TREAT Act

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

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

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

Mainstreaming Addiction Treatment Act (S. 445/H.R. 1384), all provisions related to removing the waiver requirement for health care providers to prescribe buprenorphine for opioid use disorder. Improving Access to Remote Behavioral Health Treatment Act of 2019, all provisions related to amending regulations for the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 and allowing community mental health centers to register to practice telemedicine. Medication Access and Training Expansion Act (H.R. 2067), all provisions related to requiring physicians and other prescribers of controlled substances to complete training on treating and managing patients with substance use disorders. CONNECT for Health Act of 2021 (H.R. 2903/S. 1512), all provisions related to expanding access to telehealth services. Telemental Health Care Access Act of 2021 (S. 2061), all provisions related to ensuring coverage of mental health services furnished through telehealth. HELP Act of 2021 (S. 1570), all provisions related to the accessibility and coordination of 211 services and 988 services. Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act (H.R. 708/S. 168), all provisions related to temporary authorization of in-person and telehealth services. Behavioral Health Crisis Services Expansion Act (S. 1902), all provisions related to empowering communities to establish a continuum of care for individuals experiencing a behavioral health crisis. Preventing Overdoses and Saving Lives Act of 2021 (H.R. 5442), all provisions related to authorizing grants to develop strategic response plans with respect to the opioid crisis, and to require practitioners prescribing an opioid for certain patients to also prescribe an opioid overdose reversal drug. Coronavirus Mental Health and Addiction Assistance Act of 2021 (H.R. 593/S. 135), all provisions related to providing grants to entities that provide mental health and substance use disorder programs during the COVID-19 pandemic. Mental Health Services for Students Act of 2021 (H.R. 721/S. 1841), all provisions related to school-based mental health services. Stopping the Mental Health Pandemic Act (H.R. 7080/S. 4059), all provisions related to grants to support behavioral health treatment and services during the COVID-19 pandemic. Emergency Support for Substance Use Disorders Act (S. 4058), all provisions related to grants for harm reduction activities during the COVID-19 pandemic. Elementary and Secondary School Counseling Act (H.R. 6214/S. 3356), all provisions related to awarding grants to increase access to school-based, mental health services. Campus Prevention and Recovery Services for Students Act of 2019 (H.R. 3591), all provisions related to expanding the illicit drug and alcohol abuse prevention program to include campus efforts to prevent substance misuse. Opioid Treatment Access Act of 2022 (H.R. 6279), all provisions related to authorizing a study on certain exemptions for treatment of opioid use disorder through opioid treatment programs. 9-8-8 Implementation Act of 2022 (H.R. 7116), all provisions related to providing for improvements in the implementation of the National Suicide Prevention Lifeline, and for other purposes. 9-8-8 and Parity Assistance Act of 2022 (H.R.7232), all provisions related to providing for improvements in the implementation of the National Suicide Prevention Lifeline, and for other purposes. Into the Light for MMH and SUD Act of 2022 (H.R. 7073), all provisions related to reauthorizing a grant program for screening, assessment, and treatment services for maternal mental health and substance use disorders, and for other purposes. Anna Westin Legacy Act (H.R. 7249/S. 3686), all provisions related to providing education and training on eating disorders for health care providers and communities, and for other purposes. Behavioral Health Information Technology Act, (H.R.7427), all provisions related to CMI testing of incentive payments for behavioral health providers and certain other providers for adoption and use of certified electronic health record technology, and for other purposes Safe Step Act (H.R. 2163/S. 464), all provisions related to creating an exception for medication step-therapy. Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (S. 586), all provisions related to establishing separate payments for certain non-opioid treatments under the Medicare prospective payment system for hospital outpatient department services and the payment system for ambulatory surgical center services Food and Drug Administration Safety and Landmark Advancements Act of 2022 (S.4348), all provisions related to addressing substance use disorders and the safe disposal of opioids. Telemental Health Access to Care Act (S.2061/H.R. 4058), all provisions related to intended to increase access to tele-mental health care and telehealth. Stop Pills That Kill Act (S.4151), all provisions related to penalizing the manufacture and/or facilitation of manufacturing counterfeit pills that contain fentanyl, an analogue of fentanyl, or a counterfeit substance. Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R. 7666), all provisions related to reauthorizations, expansions, and modifications of programs, grants, and activities that focus on mental and behavioral health. CONNECT Act of 2022 (H.R.8391), all provisions related to awarding grants for crisis centers to provide follow-up services to individuals receiving suicide prevention and crisis intervention services. BENEFIT Act of 2021 (H.R.4472), all provisions related to strengthen the use of patient-experience data within the benefit-risk framework for approval of new drugs. Advancing Telehealth Beyond COVID-19 Act of 2021 (H.R.4040), all provisions related to extending telehealth flexibilities under the Medicare program Expanding Access to Mental Health Training Act (S. 4461), all provisions related to reauthorizing grants for training teachers and other school personnel to recognize the symptoms of childhood and adolescent mental health disorders. Behavioral Health Network and Directory Improvement Act (S. 5093), all provisions related to protect patients and improve the accuracy of provider directory information by eliminating ghost networks. Any legislation published by the Senate Finance Committee relating to behavioral healthcare, including workforce, mental health integration, and parity policy.

Client expense: $130,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Communications Commission (FCC), Federal Reserve System, HOUSE OF REPRESENTATIVES, SENATE

Affordable prescription drugs; 340B Drug pricing program; Health care privacy; Patient privacy issues; Issues related to the American Rescue Plan Act, PL 117-2; Issues related to expanding health care coverage, including in non-Medicaid expansion states; Issues related to improving social determinants of health; Issues related to extending and expanding flexibilities for virtual care; Financial support for providers for diagnosis and treatment related to COVID-19, coverage of COVID-19 related conditions, access to PPE and other materials and equipment related to the treatment of patients with COVID-19, including funding for the Provider Relief Fund; Issues related to affordable health care coverage; H.R. 2228 - Rural Behavioral Health Access Act; Issues related to drug pricing; Issues related to Bipartisan Infrastructure Framework; Issues related to telehealth; Efforts to extend Medicare sequester delay, including H.R.1868; Issues related to Medicare policy on virtual care; Issues related to vaccine mandates; S. 168/H.R. 708 - Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act; S. 346/H.R. 959 - Black Maternal Health Momnibus Act; S. 773/H.R. 3203 - Legislation related to 340B eligibility; S. 834/H.R. 2256 - Resident Physician Shortage Reduction Act; S. 834/H.R. 2256 - Healthcare Workforce Resilience Act; S. 368/H.R. 1332 - Telehealth Modernization Act ; S. 1512/H.R. 2903 - CONNECT for Health Act; S. 1988 - Protecting Rural Telehealth Access Act; H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act; S.773/H.R. 3203 - A bill to enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program; H.R. 4943 - Childrens Mental Health Infrastructure Act; H.R. 4944 - Helping Kids Cope Act; H.R. 5376 - Build Back Better Act; H.R. 1667 - Dr. Lorna Breen Health Care Provider Protection Act; Issues related to workforce retention; H.R. 2471 - Consolidated Appropriations Act (FY 2022 Omnibus); H.R. 7007 - Covid-19 Supplemental Appropriations Act; H.R. 7053/S. 3792 - Hospital Inpatient Services Modernization Act; issues related to the Acute Hospital Care at Home (AHCAH) waiver; H.R. 4407/S. 1568 - Technical Reset to Advance the Instruction of Nurses (TRAIN) Act; S. 3493 - Telehealth Extension and Evaluation Act; H.R. 6202 - Telehealth Extension Act; H.R. 5376 - Inflation Reduction Act (Public Law 117-169); H.R. 6833 - Continuing Resolution; H.R. 2617 - Consolidated Appropriations Act, 2023; Issues related to adequate financing for hospitals and providers; H.R. 4040 - Advancing Telehealth Beyond COVID-19 Act; Issues related to extending the Medicare Dependent Hospital and Low Volume Hospital programs; Issues related to extending bonus payments for Advanced Alternative Payment models; H.R. 4587 - Value in Health Care Act; Issues related to coding and coverage of spiritual care through chaplain services; Issues related to value-based care programs, including the Bundled Payments for Care Improvement (BPCI) Advanced Model; Issues related to data and quality measure reporting and eligibility for corresponding reimbursements; Issues related to prior authorization; H.R. 3173 - Improving Seniors Timely Access to Care Act; Issues related to Rural Emergency Hospital designation; Issues related to safety net hospital reimbursements.

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

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

340B Drug Pricing Program; Issues related to 340B contract pharmacies; Financial support for providers for diagnosis and treatment related to COVID-19, including funding for the Provider Relief Fund; coverage of COVID-19 related conditions; S. 168/H.R. 708 - Temporary; Reciprocity to Ensure Access to Treatment (TREAT) Act; S. 346/H.R. 959 - Black Maternal Health Momnibus Act; S. 773/H.R. 3203 - Legislation related to 340B eligibility; S. 368/H.R. 1332 - Telehealth Modernization Act; S. 1512/H.R. 2903 - CONNECT for Health Act; S. 1988 -Protecting Rural Telehealth Access Act; H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act; S.773/H.R. 3203 - A bill to enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program; - S.773/H.R. 3203; H.R. 5376 - Build Back Better Act; H.R. 853 - Closing Loopholes for Orphan Drugs Act; H.R. 2471 - Consolidated Appropriations Act (FY 2022 Omnibus); H.R. 7007 - Covid-19 Supplemental Appropriations Act; H.R. 5376 - Inflation Reduction Act (Public Law 117-169); H.R. 6833 - Continuing Resolution

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

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

Healthcare Supply Chain - Highlighted the important role played by hospital group purchasing organizations in promoting resiliency and value in healthcare purchasing. Engaged to support policies to ensure greater transparency and mitigate or limit shortages of prescription drugs. Supported policies that would expedite critical cargo, including cargo necessary for medical care, during a public health emergency or disaster. Advocated for greater transparency in the health care supply chain for drugs and medical devices. Supported updating language related to the Unapproved Drugs Initiative, and incorporating the PASTUER Act (S.2076) and the PATCH Act (H.R. 7084) in omnibus legislation (H.R. 2617). Telehealth - Supported efforts to make telehealth flexibilities offered during COVID-19 Public Health Emergency permanent. Supported CONNECT for Health Act (H.R. 2617 S. 1512/H.R. 2903) and the Extending Telehealth Beyond COVID-19 Act (H.R. 4040). 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). Urged administration to examine practices of health care staffing agencies and supported passage of the Travel Nursing Agency Transparency Study Act (S. 4352). Supported passage of the Safety from Violence for Healthcare Employees Act (H.R. 7961). Prepare for and Respond to Existing Viruses, Emerging New Threats, and (PREVENT) Pandemics Act (S. 3799; H.R 2617) - monitored PREVENT Pandemics Act and supported inclusion of provisions to improve supply chain transparency, enhance cybersecurity of medical devices and extend shelf life of prescription drugs in omnibus legislation. 340B Drug Pricing Program - Urged HHS to enforce guidance that would allow 340B Covered Entities to utilize contract pharmacies. 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). Supported passage of Opioid Treatment Access Act (S. 3629/H.R. 6279). Supported passage of Drug Shortages Shelf Life Extension Act (S. 3493). Supported passage of the Biologics Competition Act (H.R. 8877).

