I CAN Act

H.R.8812 - Water Resources Development Act of 2024 - provides for improvements to the rivers and harbors of the United States, to provide for the conservation and development of water and related resources, and for other purposes. Section 142 regarding corrosion prevention and standards for related employment and training activity. General education around the implementation of workforce development in The Infrastructure Investment and Jobs Act (IIJA) Public Law 117-58 (Nov. 15, 2021) Title I, Subtitle A, section 11118 The Bridge Investment Program.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.8812/S.4367, Water Resources Development Act of 2024, Water infrastructure related issues Monitor the following: PFAS related issues Public Law 117-58, Infrastructure Investment and Jobs Act, ACoE, EPA and Bureau of Reclamation infrastructure issues, Low Income Rate Payer Assistance Water infrastructure issues; and Water Recycling issues

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor Water infrastructure issues as follows: Public Law 117-58, Infrastructure Investment and Jobs Act H.R.8812/S.4367, Water Resources Development Act of 2024 Public Law 117-169, Inflation Reduction Act

Client expense: Not reported · Firm income: Not reported

Monitor the following: Bureau of Reclamation grant related issues H.R.8812/S.4367, Water Resources Development Act of 2024, Water infrastructure related issues PFAS related issues Public Law 117-169, Inflation Reduction Act, Utility related issues

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

Medicare sequester, PAYGO H.R.8812, I CAN Act: provision of service under Medicare H.R. 2474, Strengthening Medicare for Patients and Providers Act: an annual inflation adjustment to Medicare physician payments Medicare for All/Public Option Rural Anesthesiology: Rural Pass Through Out of Network/Out of Network Payment Network Adequacy Historical Medicare payment undervaluation for anesthesiology services (33% problem) Anesthesia Conversion Factor Perioperative Surgical Home Model Bundled payments CMS Interpretive Guidelines: Hospital Conditions of Participation Related to Anesthesia Services Medicare Physician Fee Schedule Rule CMS Value-Based purchasing Conditions of Participation - Anesthesia services, opt-outs, supervision Physician Quality Reporting System, PPACA, Sec. 3007 Quality Modifier implementation Graduate Medical Education Value-based modifier - PPACA QCDR - Qualified Clinical Data Registry Evaluation and Monitoring codes & cuts Certified Anesthesiologist Assistants CMS: Federal Independent Dispute Resolution (IDR) Process, Batching Budget neutrality Medicare Economic Index: Medicare inflationary increase

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

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

H.R.8812/S.4367, Water Resources Development Act of 2024, Water infrastructure related issues PFAS related issues Public Law 117-58, Infrastructure Investment and Jobs Act, ACoE, EPA and Bureau of Reclamation infrastructure issues, Low Income Rate Payer Assistance Water infrastructure issues; and Water Recycling issues

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

Government targets: Bureau of Reclamation, HOUSE OF REPRESENTATIVES, SENATE

Monitor Water infrastructure issues as follows: Public Law 117-58, Infrastructure Investment and Jobs Act H.R.8812/S.4367, Water Resources Development Act of 2024 Public Law 117-169, Inflation Reduction Act

Client expense: Not reported · Firm income: Not reported

Bureau of Reclamation grant related issues H.R.8812/S.4367, Water Resources Development Act of 2024, Water infrastructure related issues PFAS related issues Monitor Public Law 117-169, Inflation Reduction Act, Utility related issues

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare sequester, PAYGO H.R.8812, I CAN Act: provision of service under Medicare H.R. 2474, Strengthening Medicare for Patients and Providers Act: an annual inflation adjustment to Medicare physician payments Medicare for All/Public Option Rural Anesthesiology: Rural Pass Through Out of Network/Out of Network Payment Network Adequacy Historical Medicare payment undervaluation for anesthesiology services (33% problem) Anesthesia Conversion Factor Perioperative Surgical Home Model Bundled payments CMS Interpretive Guidelines: Hospital Conditions of Participation Related to Anesthesia Services Medicare Physician Fee Schedule Rule CMS Value-Based purchasing Conditions of Participation - Anesthesia services, opt-outs, supervision Physician Quality Reporting System, PPACA, Sec. 3007 Quality Modifier implementation Graduate Medical Education Value-based modifier - PPACA QCDR - Qualified Clinical Data Registry Evaluation and Monitoring codes & cuts Certified Anesthesiologist Assistants CMS: Federal Independent Dispute Resolution (IDR) Process, Batching Budget neutrality Medicare Economic Index

