vaccination of employees and others in CMS-regulated settings. - Distributed to the House members of the Missouri congressional delegation a memorandum of support for H.R. 5963, the Provider Relief Fund Improvement Act. - Conversation via telephone with a member of Missouri congressional delegation regarding the expected effects of the vaccine mandate. - Distributed to the members of the Missouri congressional delegation a document concerning ARPA pandemic financial relief for hospitals in Missouri. - Distributed to the members of the Missouri congressional delegation a fact sheet prepared by the Missouri Hospital Association outlining the issues being faced by health care providers regarding the disruption caused using temporary staffing agencies and the inability of nursing schools to enroll all interested students. - Corresponded with a member of the Missouri congressional delegation regarding HRSA Resiliency Grants and related testimony from a House Energy and Commerce Committee hearing on health workforce shortages. - Convened a virtual meeting with a member of the Missouri congressional delegation regarding the potential legislation to relieve pandemic stresses on nurses. - Responded to a member of the Missouri congressional delegation regarding Missouri Hospital Associations position on HR 3165, the Nurse Staffing Standards for Hospital Patient Safety & Quality Care Act. - Corresponded with a member of the Missouri congressional delegation regarding an upcoming HRSA deadline to apply for funding from the Provider Relief Fund Phase 4 and ARPA rural distribution. - Corresponded with a member of the Missouri congressional delegation regarding legislative language regarding Medicare reimbursement reductions on services furnished by Physical Therapy Assistants and Occupational Therapy Assistants. - Corresponded with a member of the Missouri congressional delegation regarding issues from hospitals concerning workforce, provider relief funding expenditure deadlines and reporting concerns, 340B concerns and vaccination mandates. Also, discussed the impending Medicare cut from PAYGO and the expiration of the moratorium on the Medicare sequestration and support of H.R. 4735/S.2493. - Corresponded with a member of the Missouri congressional delegation regarding Medicare Sequestration Relief and prevention of the PAYGO cut. - Corresponded with members of the Missouri congressional delegation regarding Missouri Hospital Associations staff transitions at the end of 2021.

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

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

Build Back Better Act H.R 5376 (Reconciliation bill) Infrastructure Investment and Jobs Act H.R. 2638 (Infrastructure legislation) Dr. Lorna Breen Health Care Provider Protection Act S. 4349/HR 8094 Provider Relief Fund Deadline Extension Act S.2493/HR 4735 Provider Relief Fund Improvement Act H.R. 5963 Healthcare Workforce Resilience Act of 2021 Rural America Health Corps Act S.54 Maternal health: MOMMAs Act S. 411/HR 3407; Black Maternal Health Omnibus Act of 2021 S. 346/H.R. 959; Data to Save Moms Act S. 347/HR 925; IMPACT to Save Moms Act S 1675/HR 4387; Maternal Health Quality Improvement Act S. 1675/H.R. 4387 Conrad State 30 & Physician Access Reauthorization Act S. 1810/H.R. 3541 Public Health and Social Services Emergency Fund Regulatory relief in light of coronavirus Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program, including S. 773/H.R. 3203 Leading Infrastructure for Tomorrows America Act/LIFT America Act H.R. 1848 Rural Hospital Closure Relief Act H.R. 1639/S.644 Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885) Rural America Health Corps Act (S. 924/H.R. 2130), Strengthening Americas Health Care Readiness Act (S. 54) Resident Physician Shortage Act (S. 834/H.R. 2256) Social Determinants Accelerator Act (H.R. 2503), Leveraging Integrated Networks in Communities (LINC) to Address Social Needs Act (S. 509) OSHA rule on COVID-19 Healthcare Workplace Safety Drug-price Transparency for Competition (DTC) Act (S. 2304) No Surprises Act regulations Protecting Providers Everywhere in America Act (S. 308/H.R. 1436) 340B legislation (S. 773 HR 3203) Childrens Mental Health Infrastructure Act H.R. 4945; Helping Kids Cope Act H.R. 4944; Child Suicide Prevention and Lethal Means Safety Act H.R. 5035

Client expense: $180,000 · Firm income: Not reported

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