Client expense: $250,000 · 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

Q4 Lobbying Report (October 1-December 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 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 Train More Doctors Act of 2022 (H.R. 9156) H.R. 2617 2023 Omnibus 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: CMS-9900-NC, Request for Information; Advanced Explanation of Benefits and Good Faith Estimate for Covered Individuals, Federal Register (Vol. 87, No. 179), September 16, 2022 Request for Information on Healthcare Access, Provider Experience, Health Equity, and PHE Flexibilities, November 4, 2022

Client expense: $370,000 · 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)

Issue: Educate Congress and the administration on academic medicines missions, including education, research, patient care, GME, workforce, and physician shortages in rural and urban communities. Draft Graduate Medical Education Reform Act Issue: Support increased funding for the National Health Service Corps, Teaching Health Center GME, and National Disaster Medical Service (NDMS) demonstration pilot. Support increased Medicare support for Graduate Medical Education/physician training. Issues: Educate Congress and the administration about the role of academic medicine in the provision of mental and behavioral health care, including initiatives to respond to the opioid epidemic. Support measures to expand access to mental health care and substance use disorder treatment, including funding for training on substance use disorders, pain management, and safe prescribing practices, enhance enforcement of mental health parity laws, increased financial support for integrated behavioral health models. Support the provision of additional Medicare-supported graduate medical education slots for psychiatry and psychiatry sub-specialties. P.L. 117-328, Consolidated Appropriations Act, 2023 Support the provision of 200 additional Medicare-supported graduate medical education (GME) positions. Support the extension of COVID-related telehealth flexibilities. Support elimination or delay of Statutory Pay-As-You-Go (PAYGO) Medicare sequester and eliminating or reducing scheduled cuts to the Physician Fee Schedule. Support one-year of continuous Medicaid coverage for children. Support extension of postpartum Medicaid and CHIP coverage for 12 months. H.R. 1384/ S.445, Mainstreaming Addiction Treatment (MAT) Act of 2021 P.L. 117-328, Consolidated Appropriations Act, 2023, Division FF Issue: Support suspension of waiver requirement for certain providers to prescribe buprenorphine. H.R. 2067, Medication Access and Training Expansion (MATE) Act of 2021 P.L. 117-328, Consolidated Appropriations Act, 2023, Division FF Issue: Oppose legislative mandates dictating medical education curriculum on pain management and addiction. H.R. 7236, Strengthen Kids Mental Health Now Act/ S. 2727 Investing in Kids Mental Health Now Act Issue: Support increasing Medicaid reimbursement rates for pediatric mental health services through a 100% federal match. P.L. 116-22, Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 Issues: Support the Hospital Preparedness Program and the reauthorization of the Pandemic and All-Hazards Preparedness Act. Support increased funding authorization levels. Issue: Educate Congress on how the 340B Drug Pricing Program helps safety-net providers to fulfill their missions and care for patients and communities. Support measures to preserve and strengthen the 340B Drug Pricing Program and oppose efforts to reduce the scope of the program, including restrictions on covered entities use of contract pharmacy to distribute covered drugs. H.R. 4390, Preserving Rules Ordered for the Entities Covered Through 340B Act of 2021 (PROTECT 340B Act) Issue: Support measures to prevent pharmacy benefit managers and commercial insurers from discriminating against 340B covered entities. H.R. 3203/S. 773 Issue: Support policy to allow 340B DSH hospitals to remain eligible to participate in the program throughout the current public health emergency even if their DSH adjustment falls below the current threshold due to changes in payer mix as a result of the COVID-19 pandemic. Issue: Oppose insurance plans that do not meet Affordable Care Act requirements. Issue: Support increased interoperability and exchange of electronic health information and delayed enforcement of information blocking rule until comprehensive guidance is issued. Issue: Support the ongoing refinement of the two new mandatory alternative payment models, the Radiation Oncology Model and End-stage Renal Disease Treatment Choices Model, to better incentivize high-quality care for all patients. H.R. 4128/ S. 2209, Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2021 S. 4348, Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act of 2022 P.L. 117-328, Consolidated Appropriations Act, 2023 Issue: Educate Congress on development of Laboratory Developed Tests at academic medical centers and oppose policies that would increase burdensome regulations and negatively impact patients access to care by allowing Food and Drug Administration regulation of the development of Laboratory Developed Tests at academic medical centers. S. 4348, Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act of 2022 H.R. 7667, Food and Drug Amendments of 2022 (FDA22) P.L. 117-328, Consolidated Appropriations Act, 2023 Issue: Support promotion of data sharing and clinical trials results reporting. Support increased clinical trials diversity. Issue: Development of Enhanced Primary Care Pilot Act proposal H.R. 2503 / S. 3039, Social Determinants Accelerator Act of 2021 Issue: Support grants to address social determinants of health H.R. 7585 / S. 4486, Health Equity and Accountability Act Issue: Support programs to improve health equity and address social determinants of health. Issue: Support incentives to encourage the inclusion of implicit bias training in medical education and residency training. Issue: Support congressional investment in the Centers for Medicare and Medicaid Innovation (CMMI) models to reduce maternal mortality and improve maternal health. Issue: Support maternal health initiatives to expand coverage during the postpartum period and expand demonstration project grants. H.R. 959, Black Maternal Health Momnibus Act of 2021 S. 1695 / H.R. 4387, Maternal Health Quality Improvement Act S. 1491/ H.R. 769, Rural MOMs Act H.R. 4387, Maternal Health Quality Improvement Act of 2021 H.R. 925 / S. 347, Data to Save Moms Act Issue: Support legislative efforts to improve maternal health and reduce rates of maternal mortality, including the Momnibus. Support legislative initiatives to improve data collection to improve maternal health equity. P.L. 117-159, Bipartisan Safer Communities Act Issue: Support policies to promote firearm safety, universal background checks, violence prevention programs, extreme risk protection orders, child access safety laws, reinstating assault weapons ban, data infrastructure, hospital based and community violence intervention programs, and programs to address mental and behavioral health impact of gun violence. Issue: Support funding for Community Violence Interventions / Hospital Based Violence Intervention Programs P.L. 117-105, Dr. Lorna Breen Health Care Provider Protection Act Issue: Support grants directed at improving clinician burnout and well-being. Issue: Provide feedback on implementation of the Provider Relief Fund. Support extension for use of PRF funds. Issue: Support improvements to the Medicare Accelerated and Advance Payment Programs, including delaying recoupment of MAAP loans. Issue: Support extension of public health emergency declaration. Issue: Provide feedback on COVID-19 and pandemic response. Provide feedback on monkeypox response including testing. S. 3799, PREVENT Pandemics Act P.L. 117-328, Consolidated Appropriations Act, 2023, Division FF Issue: Provide feedback on pandemic preparedness legislation, urge inclusion of provisions to support academic medical centers preparedness activities. Issue: Support establishment of regional pandemic response centers, stronger linkages between public health and academic medicine, and the role of medical students and academic medical centers in administering COVID vaccines. Issue: Support efforts of academic medical centers to respond to public health threats such as monkeypox and COVID-19. Urge establishment and implementation of robust national testing strategy; functional, redundant, and transparent supply chain; improved federal coordination; investments in public health and health care human and other resources; data modernization initiatives; and other actions to improve current and future pandemic response. H.R. 708, S. 168, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act Issue: Support for a temporary uniform licensing standard for all practitioners in all states throughout the COVID-19 public health emergency S. 674 Public Health Infrastructure Saves Lives Act Issue: Support investments in core public health infrastructure. Issue: Support ensuring patients are put first, that conscience protections align with medical professionalism standards, and oppose interference in the patient-physician relationship. Issue: Support increased interoperability and exchange of electronic health information. Support delay of enforcement beyond April 2021. H.R. 6000, Cures 2.0 Act Issue: Provide feedback on provisions related to public health, patients and caregivers, FDA, CMS, and research, and ARPA-H. Issue: Promote strategies to strengthen the health, public health, and research workforces. H.R. 3671, Doctors of Community Act Issue: Discuss authorization of the Teaching Health Center Graduate Medical Education program. H.R. 8131, Increasing Competition for Medical Residency Act Issue: Educate Congress on the medical education and training continuum, the annual residency Match, and the role of the National Resident Matching Program (NRMP) in medical education and residency. Issue: Provide guidance on the implementation of the No Surprises Act. Issue: Provide feedback on proposed modifications to the HIPAA privacy rule. H.R. 5035 / S. 2982, Child Suicide Prevention and Lethal Means Safety Act Issue: Support legislation to provide grants to improve suicide prevention and lethal means safety. Issue: Inform Congress and Administration about medical education on caring for older adults, nutrition, climate change, stigma around addiction, reproductive health, and accelerated medical education training programs. Issue: Provide feedback on efforts of the academic medicine community to address climate change and decarbonization. Issue: Support efforts of teaching hospitals to promote patient safety and high-quality care. H.R. 7152/ S.3534, The Tracking Pathogens Act P.L. 117-328, Consolidated Appropriations Act, 2023, Division FF Issue: Support expansion of CDC activities related to genomic sequencing of pathogens. Issue: Support reignition of Cancer Moonshot. H.R. 7961, Safety from Violence for Healthcare Employees (SAVE) Act Issue: Support statutory protections against violence and intimidation for health care workers and provide grants for hospital programs aimed at preventing violence in health care settings. P.L. 117-263, James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 Issue: Support a one year pause in military medical billet reductions in the Military Health System.

Client expense: $876,000 · 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), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Natl Institutes of Health (NIH), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Vice President of the U.S., White House Office