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

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

Medicare sequester, PAYGO H.R.8812, I CAN Act: provision of service under Medicare H.R. 2474, Strengthening Medicare for Patients and Providers Act: an annual inflation adjustment to Medicare physician payments S. 1512, CONNECT for Health Act of 2021: Telehealth H.R. 2903, CONNECT for Health Act of 2021: Telehealth H.R. 5932, The Inpatient Opioid Safety Act: patient safety Medicare for All/Public Option Rural Anesthesiology: Rural Pass Through Out of Network/Out of Network Payment Network Adequacy Historical Medicare payment undervaluation for anesthesiology services (33% problem) Anesthesia Conversion Factor Perioperative Surgical Home Model Bundled payments CMS Interpretive Guidelines: Hospital Conditions of Participation Related to Anesthesia Services Medicare Physician Fee Schedule Rule CMS Value-Based purchasing CMS Medicare Data Final Rule Conditions of Participation - Anesthesia services, opt-outs, supervision Physician Quality Reporting System, PPACA, Sec. 3007 Quality Modifier implementation Graduate Medical Education Value-based modifier - PPACA Debt ceiling - Medicare sequestration QCDR - Qualified Clinical Data Registry CMS Meaningful Use Stage 3 Evaluation and Monitoring codes & cuts Certified Anesthesiologist Assistants CMS: Federal Independent Dispute Resolution (IDR) Process, Batching Budget neutrality Medicare Economic Index

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

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

- Opposition to H.R. 8812, the Improving Care and Access to Nurses Act, or the I CAN Act. This legislation would endanger the quality of care that Medicare and Medicaid patients receive by expanding the scope of practice for nonphysician practitioners (NPPs), including nurse practitioners (NPs), certified nurse midwives (CNMs), certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNS), and physician assistants (PAs).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.315-Medicare Sequester COVID Moratorium Act H.R.3650-Improving Access to Medicare Coverage Act of 2021 H.R.8800-Supporting Medicare Providers Act of 2022 H.R.8812-I CAN Act S.2048-Improving Access to Medicare Coverage Act of 2021 S.3314-Supporting Medicare Providers Act of 2021 S.5212-I CAN Act

Client expense: $515,937 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitoring the following bills HR22114- To amend titles XVIII and XIX of the Social Security Act to require skilled nursing facilities, nursing facilities, and intermediate care facilities for the intellectually disabled to permit certain essential caregiver visitors during a public health emergency under the Medicare and Medicaid programs. HR331- Nurses CARE Act of 2021 Nurses Certification And Recognition of Experience Act of 2021 HR828- PREPARE LTC Act Promoting Restoration of Emergency Preparedness and Advancing Response to Epidemics in Long-Term Care Act HR844-PROTECT Long Term Care Facilities Act Protecting Residents with Oversight, Transparency, and Enforcement for Compassionate Treatment in Long-Term Care Facilities Act S230 PREPARE LTC Act Promoting Restoration of Emergency Preparedness and Advancing Response to Epidemics in Long-Term Care Act S782 Nursing Home Reform Modernization Act of 2021 SRes151- A resolution calling on the President and the Secretary of Health and Human Services to take action to lower prescription drug costs. S274-Stronger Medicaid Response to the COVID-19 Pandemic Act H.R. 2455 The Resetting the IMPACT Act of 2021 Monitoring HR1868 To prevent across-the-board direct spending cuts, and for other purposes. Support HR 2455 Resetting the Impact Act of 2021 TRIA Act of 2021 Support HR 5376 Support HR 3617 Support HR 2768 Support S 3018 Monitoring S870 Improving Access to Mental Health Act of 2021 Monitoring HR 5563 Stop Penalizing Working Seniors Act Support HR 1868 To prevent across-the-board direct spending cuts, and for other purposes. Monitoring HR3173 Improving Seniors Timely Access to Care Act of 2022 Support HR8812 To amend titles XVIII and XIX of the Social Security Act and the Bipartisan Budget Act of 2018 to increase access to services provided by advanced practice registered nurses under the Medicare and Medicaid programs, and for other purpose Monitoring HR7755 John Lewis Equality in Medicare and Medicaid Treatment Act of 2022