H.R. 708, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, provisions relating to fraud, waste, and abuse S. 168, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, provisions relating to fraud, waste, and abuse H.R. 2617, Consolidated Appropriations Act, 2023, provisions relating to COVID-19 telehealth flexibilities H.R. 1364, Parity Enforcement Act of 2021, all provisions H.R. 3753, Parity Implementation Assistance Act, all provisions S. 1962, Parity Implementation Assistance Act, all provisions S. 3799, Prepare for and Respond to Existing Viruses, Emerging New Threats, and (PREVENT) Pandemics Act, provisions relating to hospital-at-home flexibilities H.R. 925, Data to Save Moms Act, all provisions H.R. 959, Black Maternal Health Momnibus Act of 2021, all provisions S. 346, Black Maternal Health Momnibus Act of 2021, all provisions H.R. 6878, Pregnant Women in Custody Act, all provisions S. 5027, Protecting the Health and Wellness of Babies and Pregnant Women in Custody Act, all provisions H.R. 1384, Mainstreaming Addiction Treatment (MAT) Act of 2021, all provisions S. 445, Mainstreaming Addiction Treatment (MAT) Act of 2021, all provisions H.R. 2067, Medication Access and Training Expansion (MATE) Act of 2021, all provisions S. 2235, Medication Access and Training Expansion (MATE) Act of 2021, all provisions H.R. 7234, Summer Barrow Prevention, Treatment, and Recovery Act, all provisions H.R. 8908, Fighting Stimulant and other Substance Use Disorders Act, all provisions H.R. 8891, No Surprises for Survivors Act of 2022, al provisions H.R. 8885, Better Health Care Directories Act, all provisions H.R. 8886, Promoting Clarity in Mental Health and Substance Use Disorder Treatment Act, all provisions H.R. 8892, Access to Mental Health Services Act, all provisions H.R. 8881, Mental Health Transparency Act, all provisions H.R. 8889, Readable Insurance Coverage Explanations (RICE) Act, all provisions S. 5041, Training Psychiatrists for the Future 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. 1446, Enhanced Background Checks Act of 2021, all provisions H.R. 8, Bipartisan 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. 2163, Safe Step Act, all provisions S. 464, Safe Step Act, all provisions H.R. 5248, Temporary Responders for Immediate Aid in Grave Emergencies (TRIAGE) Act of 2021, all provisions H.R. 5602, Bolstering Infectious Outbreaks (BIO) Preparedness Workforce Act of 2021, all provisions S. 3244, Bolstering Infectious Outbreaks (BIO) Preparedness Workforce Act of 2021, all provisions H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act, all provisions S. 3904, Healthcare Cybersecurity Act of 2022, all provisions H.R. 4128, Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2021, all provisions S. 2209, Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2021, all provisions H.R. 6000, Cures 2.0 Act, all provisions H.R. 8152, American Data Privacy and Protection Act, all provisions H.R. 2377, Federal Extreme Risk Protection Order Act of 2022, provisions related to gun violence H.R. 7910, Protecting Our Kids Act, all provisions S. 2938, Bipartisan Safer Communities Act, all provisions H.R. 7667, Food and Drug Amendments of 2022, all provisions H.R. 7666, Restoring Hope for Mental Health and Well-Being Act of 2022, all provisions H.R. 8318, To restrict limitations on the possession, sale, purchase, transportation or use of any contraceptive that relates to interstate commerce, all provisions H.R. 8296, Womens Health Protection Act of 2022, all provisions H.R. 8297, Ensuring Womens Right to Reproductive Freedom Act, all provisions H.R. 8373, Right to Contraception Act, all provisions H.R. 1235, Charlotte Woodward Organ Transplant Discrimination Prevention Act, all provisions H.R. 3301, Charlotte Woodward Organ Transplant Discrimination Prevention Act, all provisions H.R. 8454, Medical Marijuana and Cannabidiol Research Expansion Act, all provisions S. 253, Cannabidiol and Marihuana Research Expansion Act, all provisions H.R. 3085, Equity in Neuroscience and Alzheimers Clinical Trials Act of 2021, all provisions H.R. 5030, Diversifying Investigations Via Equitable Research Studies for Everyone (DIVERSE) Trials 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. 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. 6311, Comprehensive Addiction Resources Emergency Act of 2021, all provisions S. 3418, Comprehensive Addiction Resources Emergency Act of 2021, all provisions H.R. 7232, 9-8-8 and Parity Assistance Act of 2022, all provisions S. 4090, Dietary Supplement Listing Act of 2022, all provisions No Surprises Act/implementation Hospice Code Modernization Act of 2022 Cybersecurity Climate change and inhalers WIC/Nutrition Opioids/Pain Care and Substance Use Disaster funding/Puerto Rico and Florida Gender reassignment surgery/provider threats Health Equity Long-term care/special needs Data Privacy Prior authorization Artificial Intelligence(AI)/Bias/Equity Digital health/AI/Digital therapeutics Maternal mortality and morbidity/Equity Infectious disease - COVID-19, monkey pox, RSV COVID-19/testing/misinformation/vaccines/therapeutics Opioids Reproductive health Cannabis/marketing/unapproved medical claims Emergency departments/patient boarding Precision medicine/diagnostics Section 1557/nondiscrimination

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

Government targets: Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Office of Natl Drug Control Policy (NDCP), SENATE, White House Office

Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S.3018) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments Organ acquisition payment policies Clinical lab fee schedule Medicare Mental Health Inpatient Equity Act (S. 3061/H.R. 5674) HR 4040: Advancing Telehealth Beyond COVID-19 Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

funding for hospitals and physicians related to COVID 19 Health care policy Proposals to strengthen the health care system and achieve Affordable Care Act (ACA) market stability, including extending the expanded ACA subsidies Funding for National Ebola Network/RSPTCs Elimination of Title X Waiver H.R. 1319, "American Rescue Plan Act" - provisions related to healthcare, Medicaid, and federal funding aimed at combating COVID-19, including funding to support vaccination administration, testing and contact tracing and expanding the public health workforce H.R. 3, "Elijah E. Cummings Lower Drug Prices Now Act" Additional legislative proposals to address rising drug costs S. 773, To ensure eligible hospitals continue to have access to the 340B Drug Pricing Program throughout the COVID-19 public health emergency Additional legislative proposals modifying the 340B program including the Protect 340B Act Infrastructure proposals that support the healthcare workforce and hospitals and health facilities, including provisions to improve physical and technical upgrades S.168 / HR 708 Temporary Reciprocity to Ensure Access to Treatment Act or the TREAT Act HR 1195 Workplace Violence Prevention Standard for health care facilities Medicare Coverage for Telehealth - HR 1332/ S 368 Telehealth Modernization Act Ensuring Parity in MA and PACE for Audio-Only Telehealth Act HR 2166 Federal funding to reduce and/or eliminate health care disparities Federal funding to address social determinants of health, especially housing and nutrition Bills to support mental health access and workforce Bills to support funding for nursing working and allied health professionals

Client expense: $293,950 · Firm income: Not reported

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

HR 432 and S 828 To provide for the coverage of marriage and family therapist services and mental health counselor services under Medicare. HR 708 and S 168 To provide temporary licensing reciprocity for telehealth and interstate health care treatment. HR 1384 and S 445 Loosens restrictions on doctors prescribing buprenorphine for addiction treatment. HR 2503 To direct the HHS Secretary to establish an interagency council on social determinants of health. S 660 Improves access to tele-mental health during the length of the COVID-19 PHE. S 674 To support public health infrastructure (funding up to $4.5 billion). HR 2255/S. 1024 To recapture unused immigrant visas and allocate them to doctors and nurses to help in the fight against COVID-19. HR 2903/S. 1512 Comprehensive bill to expand telehealth access and make permanent telehealth flexibilities available during COVID-19 pandemic. HR 3203/S. 773 To enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program. S. 1162 To expand access to Programs of All-Inclusive Care for the Elderly (PACE). HR 4118 To authorize the HHS Secretary to invest in community-based violence reduction initiatives. S. 2257 To reduce drug and device shortages and costs. HR 5801 To apply additional payments, discounts, and other financial assistance towards the cost-sharing requirements of health insurance plans. Health care workforce shortage concerns. S. 3626 To improve access to the Program of All-Inclusive Care for the Elderly (PACE) HR 7236 To expand the availability of mental, emotional, and behavioral health services under the Medicaid program HR 7353 To treat telehealth services as excepted benefits HR 7961 To protect hospital personnel from violence S 4352 To require a study on the effects of travel nurse agencies on the health industry during the COVID-19 pandemic S 3189 To provide a pathway to health careers through health profession opportunity grants HR 7666 Reauthorizes, expands, and modifies programs, grants, and activities that focus on mental and behavioral health

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

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

Met with legislative staff to express support for biomedical research. Urged legislative staff to support a proposal to expand Centers for Public Health Preparedness and Response (S 3800). Urged legislative staff to support S 168/HR 708, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act. Urged legislative staff to address telehealth provisions CMS identified as under Congress purview including audio-only visits and the ability for telehealth services to be provided to both new and established patients for acute and chronic conditions. Urged agency staff to create a dedicated fund within the provider relief fund to provide relief to faculty practice plans. Asked Representatives to consider legislation that makes changes to the regulation of laboratory testing (including the VALID Act) separately from the Medical Device User Fee Agreement (MDUFA) V legislative process.

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

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

Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Resetting the Impact (TRIA) Act of 2021 (H.R. 2455) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S.3018) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments Organ acquisition payment policies Clinical lab fee schedule False Claims Act amendments CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule Hospital Inpatient Services Modernization Act (H.R. 7053 /S. 3792) - to extend the hospital at home waiver program Medicare Mental Health Inpatient Equity Act (S. 3061/H.R. 5674) HR 4040: Advancing Telehealth Beyond COVID-19 Act HELP Act Inpatient Psychiatric Facility Improvement Act MIND Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

TRAIN Act (S. 1568/H.R. 4407) to stop cuts to nursing and allied health programs Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 7961) to protect healthcare workers. Sequestration relief Rural hospital policies (Rural Health Clinic payment - H.R. 1868; 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); Rural America Health Corps Act S.54); Rural Hospital Support Act (S. 4009) and the Assistance for Rural Community Hospitals (ARCH) Act (H.R. 8747) to extend the MDH and LVA programs) Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053) Value in Health Care Act (H.R. 4587) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 S. 834/H.R. 2256); Opioid Workforce Act S. 1438/ Substance Use Disorder Workforce Act H.R. 3441 Telehealth flexibilities and payment (Telehealth Extension Act - H.R. 6202; TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act - S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166) Resetting the Impact (TRIA) Act of 2021 H.R. 2455 Technical Reset to Advance the Instruction of Nurses (TRAIN) Act Value in Healthcare Act (H.R. 4587) Improving Seniors Timely Access to Care Act (S. 3018/H.R. 3173) Annual Prospective Payment System Rules

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

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

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

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

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

H.R.708; S.168 Temporary Reciprocity to Ensure Access to Treatment Act H.R. 2256, S. 834 Resident Physician Shortage Reduction Act of 2021 S. 2209 VALID Act of 2021 S. 4348 User Fee Amendments of 2022 - provisions relating to laboratory developed tests Policy regarding HIPAA & patient privacy

Client expense: $90,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

H.R. 708 and S. 168: Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act To provide temporary licensing reciprocity for telehealth and interstate health care treatment (ALL). S. 54: Strengthening Americas Health Care Readiness Act A bill to address health workforce shortages and disparities highlighted by the COVID-19 pandemic through additional funding for the National Health Service Corps and the Nurse Corps, and to establish a National Health Service Corps Emergency Service demonstration project (ALL). H.R. 2256 and S. 834: Resident Physician Shortage Reduction Act To amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes (ALL). S. 3799: Prepare for and Respond to Existing Viruses, Emerging New Threats and (PREVENT) Pandemics Act A bill to prepare for, and respond to, existing viruses, emerging new threats, and pandemics (provisions relating to the creation of the Advanced Research Projects Agency-Health, advanced and continuous pharmaceutical manufacturing university centers of excellence, pandemic preparedness university centers of excellence, and research at regional biocontainment labs). H.R. 5585: Advanced Research Project Agency-Health Act To establish the Advanced Research Projects Agency-Health, and for other purposes (ALL). H.R. 6000: Cures 2.0 Act To continue the acceleration of the discovery, development, and delivery of 21st century cures, and for other purposes (provision relating to the creation of the Advanced Research Projects Agency-Health). H.R. 7667: Food and Drug Amendments of 2022 To amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs, medical devices, generic drugs, and biosimilar biological products, and for other purposes (provision relating to university centers of excellence in advanced and continuous pharmaceutical manufacturing). S. 4348: Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act of 2022 A bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs, medical devices, generic drugs, and biosimilar biological products, and for other purposes (provisions relating to laboratory-developed tests and university centers of excellence in advanced and continuous pharmaceutical manufacturing). H.R. 2617: Consolidated Appropriations Act, 2023 Making consolidated appropriations for the fiscal year ending September 30, 2023, and for providing emergency assistance for the situation in Ukraine, and for other purposes (provisions relating to university centers of excellence in advanced and continuous pharmaceutical manufacturing and the authorization of the Advanced Research Projects Agency-Health).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 708 - TREAT ACT S. 168 - TREAT ACT -- regarding policy issues affecting higher education institutions and their faculty and students

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

H.R. 708: TEMPORARY RECIPROCITY TO ENSURE ACCESS TO TREATMENT (TREAT) ACT; ALL PROVISIONS H.R. 4040: ADVANCING TELEHEALTH BEYOND COVID-19 ACT OF 2022; ALL PROVISIONS P.L. 117-169: (H.R. 5376) INFLATION REDUCTION ACT OF 2022; PROVISIONS RELATING TO MEDICAID COVERAGE GAP, PART D OUT OF POCKET COSTS, AND EXTENDING THE ENHANCED PREMIUM TAX CREDITS H.R. 5801: HELP ENSURE LOWER PATIENT (HELP) COPAYS ACT; ALL PROVISIONS H.R. 6833: AFFORDABLE INSULIN NOW ACT; PROVISIONS RELATING TO FDA USER FEE REAUTHORIZATION S. 168: TEMPORARY RECIPROCITY TO ENSURE ACCESS TO TREATMENT (TREAT) ACT; ALL PROVISIONS S. 368: TELEHEALTH MODERNIZATION ACT; ALL PROVISIONS S. 942: NO JUNK PLANS ACT; ALL PROVISIONS GENERAL DISCUSSIONS REGARDING ACE KIDS 2.0; ALL PROVISIONS

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 482: NEWBORN SCREENING SAVES LIVES REAUTHORIZATION ACT OF 2021; ALL PROVISIONS H.R. 708: TEMPORARY RECIPROCITY TO ENSURE ACCESS TO TREATMENT (TREAT) ACT; ALL PROVISIONS H.R. 3932: THE PIONEERING ANTIMICROBIAL SUBSCRIPTIONS TO END UP SURGING RESISTANCE (PASTEUR) ACT OF 2021; ALL PROVISION H.R. 4040: ADVANCING TELEHEALTH BEYOND COVID-19 ACT OF 2022; ALL PROVISIONS H.R. 5030: DIVERSIFYING INVESTIGATIONS VIA EQUITABLE RESEARCH STUDIES FOR EVERYONE (DIVERSE) TRIALS ACT; ALL PROVISIONS P.L. 117-169: (H.R. 5376) INFLATION REDUCTION ACT OF 2022; PROVISIONS RELATING TO MEDICAID COVERAGE GAP, PART D OUT OF POCKET COSTS, AND EXTENDING THE ENHANCED PREMIUM TAX CREDITS H.R. 5566: FINDING ORPHAN-DISEASE REMEDIES WITH ANTIFUNGAL RESEARCH AND DEVELOPMENT (FORWARD) ACT OF 2021; ALL PROVISIONS H.R. 5801: HELP ENSURE LOWER PATIENT (HELP) COPAYS ACT; ALL PROVISIONS H.R. 6000: CURES 2.0 ACT; ALL PROVISIONS H.R. 6833: AFFORDABLE INSULIN NOW ACT; PROVISIONS RELATING TO FDA USER FEE REAUTHORIZATION S. 168: TEMPORARY RECIPROCITY TO ENSURE ACCESS TO TREATMENT (TREAT) ACT; ALL PROVISIONS S. 350: NEWBORN SCREENING SAVES LIVES REAUTHORIZATION ACT OF 2021; ALL PROVISIONS S. 368: TELEHEALTH MODERNIZATION ACT; ALL PROVISIONS S. 942: NO JUNK PLANS ACT; ALL PROVISIONS S. 2076: THE PIONEERING ANTIMICROBIAL SUBSCRIPTIONS TO END UP SURGING RESISTANCE (PASTEUR) ACT OF 2021; ALL PROVISIONS S. 2706: DIVERSIFYING INVESTIGATIONS VIA EQUITABLE RESEARCH STUDIES FOR EVERYONE (DIVERSE) TRIALS ACT; ALL PROVISIONS GENERAL DISCUSSIONS REGARDING ACE KIDS 2.0; ALL PROVISIONS

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 708 and S. 168: Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act To provide temporary licensing reciprocity for telehealth and interstate health care treatment (ALL). S. 54: Strengthening Americas Health Care Readiness Act A bill to address health workforce shortages and disparities highlighted by the COVID-19 pandemic through additional funding for the National Health Service Corps and the Nurse Corps, and to establish a National Health Service Corps Emergency Service demonstration project (ALL). H.R. 2256 and S. 834: Resident Physician Shortage Reduction Act To amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes (ALL). S. 3799: Prepare for and Respond to Existing Viruses, Emerging New Threats and (PREVENT) Pandemics Act A bill to prepare for, and respond to, existing viruses, emerging new threats, and pandemics (provisions relating to the creation of the Advanced Research Projects Agency-Health, advanced and continuous pharmaceutical manufacturing university centers of excellence, pandemic preparedness university centers of excellence, and research at regional biocontainment labs). H.R. 5585: Advanced Research Project Agency-Health Act To establish the Advanced Research Projects Agency-Health, and for other purposes (ALL). H.R. 6000: Cures 2.0 Act To continue the acceleration of the discovery, development, and delivery of 21st century cures, and for other purposes (provision relating to the creation of the Advanced Research Projects Agency-Health). H.R. 7667: Food and Drug Amendments of 2022 To amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs, medical devices, generic drugs, and biosimilar biological products, and for other purposes (provision relating to university centers of excellence in advanced and continuous pharmaceutical manufacturing). S. 4348: Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act of 2022 A bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs, medical devices, generic drugs, and biosimilar biological products, and for other purposes (provisions relating to laboratory-developed tests and university centers of excellence in advanced and continuous pharmaceutical manufacturing). H.R. 6833: Continuing Appropriations and Ukraine Supplemental Appropriations Act Making continuing appropriations for fiscal year 2023, and for other purposes (provision relating to university centers of excellence in advanced and continuous pharmaceutical manufacturing within FDA user fee reauthorization).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Affordable prescription drugs; 340B Drug pricing program; Health care privacy; Patient privacy issues; Issues related to the American Rescue Plan Act, PL 117-2; Issues related to expanding health care coverage, including in non-Medicaid expansion states; Issues related to improving social determinants of health; Issues related to extending and expanding flexibilities for virtual care; Financial support for providers for diagnosis and treatment related to COVID-19, coverage of COVID-19 related conditions, access to PPE and other materials and equipment related to the treatment of patients with COVID-19, including funding for the Provider Relief Fund; Issues related to affordable health care coverage; H.R. 2228 - Rural Behavioral Health Access Act; Issues related to drug pricing; Issues related to Bipartisan Infrastructure Framework; Issues related to telehealth; Efforts to extend Medicare sequester delay, including H.R.1868; Issues related to Medicare policy on virtual care; Issues related to vaccine mandates; S. 168/H.R. 708 - Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act; S. 346/H.R. 959 - Black Maternal Health Momnibus Act; S. 773/H.R. 3203 - Legislation related to 340B eligibility; S. 834/H.R. 2256 - Resident Physician Shortage Reduction Act; S. 834/H.R. 2256 - Healthcare Workforce Resilience Act; S. 368/H.R. 1332 - Telehealth Modernization Act ; S. 1512/H.R. 2903 - CONNECT for Health Act; S. 1988 - Protecting Rural Telehealth Access Act; H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act; S.773/H.R. 3203 - A bill to enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program; H.R. 4943 - Childrens Mental Health Infrastructure Act; H.R. 4944 - Helping Kids Cope Act; H.R. 5376 - Build Back Better Act; H.R. 1667 - Dr. Lorna Breen Health Care Provider Protection Act; Issues related to workforce retention; H.R. 2471 - Consolidated Appropriations Act (FY 2022 Omnibus); H.R. 7007 - Covid-19 Supplemental Appropriations Act; H.R. 7053/S. 3792 - Hospital Inpatient Services Modernization Act; issues related to the Acute Hospital Care at Home (AHCAH) waiver; H.R. 4407/S. 1568 - Technical Reset to Advance the Instruction of Nurses (TRAIN) Act; S. 3493 - Telehealth Extension and Evaluation Act; H.R. 6202 - Telehealth Extension Act; H.R. 5376 - Inflation Reduction Act (Public Law 117-169); H.R. 6833 - Continuing Resolution; Issues related to adequate financing for hospitals and providers; H.R. 4040 - Advancing Telehealth Beyond COVID-19 Act; Issues related to extending the Medicare Dependent Hospital and Low Volume Hospital programs; Issues related to extending bonus payments for Advanced Alternative Payment models; H.R. 4587 - Value in Health Care Act; Issues related to coding and coverage of spiritual care through chaplain services; Issues related to value-based care programs, including the Bundled Payments for Care Improvement (BPCI) Advanced Model

Client expense: $660,000 · Firm income: Not reported

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

340B Drug Pricing Program; Issues related to 340B contract pharmacies; Financial support for providers for diagnosis and treatment related to COVID-19, including funding for the Provider Relief Fund; coverage of COVID-19 related conditions; S. 168/H.R. 708 - Temporary; Reciprocity to Ensure Access to Treatment (TREAT) Act; S. 346/H.R. 959 - Black Maternal Health Momnibus Act; S. 773/H.R. 3203 - Legislation related to 340B eligibility; S. 368/H.R. 1332 - Telehealth Modernization Act; S. 1512/H.R. 2903 - CONNECT for Health Act; S. 1988 -Protecting Rural Telehealth Access Act; H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act; S.773/H.R. 3203 - A bill to enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program; - S.773/H.R. 3203; H.R. 5376 - Build Back Better Act; H.R. 853 - Closing Loopholes for Orphan Drugs Act; H.R. 2471 - Consolidated Appropriations Act (FY 2022 Omnibus); H.R. 7007 - Covid-19 Supplemental Appropriations Act; H.R. 5376 - Inflation Reduction Act (Public Law 117-169); H.R. 6833 - Continuing Resolution

Client expense: $660,000 · Firm income: Not reported

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

HR 432 and S 828 To provide for the coverage of marriage and family therapist services and mental health counselor services under Medicare. HR 708 and S 168 To provide temporary licensing reciprocity for telehealth and interstate health care treatment. HR 1384 and S 445 Loosens restrictions on doctors prescribing buprenorphine for addiction treatment. HR 2503 To direct the HHS Secretary to establish an interagency council on social determinants of health. S 660 Improves access to tele-mental health during the length of the COVID-19 PHE. S 674 To support public health infrastructure (funding up to $4.5 billion). HR 2255/S. 1024 To recapture unused immigrant visas and allocate them to doctors and nurses to help in the fight against COVID-19. HR 2903/S. 1512 Comprehensive bill to expand telehealth access and make permanent telehealth flexibilities available during COVID-19 pandemic. HR 3203/S. 773 To enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program. S. 1162 To expand access to Programs of All-Inclusive Care for the Elderly (PACE). HR 4118 To authorize the HHS Secretary to invest in community-based violence reduction initiatives. S. 2257 To reduce drug and device shortages and costs. HR 5801 To apply additional payments, discounts, and other financial assistance towards the cost-sharing requirements of health insurance plans. Health care workforce shortage concerns. S. 3626 To improve access to the Program of All-Inclusive Care for the Elderly (PACE) HR 7236 To expand the availability of mental, emotional, and behavioral health services under the Medicaid program HR 7353 To treat telehealth services as excepted benefits HR 7961 To protect hospital personnel from violence S 4352 To require a study on the effects of travel nurse agencies on the health industry during the COVID-19 pandemic S 3189 To provide a pathway to health careers through health profession opportunity grants HR 7666 Reauthorizes, expands, and modifies programs, grants, and activities that focus on mental and behavioral health

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

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

Met with legislative staff to express support for biomedical research. Urged legislative staff to support a proposal to expand Centers for Public Health Preparedness and Response (S 3800). Urged legislative staff to support S 168/HR 708, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act. Urged legislative staff to address telehealth provisions CMS identified as under Congress purview including audio-only visits and the ability for telehealth services to be provided to both new and established patients for acute and chronic conditions. Urged agency staff to create a dedicated fund within the provider relief fund to provide relief to faculty practice plans. Asked Representatives to consider legislation that makes changes to the regulation of laboratory testing (including the VALID Act) separately from the Medical Device User Fee Agreement (MDUFA) V legislative process.