Client expense: $29,721 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation and policies relating to: Adoption of recommendations of the National Academy of Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Section 2706 of the ACA regarding provider non-discrimination Policies affecting nurse practitioner education and workforce Definition, evaluation and enforcement of essential health benefits and provider network adequacy Health information technology and electronic health records Mental health services and violence prevention H.R. 909/S. 484, Moms Matter Act H.R. 959/S. 346, Black Maternal Health Momnibus Act of 2021 H.R. 1065/S. 1486, Pregnant Workers Fairness Act H.R. 1620, Violence Against Women Act Reauthorization Act of 2021 H.R. 2347/S. 2691, Strengthening the Vaccines for Children Program Act of 2021 H.R. 3407/S. 411, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act H.R. 3655, Vaccine Injury Compensation Modernization Act of 2021 H.R. 4217/S. 2779, Taskforce Recommending Improvements for Unaddressed Mental Perinatal & Postpartum Health (TRIUMPH) for New Moms Act Implementation of the Inflation Reduction Act (P.L. 117-169) provisions related to health equity and mental and behavioral health for patients and health care providers H.R. 7236, Strengthen Kids Mental Health Now Act of 2022 H.R. 7666, Restoring Hope for Mental Health and Well-Being Act of 2022 H.R. 7780, Mental Health Matters Act H.R. 8296, Womens Health Protection Act of 2022 H.R. 8391, Continuity in Necessary Evaluative Crisis Treatment (CONNECT) Act of 2022 H.R. 8812/S. 5212, Improving Care and Access to Nurses (I CAN) Act H.R. 8817/S. 4844, National Nursing Workforce Centers Act H.R. 9260, Stop Online Suicide Assistance Forums Act S. 104/H.R. 379, Improving Social Determinants of Health Act of 2021 S. 674, Public Health Infrastructure Saves Lives Act S. 3479/H.R. 8151, Building a Sustainable Workforce for Healthy Communities Act S. 3623, Violence Against Women Act Reauthorization Act of 2022 S. 3799, Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act (PREVENT Pandemics Act) S. 4170, Mental Health Reform Reauthorization Act of 2022 S. 4472, Health Care Capacity for Pediatric Mental Health Act of 2022

Client expense: Not reported · Firm income: $26,600

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

Legislation and policies related to: Physician/nurse practitioner reimbursement Adoption of recommendations of the National Academy of Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Extension of Medicare and Medicaid waivers beyond the COVID-19 public health emergency Medicare and Medicaid restrictions related to telehealth services Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures H.R. 1025, Kids Access to Primary Care Act of 2021 H.R. 1956/S. 1986, Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021 H.R. 4040, Advancing Telehealth Beyond COVID-19 Act of 2021 Implementation of the Inflation Reduction Act (P.L. 117-169) provisions related to Affordable Care Act premium subsidies and health care coverage H.R. 8812, Improving Care and Access to Nurses (ICAN) Act H.R. 8876, Jackie Walorski Maternal Child Home Visiting Reauthorization Act of 2022 S. 800, Promoting Access to Diabetic Shoes Act S. 2315/H.R. 4595, Medicaid Saves Lives Act