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

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

Healthcare Supply Chain - Highlighted the important role played by hospital group purchasing organizations in promoting resiliency and value in healthcare purchasing. Provided information on ongoing efforts to reduce greenhouse gas emissions and support environmentally preferred sourcing for healthcare supplies. Engaged to support policies to ensure greater transparency and mitigate or limit shortages of prescription drugs. Supported policies that would expedite critical cargo, including cargo necessary for medical care, during a public health emergency or disaster. Food and Drug Administration User Fee Amendments - Supported passage of legislation to extend user-fee authorities ((S. 4348, H.R.7667, H.R. 6833). Advocated for greater transparency in the health care supply chain for drugs and medical devices. Supported updating language related to the Unapproved Drugs Initiative, and incorporating the PASTUER Act (S.2076) and the PATCH Act (H.R. 7084) in final passage. Inflation Reduction Act (H.R. 5376) - Supported extension of enhanced subsidies through the health insurance marketplace. Supported provisions that would increase reimbursement for biosimilar medications and monitored impact of other policies impacting prices of prescription drugs. Public Health Emergency - Advocated for HHS to further extend the declared Public Health Emergency. Telehealth - Supported efforts to make telehealth flexibilities offered during COVID-19 Public Health Emergency permanent. Supported CONNECT for Health Act (S. 1512/H.R. 2903) and the Extending Telehealth Beyond COVID-19 Act (H.R. 4040). 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 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. Supported passage of the Travel Nursing Agency Transparency Study Act (S. 4352). Supported passage of the Safety from Violence for Healthcare Employees Act (H.R. 7961). Prepare for and Respond to Existing Viruses, Emerging New Threats, and (PREVENT) Pandemics Act (S. 3799) - monitored PREVENT Pandemics Act and 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). 340B Drug Pricing Program - Urged HHS to enforce guidance that would allow 340B Covered Entities to utilize contract pharmacies. 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). Supported passage of the Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053).

Client expense: $320,000 · 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, White House Office

H.R. 6072, Leveraging Integrated Networks in Communities (LINC) to Address Social Needs Act of 2021, provisions relating to social determinants of health, mental health, and social services S. 509, LINC to Address Social Needs Act of 2021, provisions relating to social determinants of health, mental health, and social services 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 S. 3799, Prepare for and Respond to Existing Viruses, Emerging New Threats, and (PREVENT) Pandemics Act, 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. 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. 1384, Mainstreaming Addiction Treatment (MAT) Act of 2021, all provisions S. 445, MAT Act of 2021, all provisions H.R. 2163, Safe Step Act, all provisions S. 464, Safe Step 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. 5602, Bolstering Infectious Outbreaks (BIO) Preparedness Workforce Act of 2021, all provisions S. 3244, BIO Preparedness Workforce Act of 2021, 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 H.R. 1364, Parity Enforcement Act of 2021, all provisions H.R. 3753, Parity Implementation Assistance Act, all provisions S. 1962, Parity Implementation Assistance Act, all provisions H.R. 7232, 9-8-8 and Parity Assistance Act of 2022, all provisions H.R. 2067, Medication Access and Training Expansion (MATE) Act of 2021, all provisions S. 2235, MATE Act of 2021, all provisions S. 2938, Bipartisan Safer Communities Act, all provisions S. 4090, Dietary Supplement Listing Act of 2022, all provisions H.R. 8296, Womens Health Protection Act of 2022, all provisions H.R. 8373, Right to Contraception Act, all provisions H.R. 8318, To restrict limitations on the possession, sale, purchase, transportation or use of any contraceptive that relates to interstate commerce, all provisions H.R. 8454, Medical Marijuana and Cannabidiol Research Expansion Act S. 253, Cannabidiol and Marihuana Research Expansion Act, all provisions S. 2866, Treatment Restoration for Emergency Antibody Therapeutics (TREAT) Act, all provisions H.R. 6087, Improving Access to Workers Compensation for Injured Federal Workers Act of 2022, all provisions H.R. 3085, Equity in Neuroscience and Alzheimers Clinical Trials (ENACT) Act of 2021, all provisions H.R. 5030, Diversifying Investigations Via Equitable Research Studies for Everyone (DIVERSE) Trials Act, all provisions S. 1675, Maternal Health Quality Improvement Act, all provisions S. 3904, Healthcare Cybersecurity Act of 2022, all provisions H.R. 4128, Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2021, all provisions S. 2209, VALID Act of 2021, all provisions H.R. 8152, American Data Privacy and Protection Act, all provisions H.R. 2377, Federal Extreme Risk Protection Order Act of 2022, all provisions H.R. 7910, Protecting Our Kids Act, all provisions S. 2938, Protecting Our Kids Act, all provisions H.R. 7667, Food and Drug Amendments of 2022, all provisions H.R. 7666, Restoring Hope for Mental Health and Well-Being Act of 2022, all provisions H.R. 8297, Ensuring Womens Right to Reproductive Freedom Act, all provisions H.R. 1235, Charlotte Woodward Organ Transplant Discrimination Prevention Act, all provisions S. 3301, Charlotte Woodward Organ Transplant Discrimination Prevention Act, all provisions H.R. 708, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, all provisions S. 168, TREAT Act, all provisions H.R. 4480, Telehealth Coverage and Payment Parity Act, all provisions H.R. 5541, Primary and Virtual Care Affordability Act, 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. 3778, Nullifying Opportunities for Variants to Infect and Decimate (NOVID) Act, all provisions S. 1976, NOVID Act, all provisions H.R. 6904, Patients Before Profits Act of 2022, all provisions H.R. 7116, 9-8-8 Implementation Act of 2022, all provisions H.R. 8890, Physician Wellness Program Act of 2022, all provisions H.R. 8908, Fighting Stimulant and other Substance Use Disorders Act, all provisions H.R. 8891, No Surprises for Survivors Act of 2022, all provisions H.R. 8885, Better Health Care Directories Act, all provisions H.R. 8886, Promoting Clarity in Mental Health and Substance Use Disorder Treatment Act, all provisions H.R. 8892, To direct the Secretary of Health and Human Services to conduct a public outreach campaign to inform individuals covered under a group health plan or group or individual health insurance coverage of Federal requirements relating to mental health and substance use disorder crisis services, and for other purposes, all provisions H.R. 8881, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to disclose the percentage of in-network participation for certain provider types, and for other purposes, all provisions H.R. 8889, Readable Insurance Coverage Explanations (RICE) Act, all provisions H.R. 7780, Mental Health Matters Act, all provisions H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act, all provisions H.R. 5224, Preventing Overdoses and Saving Lives Act of 2021, all provisions H.R. 6279, Opioid Treatment Access Act of 2022, all provisions H.R. 925, Data to Save Moms Act, all provisions H.R. 3352, Midwives for MOMS Act of 2021, all provisions H.R. 847, Promoting Digital Privacy Technologies Act, all provisions S. 224, Promoting Digital Privacy Technologies Act, all provisions H.R. 3771, South Asian Heart Health Awareness and Research Act of 2022, all provisions H.R. 7559, Prescription Information Modernization Act of 2022, all provisions H.R. 8289, Banning Misleading Drug Ads Act of 2022, all provisions Emergency Room Hero and Patient Safety Act No Surprises Act/implementation Global health security/pandemics Digital Health/AI/Digital Therapeutics Privacy/non-HIPAA covered health apps Abortion/Dobbs decision Drug overdose epidemic Telehealth Scope of practice/patient safety Prior authorization Physician burnout/mental health stigma Health equity/COVID-19 COVID-19 Provider Relief Fund COVID-91/testing/misinformation/vaccine issues/therapeutics Section 1557/nondiscrimination/limited English proficiency Maternal Mortality Modifier 25, Impossible Day Hunger, Nutrition and Health WIC/SNAP/Nutrition Strengthening primary health care Data privacy Physician-led aerospace medicine teams Men who have sex with men/blood donations Federally qualified health centers and clinical trials

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

Government targets: Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Federal Aviation Administration (FAA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Natl Drug Control Policy (NDCP), SENATE, White House Office

Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Resetting the Impact (TRIA) Act of 2021 (H.R. 2455) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S.3018) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments Organ acquisition payment policies Clinical lab fee schedule False Claims Act amendments CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule Hospital Inpatient Services Modernization Act (H.R. 7053 /S. 3792) - to extend the hospital at home waiver program Medicare Mental Health Inpatient Equity Act (S. 3061/H.R. 5674) HR 4040: Advancing Telehealth Beyond COVID-19 Act HELP Act Inpatient Psychiatric Facility Improvement Act MIND Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issue: Educate Congress and the administration on academic medicines missions, including education, research, patient care, GME, workforce, and physician shortages in rural and urban communities. Draft Graduate Medical Education Reform Act Issue: Support increased funding for the National Health Service Corps, Teaching Health Center GME, and National Disaster Medical Service (NDMS) demonstration pilot. Support increased Medicare support for Graduate Medical Education/physician training. Issues: Educate Congress and the administration about the role of academic medicine in the provision of mental and behavioral health care, including initiatives to respond to the opioid epidemic. Support measures to expand access to mental health care and substance use disorder treatment, including funding for training on substance use disorders, pain management, and safe prescribing practices, enhance enforcement of mental health parity laws, increased financial support for integrated behavioral health models, and the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). Support Senate Finance Committee proposal to provide 400 additional Medicare-supported graduate medical education slots for psychiatry and psychiatry sub-specialties. H.R. 1384/ S.445 Mainstreaming Addiction Treatment (MAT) Act of 2021 Issue: Support suspension of waiver requirement for certain providers to prescribe buprenorphine. H.R. 2067 Medication Access and Training Expansion Act of 2021 Issue: Oppose legislative mandates dictating medical education curriculum on pain management and addiction. H.R. 7236 Strengthen Kids Mental Health Now Act Issue: Support increasing Medicaid reimbursement rates for pediatric mental health services through a 100% federal match. P.L. 116-22, Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 Issues: Support the Hospital Preparedness Program and the reauthorization of the Pandemic and All-Hazards Preparedness Act. Support increased funding authorization levels. Issue: Educate Congress on how the 340B Drug Pricing Program helps safety-net providers to fulfill their missions and care for patients and communities. Support measures to preserve and strengthen the 340B Drug Pricing Program and oppose efforts to reduce the scope of the program, including not providing 340B discounts on covered drugs purchased at community pharmacies. H.R. 4390 Preserving Rules Ordered for the Entities Covered Through 340B Act of 2021 (PROTECT 340B Act) Issue: Support measures to prevent pharmacy benefit managers and commercial insurers from discriminating against 340B covered entities. H.R. 3203/S. 773 Issue: Support policy to allow 340B DSH hospitals to remain eligible to participate in the program throughout the current public health emergency even if their DSH adjustment falls below the current threshold due to changes in payor mix as a result of the COVID-19 pandemic. Issue: Oppose insurance plans that do not meet Affordable Care Act requirements. Issue: Support increased interoperability and exchange of electronic health information and delayed enforcement of information blocking rule until comprehensive guidance is issued. Issue: Support the ongoing refinement of the two new mandatory alternative payment models, the Radiation Oncology Model and End-stage Renal Disease Treatment Choices Model, to better incentivize high-quality care for all patients. H.R. 4128/ S. 2209 Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2021 S. 4348, Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act of 2022 Issue: Educate Congress on development of Laboratory Developed Tests at academic medical centers and oppose policies that would increase burdensome regulations and negatively impact patients access to care by allowing Food and Drug Administration regulation of the development of Laboratory Developed Tests at academic medical centers. S. 4348, Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act of 2022 H.R. 7667, Food and Drug Amendments of 2022 (FDA22) Issue: Support promotion of data sharing and clinical trials results reporting. Support increased clinical trials diversity. Issue: Development of Enhanced Primary Care Pilot Act proposal Issue: Support initiatives of hospitals to promote affordable housing in local communities and eliminate other social determinants of health to improve health equity. H.R. 2503 Social Determinants Accelerator Act of 2021 Issue: Support grants to address social determinants of health H.R. 7585 / S. 4486, Health Equity and Accountability Act Issue: Support programs to improve health equity and address social determinants of health. Issue: Support incentives to encourage the inclusion of implicit bias training in medical education and residency training. Issue: Support congressional investment in the Centers for Medicare and Medicaid Innovation (CMMI) models to reduce maternal mortality and improve maternal health. Issue: Support maternal health initiatives to expand coverage for postpartum women and expand demonstration project grants. H.R. 959 Black Maternal Health Momnibus Act of 2021 S. 1695 / H.R. 4387 Maternal Health Quality Improvement Act S. 1491/ H.R. 769 Rural MOMs Act H.R. 4387 Maternal Health Quality Improvement Act of 2021 H.R. 5376, Build Back Better Act H.R. 925 / S. 347 Data to Save Moms Act Issue: Support legislative efforts to improve maternal health and reduce rates of maternal mortality, including the Momnibus. Support legislative initiatives to improve data collection to improve maternal health equity. P.L. 117-159, Bipartisan Safer Communities Act Issue: Support policies to promote firearm safety, universal background checks, violence prevention programs, extreme risk protection orders, child access safety laws, reinstating assault weapons ban, data infrastructure, hospital based and community violence intervention programs, and programs to address mental and behavioral health impact of gun violence. Issue: Support funding for Community Violence Interventions/ Hospital Based Violence Intervention Programs P.L. 117-105, Dr. Lorna Breen Health Care Provider Protection Act Issue: Support grants directed at improving clinician burnout and well-being. Issue: Provide feedback on implementation of the Provider Relief Fund. Support extension for use of PRF funds. Issue: Support improvements to the Medicare Accelerated and Advance Payment Programs, including delaying recoupment of MAAP loans. Issue: Support extension of public health emergency declaration. Issue: Provide feedback on COVID-19 and pandemic response. Provide feedback on monkeypox response including testing. S. 3799, PREVENT Pandemics Act Issue: Provide feedback on pandemic preparedness legislation, urge inclusion of provisions to support academic medical centers preparedness activities. Issue: Support establishment of regional pandemic response centers, stronger linkages between public health and academic medicine, and the role of medical students and academic medical centers in administering COVID vaccines. H.R. 8131 Increasing Competition for Medical Residency Act Issue: Educate Congress on the medical education and training continuum, the annual residency Match, and the role of the National Resident Matching Program (NRMP) in medical education and residency. Issue: Support efforts of academic medical centers to respond to public health threats such as monkeypox and COVID-19. Urge establishment and implementation of robust national testing strategy; functional, redundant, and transparent supply chain; improved federal coordination; investments in public health and health care human and other resources; data modernization initiatives; and other actions to improve current and future pandemic response. H.R. 708, S. 168, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act Issue: Support for a temporary uniform licensing standard for all practitioners in all states throughout the COVID-19 public health emergency S. 674 Public Health Infrastructure Saves Lives Act Issue: Support investments in core public health infrastructure. Issue: Support ensuring patients are put first, that conscience protections align with medical professionalism standards, and oppose interference in the patient-physician relationship. Issue: Support increased interoperability and exchange of electronic health information. Support delay of enforcement beyond April 2021. H.R. 6000, Cures 2.0 Act Issue: Provide feedback on provisions related to public health, patients and caregivers, FDA, CMS, and research, and ARPA-H. Issue: Promote strategies to strengthen the health, public health, and research workforces. H.R. 3671, Doctors of Community Act Issue: Discuss authorization of the Teaching Health Center Graduate Medical Education program. Issue: Provide guidance on the implementation of the No Surprises Act. Issue: Provide feedback on proposed modifications to the HIPAA privacy rule. H.R. 5035, S. 2982 Child Suicide Prevention and Lethal Means Safety Act Issue: Support legislation to provide grants to improve suicide prevention and lethal means safety. Issue: Inform Congress and Administration about medical education on caring for older adults, nutrition, climate change, stigma around addiction, reproductive health, and accelerated medical education training programs. Issue: Provide feedback on efforts of the academic medicine community to address climate change and decarbonization. H.R. 7152/ S.3534, The Tracking Pathogens Act Issue: Support expansion of CDC activities related to genomic sequencing of pathogens. Issue: Support reignition of Cancer Moonshot. H.R. 7961 - Safety from Violence for Healthcare Employees (SAVE) Act Issue: Support statutory protections against violence and intimidation for healthcare workers and provide grants for hospital programs aimed at preventing violence in healthcare settings. Issue: Support a one-year pause in military medical billet reductions in the Military Health System.

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of the Vice President of the United States, SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

-Inflation Reduction Act (H.R. 5376) -- Provisions related to providing up to 12 weeks of paid family and medical leave; extending Medicare telehealth flexibilities beyond the COVID-19 public health emergency; the establishment Advanced Research Projects Agency for Health (ARPA-H); provisions related to extending marketplace subsidies under the Patient Protection and Affordable Care Act; and provisions related to an out-of-pocket maximum for Medicare beneficiaries' prescription drugs. Advancing Telehealth Beyond COVID-19 Act of 2021 (H.R. 4040) -- Provisions related to extension of Medicare flexibilities including originating site, allowance of occupational and physical therapists, speech-language pathologists, and audiologists to continue to provide services, allowance for qualified health centers and rural health clinics to serve as a distant site, behavioral services to continue to be provided via audio-only technology, and allowance of hospice physicians and nurse practitioners to complete patient recertification via telehealth. Additional provisions related to delay of in-person evaluation requirements for mental health services until January 1, 2025 or end of emergency period. -The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (H.R. 2903 / S. 1512) Provisions related to the Centers for Medicare & Medicaid Services (CMS) to waive certain restrictions, such as geographic restrictions, for services provided in high-need health professional shortage areas; excludes mental health and emergency medical services, as well as services provided at rural health clinics, federally qualified health centers, and Indian Health Service facilities, from such geographic restrictions; and waive coverage restrictions during national emergencies. -Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act (H.R. 708 / S. 168) temporarily authorizes the interstate provision of in-person and telehealth services. This authorization applies during, and for at least 180 days after, the COVID-19 (i.e. coronavirus disease 2019) emergency. Specifically, subject to scope of practice and other requirements, a health care professional may provide health services in any U.S. jurisdiction based on that individual's authorization to practice in any one state or territory. The bill also provides certain related powers to health care professional regulatory bodies, such as medical boards. Specifically, a regulatory may investigate and take disciplinary actions against a processional who provides services pursuant to this bill to a patient in that body's jurisdiction. -CURES 2.0 Act (H.R. 6000) -- Provisions related to drug development, research, and access to emerging therapies for Americans with ALS and other rare diseases through the creation of ARPA-H and other mechanisms.

Client expense: $25,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

American Rescue Plan Act of 2021 (H.R. 1319), all provisions related to relief to address the continued impact of COVID-19. Mainstreaming Addiction Treatment Act (S. 445/H.R. 1384), all provisions related to removing the waiver requirement for health care providers to prescribe buprenorphine for opioid use disorder. Improving Access to Remote Behavioral Health Treatment Act of 2019, all provisions related to amending regulations for the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 and allowing community mental health centers to register to practice telemedicine. Medication Access and Training Expansion Act (H.R. 2067), all provisions related to requiring physicians and other prescribers of controlled substances to complete training on treating and managing patients with substance use disorders. CONNECT for Health Act of 2021 (H.R. 2903/S. 1512), all provisions related to expanding access to telehealth services. Telemental Health Care Access Act of 2021 (S. 2061), all provisions related to ensuring coverage of mental health services furnished through telehealth. HELP Act of 2021 (S. 1570), all provisions related to the accessibility and coordination of 211 services and 988 services. Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act (H.R. 708/S. 168), all provisions related to temporary authorization of in-person and telehealth services. Behavioral Health Crisis Services Expansion Act (S. 1902), all provisions related to empowering communities to establish a continuum of care for individuals experiencing a behavioral health crisis. Preventing Overdoses and Saving Lives Act of 2021 (H.R. 5442), all provisions related to authorizing grants to develop strategic response plans with respect to the opioid crisis, and to require practitioners prescribing an opioid for certain patients to also prescribe an opioid overdose reversal drug. Coronavirus Mental Health and Addiction Assistance Act of 2021 (H.R. 593/S. 135), all provisions related to providing grants to entities that provide mental health and substance use disorder programs during the COVID-19 pandemic. Mental Health Services for Students Act of 2021 (H.R. 721/S. 1841), all provisions related to school-based mental health services. Stopping the Mental Health Pandemic Act (H.R. 7080/S. 4059), all provisions related to grants to support behavioral health treatment and services during the COVID-19 pandemic. Emergency Support for Substance Use Disorders Act (S. 4058), all provisions related to grants for harm reduction activities during the COVID-19 pandemic. Elementary and Secondary School Counseling Act (H.R. 6214/S. 3356), all provisions related to awarding grants to increase access to school-based, mental health services. Campus Prevention and Recovery Services for Students Act of 2019 (H.R. 3591), all provisions related to expanding the illicit drug and alcohol abuse prevention program to include campus efforts to prevent substance misuse. Opioid Treatment Access Act of 2022 (H.R. 6279), all provisions related to authorizing a study on certain exemptions for treatment of opioid use disorder through opioid treatment programs. 9-8-8 Implementation Act of 2022 (H.R. 7116), all provisions related to providing for improvements in the implementation of the National Suicide Prevention Lifeline, and for other purposes. 9-8-8 and Parity Assistance Act of 2022 (H.R.7232), all provisions related to providing for improvements in the implementation of the National Suicide Prevention Lifeline, and for other purposes. Into the Light for MMH and SUD Act of 2022 (H.R. 7073), all provisions related to reauthorizing a grant program for screening, assessment, and treatment services for maternal mental health and substance use disorders, and for other purposes. Anna Westin Legacy Act (H.R. 7249/S. 3686), all provisions related to providing education and training on eating disorders for health care providers and communities, and for other purposes. Behavioral Health Information Technology Act, (H.R.7427), all provisions related to CMI testing of incentive payments for behavioral health providers and certain other providers for adoption and use of certified electronic health record technology, and for other purposes Safe Step Act (H.R. 2163/S. 464), all provisions related to creating an exception for medication step-therapy. Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (S. 586), all provisions related to establishing separate payments for certain non-opioid treatments under the Medicare prospective payment system for hospital outpatient department services and the payment system for ambulatory surgical center services Food and Drug Administration Safety and Landmark Advancements Act of 2022 (S.4348), all provisions related to addressing substance use disorders and the safe disposal of opioids. Telemental Health Access to Care Act (S.2061/H.R. 4058), all provisions related to intended to increase access to tele-mental health care and telehealth. Stop Pills That Kill Act (S.4151), all provisions related to penalizing the manufacture and/or facilitation of manufacturing counterfeit pills that contain fentanyl, an analogue of fentanyl, or a counterfeit substance. Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R. 7666), all provisions related to reauthorizations, expansions, and modifications of programs, grants, and activities that focus on mental and behavioral health. CONNECT Act of 2022 (H.R.8391), all provisions related to awarding grants for crisis centers to provide follow-up services to individuals receiving suicide prevention and crisis intervention services. BENEFIT Act of 2021 (H.R.4472), all provisions related to strengthen the use of patient-experience data within the benefit-risk framework for approval of new drugs. Advancing Telehealth Beyond COVID-19 Act of 2021 (H.R.4040), all provisions related to extending telehealth flexibilities under the Medicare program

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Communications Commission (FCC), Federal Reserve System, HOUSE OF REPRESENTATIVES, SENATE

Senate S. 168 by MURPHY (D-CT) Temporary Reciprocity to Ensure Access to Treatment S. 264 by DURBIN (D-IL) Dream Act of 2021 S. 323 by PAUL (R-KY) a bill to terminate the Department of Education S. 383 by DURBIN (D-IL) POST Act of 2021 S. 393 by MERKLEY (D-OR) Equality Act S. 518 by YOUNG (R-IN) a bill to amend the Higher Education Act of 1965 to support innovative, evidence-based approaches that improve the effectiveness and efficiency of postsecondary education for all students, to allow pay for success initiatives, to provide additional evaluation authority, and for other purposes S. 603 by WARNER (D-VA) Coronavirus Emergency Student Loan Refinancing Act S. 775 by CASSIDY (R-LA) a bill to require institutions of higher education to disclose hazing-related misconduct, and for other purposes S. 827 by ERNST (R-IA) a bill to authorize the Secretary of Education to establish and maintain a public website tracking the expenditures by States of COVID-19 education relief funds S. 839 by CASSIDY (R-LA) College Transparency Act S. 1173 by SINEMA (D-AZ) Earn to Learn Act S. 1225 by MURPHY (D-CT) SCORE Act S. 1260 by SCHUMER (D-NY) U. S. Innovation and Competitiveness Act (USICA) S. 1263 by SCHATZ (D-HI) Debt-Free College Act of 2021 S. 1288 by SANDERS (I-VT) College for All Act of 2021 S. 1351 by PORTMAN (R-OH) Safeguarding American Innovation Act S. 1396 by BALDWIN (D-WI) Americas College Promise S. 1440 by HASSAN (D-NH) FAFSA Simplification Technical Corrections Act S. 1445 by GRASSLEY (R-IA) Know Before You Owe Federal Student Loan Act of 2021 S. 1448 by GRASSLEY (R-IA) Net Price Calculator Improvement Act S. 1452 by GRASSLEY (R-IA) Understanding the True Cost of College Act of 2021 S. 1464 by SCOTT (R-SC) Student Loan Disclosure Modernization Act S. 1480 by HASSAN (D-NH) Recognizing Military Service in PSLF Act S. 1487 by PETERS (D-MI) ALERT Act S. 1569 by WARREN (D-MA) Student Food Security Act of 2021 S. 1585 by KENNEDY (R-LA) Improving Mental Health Access for Students Act S. 1605 by SCOTT (R-FL) National Defense Authorization Act for Fiscal Year 2022 S. 1802 by HASSAN (D-NH) the Upskilling and Retraining Assistance Act S. 1719 by HASSAN (D-NH) Fast Track to and Through College Act S. 1780 by BOOKER (D. NJ) Diversity Act S. 1847 by KAINE (D-VA) ACCESS to Careers Act of 2021 S. 1945 by COONS (D-DE) IGNITE HBCU Excellence Act S. 2004 by PADILLA (D-CA) Basic Assistance for Students in College Act S. 2020 by RUBIO (R-FL) Terrorism Survivors Student Loan Deferment Act S. 2054 by REED (D-RI) Partnership for Affordability and Student Success S. 2060 by COTTON (R-AR) Foreign Funding Accountability Act of 2021 S. 2081 by HIRONO (D-HI) Pell Grant Preservation and Expansion Act S. 2165 by SASSE (R-NE) Education Savings Accounts for Military Families Act of 2021 S. 2237 by SCHATZ (D-HI) Community College Student Success Act of 2021 S. 2244 by KAINE (D-VA) PREP Act of 2021 S. 2301 by SCHATZ (D-HI) College Equity Act of 2021 S. 2379 by WARNER (D-VA) Reverse Transfer Efficiency Act of 2021 S. 2408 by DAINES (R-MT) Protecting Life on College Campus Act of 2021 S. 2442 by DURBIN (D-IL) Adjunct Faculty Loan Fairness Act of 2021 S. 2478 by BLUMENTHAL (D-CT) Strengthening Loan Forgiveness for Public Servants Act S. 2550 by CASEY (D-PA) RISE Act of 2021 S. 2593 by RUBIO (R-FL) GIFTS in Higher Education Act S. 2596 by RUBIO (R-FL) LOAN Act of 2021 S. 2598 by DURBIN (R-IL) FRESH START through Bankruptcy Act S. 2620 by PETERS (D-MI) Making Education Affordable and Accessible Act of 2021 S. 2625 by DUCKWORTH (D-IL) CCAMPIS Reauthorization Act S.2634 by SCHATZ (D-HI) Beyond the Box for Higher Education Act of 2021 S. 2755 by HEINRICH D-NM) College Completion Fund Act of 2021 (9/15/2021) S. 2791 by MURRAY (D-WA) Tyler Clement Higher Education Anti-Harassment Act of 2021 S. 2976 by MURKOWSKI (R-AK) Student Loan Repayment Freedom Act S. 2984 by MURKOWSKI (R-AK) State-Based Education Loan Awareness Act S. 2986 by CASEY (D-PA) CREATE Grads Act S. 3026 by COTTON (R-AR) Campus Free Speech Restoration Act S. 3048 by CASEY (D-PA) Higher Education Mental Health Act of 2021 S. 3359 by CASEY (D-PA) CREATE Graduates Act S. 3360 by REED (D-RI) EDUCATORS for America Act S. 3471 by CASEY (D-PA) Safe Equitable Campus Resources and Education Act of 2022 S. 3559 by MERKELEY (D-OR) Fair College Admissions for Students Act S. 3605 by CASEY (D-PA) Fostering Success in Higher Education Act of 2022 S. 3616 by MURRAY (D-WA) Higher Education Access and Success for Homeless and Foster Youth Act of 2022 S. 3623 by FEINSTEIN (D-CA) Violence Against Women Act Reauthorization Act of 2022 S. 3639 by MARKEY (D-MA) Jumpstart on College Act S. 3794 by SMITH (D-MN) Emergency Grant Aid for College Students Act S. 3818 by DURBIN (D-IL) Affordable College Textbook Act S. 3827 by WHITEHOUSE (D-RI) Teacher Loan Forgiveness Improvement Act of 2022 S. 3828 by WHITEHOUSE (D-RI) Student Loan Forgiveness for Frontline Health Workers Act S. 3865 by ERNST (R-IA) STUDENT Act S. 3952 by WYDEN (D-OR) Student Right to Know Before You Go Act of 2022 S. 3953 by MERKLEY (D-OR) Affordable Loans for Any Student Act S. 4018 by VAN HOLLEN (D-MD) HBCU RISE Act S. 4068 by PADILLA (D-CA) Hispanic Educational Resources and Empowerment Act of 2022 S. 4094 by THUNE (R-SD) Stop Reckless Student Loan Actions Act of 2022 S. 4106 by BENNET (D-CO) Higher Education Innovation Act S. 4253 by ROMNEY (R-UT) Student Loan Accountability Act S. 4259 by CASEY (D-PA) PREP for All Students Act of 2022 S. 4342 by WHITEHOUSE (D-RI) ASAP Forgiveness Act S. 4344 by WHITEHOUSE (D-RI) Zero-Percent Student Loan Refinancing Act S. 4345 by WHITEHOUSE (D-RI) Simplifying and Strengthening Public Service Loan Forgiveness Act S. 4458 by TESTER (D-MT) To amend title 38, United States Code, to improve the process by which the Secretary of Veterans Affairs determines whether an educational institution meets requirements relating to the percentage of students who receive educational assistance furnished by the Secretary S. 4772 by SCOTT (R-FL) COLLEGE Act S. 4897 by COTTON (R-AR) Student Loan Reform Act of 2022 S. Res. 46 by SCHUMER (D-NY) a resolution calling on the President of the United States to take executive action to broadly cancel federal student loan debt S. Con. Res by SANDERS (I-VT) FY 2021 Budget Resolution S. Res. 352 by TUBERVILLE (R-AL) a resolution designating the week of September 6-10, 2021, as National Historically Black Colleges and Universities Week S. Res. 372 by MENENDEZ (D-NJ) a resolution designating the week beginning September 13, 2021 as National Hispanic-Serving Institutions Week S. Res. 425 by BLACKBURN (R-TN) a resolution recognizing the importance of protecting freedom of speech, thought, and expression at institutions of higher education S. Res. 449 by COONS (D-DE) a resolution designating November 2021 as National College Application Month S. Res. 534 by SCOTT (R-SC) A resolution condemning threats of violence against historically Black colleges and universities and reaffirming support for the students of historically Black colleges and universities. House H.R. 5 by CICILLINE (D-RI) Equality Act H.R. 6 by ROYBAL-ALLARD (D-CA) American Dream and Promise Act H.R. 177 by WITTMAN (R-VA) PROPEL Act H.R. 394 by COURTNEY (D-CT) COVID-19 Student Loan Relief Extension Act H.R. 708 by LATTA (R-OH) Temporary Reciprocity to Ensure Access to Treatment Act H.R. 899 by MASSIE (R-KY) a bill to terminate the Department of Education H.R. 1091 by BANKS (R-IN) Protect Our Universities Act of 2021 H.R. 1133 by HARDER (D-CA) to amend the Higher Education Act of 1965 to include certain employment as a health care practitioner as eligible for public service loan forgiveness, and for other purposes H.R. 1160 by MURPHY (D-CT) INFLUENCE Act H.R. 1421 by PLASKETT (D-VI-At Large) Territories College Access Act H.R. 2030 by KRISHNAMOORTHI (D-IL) College Transparency Act H.R. 2303 by CRAIG (D-MN) Supporting Apprenticeship Colleges Act of 2021 H.R. 2418 by MALONEY (D-NY) Student Loan Forgiveness for Frontline Health Workers Act H.R. 2460 by PRICE (D-NC) Joint Consolidation Loan Separation Act H.R. 2471 by JEFFRIES (D-NY) FY 2022 Consolidated Appropriations Act H.R. 2525 by MCBATH (D-GA) Report and Educate About Campus Hazing Act H.R. 2610 by PRICE (D-NC) SCORE Act H.R. 2622 by GONZALEZ (R-OH) CONFUCIUS Act H.R. 2627 by LAWRENCE (D-MI) Pell to Grad Act H. R. 2700 by MCBATH (D-GA) For-Profit College Conversion Accountability Act H.R. 2730 by JAYAPAL (D-WA) College for All Act of 2021 H.R. 2804 by POCAN (D-WI) Debt-Free College Act of 2021 H.R. 2841 by GONZALEZ (R-OH) Student Athlete Level Playing Field Act H.R. 2874 by CLEAVER (D-MO) Student Loan Disclosure Modernization Act H.R. 2912 by CARTWRIGHT (D-PA) Truth in Tuition Act of 2021 H.R. 2947 by SLOTKIN (D-MI) ALERT Act H.R. 2940 by PRICE (D-NC) Advancing International and Foreign Language Education Act H.R. 2987 by LURIA (D-VA) Teacher Loan Forgiveness Improvement Act of 2021 H.R. 3136 by BROOKS (R-AL) Zero Foreign Influence in Education Act of 2021 H.R. 3294 by ADAMS (D-NC) IGNITE HBCU Excellence Act H.R. 3393 by GARCIA (D-IL) Diversity Act H. R. 3946 by POCAN (D-WI) Pell Grant Preservation and Expansion Act H.R. 4411 Rep. Davis (D-IL) Upskilling and Retraining Assistance Act H.R. 4428 Rep. Smith (R-MO) Upward Mobility Act H.R. 4521 by JOHNSON (D-TX) America COMPETES Act H.R. 4786 by BONAMICI (D-OR) RISE Act of 2021 H.R. 5322 by BONAMACI (D-OR) Students and Young Consumers Empowerment Act H.R. 5380 by KIM (D-NJ) Helping Students Plan for College Act of 2021 H.R. 5381 by KIM (D-NJ) FLAT Act H.R. 5407 by WILD (D-PA) Enhancing Mental Health and Suicide Prevention through Campus Planning Act H.R. 5523 by LAMB (D-PA) Pay down, Upskill Act of 2021 H.R. 5588 by GUTHRIE (R-KY) Net Price Calculator Improvement Act H.R. 5654 by TRONE (D-MD) Higher Education Mental Health Act of 2021 H.R. 5685 by AGUILAR (D-CA) Protecting Students Civil Rights Act H.R. 5691 by GALLAGHER (R-WI) TEACH for Tomorrow Act of 2021 H.R. 5711 by DAVIDSON (R-OH) Educational Opportunity and Success Act of 2021 H.R. 5739 by MORELLE (D-NY) to amend the Higher Education Act of 1965 to change certain Federal Pell Grant requirements for certain students with disabilities, and for other purposes H.R. 5777 by KELLER (R-PA) CHOICE Act H.R. 5779 by LEGER FERNANDEZ (D-NM) Financial Fitness Act H.R. 5864 by GOODEN (R-TX) to prohibit the withholding of Federal education funds on the basis of vaccination requirements, and for other purposes H.R. 5890 by BONAMICI (D-OR) Student Loan Borrower Safety Net Act of 2021 H.R. 6002 by KIM (D-NJ) Understanding the True Cost of College Act of 2021 H.R. 6053 by VELA (D-TX) Protect Minority Student Borrowers Act H.R. 6108 by KELLY (D-IL) Community College to Career Fund in Higher Education Act H.R. 6205 by ADAMS (D-NC) EDUCATORS for American Act H.R. 6209 by ADAMS (D-NC) EDUCATORS for America Act H.R. 6262 by CARTER (R-GA) For the Parents Act H.R. 6371 by DINGELL (D-MI) Safe Equitable Campus Resources and Education Act of 2022 H.R. 6424 by DEFAZIO (D-OR) HIGHER ED Act H.R. 6425 by DEFAZIO (D-OR) AID Act H.R. 6466 by WILLIAMS (D-GA) Student Loan Rehabilitation and Credit Score Improvement Act of 2022 H.R. 6493 by LEGER FERNANDEZ (D-NM) Campus Prevention and Recovery Services for Students Act of 2022 H.R. 6510 by ADAMS (D-NC) STOP Campus Hunger Act H.R. 6537 by CASTEN (D-IL) Pell Grant Sustainability Act H.R. 6559 by BOWMAN (D-NY) Fair College Admissions for Students Act H.R. 6585 by ESPAILLAT (D-NY) Jumpstart on College Act H.R. 6666 by CLARK (D-MI) Higher Education Access and Success for Homeless and Foster Youth Act of 2022 H.R. 6669 by DAVIS (D-IL) Fostering Success in Higher Education Act of 2022 H.R. 6679 by JOHNSON (R-OH) Scholarship for Service: The Building Better Americans Act H.R. 6708 by GONZALEZ (D-TX) Student Loan Relief Act H.R. 6833 by CRAIG (D-MN) Making Continuing Appropriations for Fiscal Year 2023 and for other purposes H.R. 6843 by Kilmer (D-WA) Building Civic Bridges Act H.R. 6893 by ADAMS (D-NC) IGNITE HBCU and MSI Excellence Act H.R. 7031 by KELLER (R-PA) Change of Ownership and Conversion Improvement Act H.R. 7040 by NEGUSE (D-CO) Affordable College Textbook Act H.R. 7058 by GOOD (R-VA) Federal Student Loan Integrity Act H.R. 7141 by STANSBURY (D-NM) College Completion Fund Act of 2022 H.R. 7150 by BANKS (R-IN) To amend the Higher Education Act of 1965 to strengthen oversight and disclosures relating to foreign support for institutions of higher education, and for other purposes. H.R. 7288 by DELAURO (D-CT) Affordable Loans for Any Student Act H.R. 7313 by ADAMS (D-NC) Supporting Diverse STEM Students Act H.R. 7370 by PORTER (D-CA) Student Mental Health Rights Act H.R. 7454 by CASTRO (D-TX) Hispanic Educational Resources and Empowerment Act of 2022 H.R. 7465 by HOULAHAN (D-PA) PSLF Payment Completion Fairness Act H.R. 7488 by STEFANIK (R-NY) Freedom of Association in Higher Education Act of 2022 H.R. 7530 by WILSON (D-FL) Student Loan Borrower Relief Act H.R. 7588 by SESSIONS (R-TX) State-Based Education Loan Awareness Act H.R. 7607 by STEEL (R-CA) HARVARD Act H.R. 7656 by MURPHY (R-NC) Stop Reckless Student Loan Actions Act of 2022 H.R. 7727 by PORTER (D-CA) Accountability in Student Loan Data Act of 2022 H.R. 7728 by PORTER (D-CA) Student Protection Act H.R. 7729 by PORTER (D-CA) CFPB Student Loan Integrity and Transparency Act of 2022 H.R. 7780 by DESAULNIER (D-CA) Mental Health Matters Act H.R. 7851 by PFLUGER (R-TX) To amend the Higher Education Act of 1965 to require institutions of higher education to disclose certain ties to China-affiliated organizations, and for other purposes H.R. 7855 by STEFANIK (R-NY) Halting Academic Liaisons To Our Adversaries Act H.R. 7859 by WILD (D-PA) PREP for All Students Act of 2022 H.R. 7880 by CARBAJAL (D-CA) Degrees Not Debt Act of 2022 H.R. 7895 by RICE (R-SC) Combating Excessive Student Debt Act of 2022 H.R. 7964 by FEENSTRA (R-IA) STUDENT Act H.R. 7980 by DEAN (D-PA) Student Loan Deferment for Sexual Violence Survivors Act H.R. 7982 by FOSTER (D-IL) Parent PLUS Loan Fairness and Responsibility Act H.R. 8006 by FERGUSON (R-GA) Student Loan Accountability Act H.R. 8128 by SMUCKER (R-PA) Legislation to expand the use of funds under qualified tuition programs H.R. 8198 by BOST (R-IL) To amend title 38, United States Code, to improve the process by which the Secretary of Veterans Affairs determines whether an educational institution meets requirements relating to the percentage of students who receive educational assistance furnished by the Secretary H.R. 8447 by MURPHY (R-NC) Protecting Endowments from our Adversaries Act H.R. 8883 by JOYCE (R-OH) Higher Education Accountability Tax Act H. Res 100 by PRESSLEY (D-MA) A resolution calling on the President of the United States to take executive action to broadly cancel federal student loan debt H. Res. 785 by MOORE (D-WI) Expressing support for the designation of November 8, 2021, as National First-Generation College Celebration Day H. Res. 802 by WILD (D-PA) Expressing support for the designation of November 2021 as National College Application Month H. Con. Res. 70 by ADAMS (D-NC) Condemning threats of violence against historically Black colleges and universities (HBCUs) and reaffirming support for HBCUs and their students H. Res. 1193 by DELAURO (D-CT) Expressing support for the designation of June 23, 2022 as National Federal Pell Grant Day

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

Government targets: Education, Dept of, Homeland Security, Dept of (DHS), State, Dept of (DOS), Treasury, Dept of, White House Office

TRAIN Act (S. 1568/H.R. 4407) to stop cuts to nursing and allied health programs Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 7961) to protect healthcare workers. Sequestration relief Rural hospital policies (Rural Health Clinic payment - H.R. 1868; 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); Rural America Health Corps Act S.54); Rural Hospital Support Act (S. 4009) and the Assistance for Rural Community Hospitals (ARCH) Act (H.R. 8747) to extend the MDH and LVA programs) Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053) Value in Health Care Act (H.R. 4587) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 S. 834/H.R. 2256); Opioid Workforce Act S. 1438/ Substance Use Disorder Workforce Act H.R. 3441 Telehealth flexibilities and payment (Telehealth Extension Act - H.R. 6202; TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act - S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166) Resetting the Impact (TRIA) Act of 2021 H.R. 2455 Technical Reset to Advance the Instruction of Nurses (TRAIN) Act Value in Healthcare Act (H.R. 4587) Improving Seniors Timely Access to Care Act (S. 3018/H.R. 3173) Annual Prospective Payment System Rules

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

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

Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S.3018) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules CMS review of Medicaid Managed Care contracts and approval Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments Organ acquisition payment policies

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)

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

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

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

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

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

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

funding for hospitals and physicians related to COVID 19 Health care policy Proposals to strengthen the health care system and achieve Affordable Care Act (ACA) market stability, including extending the expanded ACA subsidies Funding for National Ebola Network/RSPTCs Elimination of Title X Waiver H.R. 1319, "American Rescue Plan Act" - provisions related to healthcare, Medicaid, and federal funding aimed at combating COVID-19, including funding to support vaccination administration, testing and contact tracing and expanding the public health workforce H.R. 3, "Elijah E. Cummings Lower Drug Prices Now Act" Additional legislative proposals to address rising drug costs S. 773, To ensure eligible hospitals continue to have access to the 340B Drug Pricing Program throughout the COVID-19 public health emergency Additional legislative proposals modifying the 340B program including the Protect 340B Act Infrastructure proposals that support the healthcare workforce and hospitals and health facilities, including provisions to improve physical and technical upgrades S.168 / HR 708 Temporary Reciprocity to Ensure Access to Treatment Act or the TREAT Act HR 1195 Workplace Violence Prevention Standard for health care facilities Medicare Coverage for Telehealth - HR 1332/ S 368 Telehealth Modernization Act Ensuring Parity in MA and PACE for Audio-Only Telehealth Act HR 2166 Federal funding to reduce and/or eliminate health care disparities Federal funding to address social determinants of health, especially housing and nutrition Bills to support mental health access and workforce Bills to support funding for nursing working and allied health professionals

Client expense: $303,000 · Firm income: Not reported

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

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

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

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

H.R.708; S.168 Temporary Reciprocity to Ensure Access to Treatment Act H.R. 2256, S. 834 Resident Physician Shortage Reduction Act of 2021 S. 2209 VALID Act of 2021 S. 4348 User Fee Amendments of 2022 - provisions relating to laboratory developed tests

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 708/ S 168 TREAT Act 340b issues - supporting access to the program Provider Relief Fund Telehealth Graduate Medical Education Pediatric mental health Rural Health issues FY23 Appropriations

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