Client expense: Not reported · Firm income: $26,600

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

Legislation and policies relating to: Adoption of recommendations of the National Academy of Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Reauthorization of the Childrens Health Insurance Program Reauthorization of the Child Nutrition Act Section 2706 of the ACA regarding provider non-discrimination Policies affecting nurse practitioner education and workforce Definition, evaluation and enforcement of essential health benefits and provider network adequacy Health information technology and electronic health records Mental health services and violence prevention H.R. 66, Comprehensive Access to Robust Insurance Now Guaranteed for Kids (CARING for Kids) Act H.R. 482/S. 350, Newborn Screening Saves Lives Reauthorization Act of 2021 H.R. 485, Stronger Child Abuse Prevention and Treatment Act H.R. 550, Immunization Infrastructure Modernization Act of 2021 H.R. 909/S. 484, Moms Matter Act H.R. 959/S. 346, Black Maternal Health Momnibus Act of 2021 H.R. 1065/S. 1486, Pregnant Workers Fairness Act H.R. 1324/S/ 467, Effective Suicide Screening and Assessment in the Emergency Department Act of 2021 H.R. 1390, Childrens Health Insurance Program Pandemic Enhancement and Relief (CHIPPER) Act H.R. 1620, Violence Against Women Act Reauthorization Act of 2021 H.R. 1791, Childrens Health Insurance Program Permanency (CHIPP) Act H.R. 2094/S. 1301, Promoting Physical Activity for Americans Act H.R. 2347/S. 2691, Strengthening the Vaccines for Children Program Act of 2021 H.R. 3173/S. 3018, Improving Seniors Timely Access to Care Act of 2021 H.R. 3182, Safe Sleep for Babies Act of 2021 H.R. 3407/S. 411, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act H.R. 3655, Vaccine Injury Compensation Modernization Act of 2021 H.R. 4128/S. 2209, Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2021 H.R. 4217/S. 2779, Taskforce Recommending Improvements for Unaddressed Mental Perinatal & Postpartum Health (TRIUMPH) for New Moms Act Implementation of the Inflation Reduction Act (P.L. 117-169) provisions related to health equity and mental and behavioral health for patients and health care providers H.R. 5487/S. 3972, Stillbirth Health Improvement and Education (SHINE) for Autumn Act of 2021 H.R. 7076, Supporting Childrens Mental Health Care Access Act of 2022 H.R. 7236, Strengthen Kids Mental Health Now Act of 2022 H.R. 7666, Restoring Hope for Mental Health and Well-Being Act of 2022 H.R. 7780, Mental Health Matters Act H.R. 8296, Womens Health Protection Act of 2022 H.R. 8391, Continuity in Necessary Evaluative Crisis Treatment (CONNECT) Act of 2022 H.R. 8450, Healthy Meals, Healthy Kids Act H.R. 8812/S. 5212, Improving Care and Access to Nurses (I CAN) Act H.R. 8817/S. 4844, National Nursing Workforce Centers Act H.R. 9260, Stop Online Suicide Assistance Forums Act S. 104/H.R. 379, Improving Social Determinants of Health Act of 2021 S. 248/H.R. 804, Family and Medical Insurance Leave (FAMILY) Act S. 499/H.R. 369, Improving Health Insurance Affordability Act of 2021 S. 674, Public Health Infrastructure Saves Lives Act S. 844/H.R. 3109, PHIT Act of 2021 S. 1259, Safe Cribs Act S. 1275/H.R. 2119, Family Violence Prevention and Services Improvement Act of 2021 S. 1658/H.R. 3110, Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act S. 1675/H.R. 4387, Maternal Health Quality Improvement Act S. 2069/H.R. 4323, Excellence in Mental Health and Addiction Treatment Act S. 3479/H.R. 8151, Building a Sustainable Workforce for Healthy Communities Act S. 3623, Violence Against Women Act Reauthorization Act of 2022 S. 3799, Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act (PREVENT Pandemics Act) S. 4170, Mental Health Reform Reauthorization Act of 2022 S. 4472, Health Care Capacity for Pediatric Mental Health Act of 2022

Client expense: Not reported · Firm income: $24,000

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

Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the National Academy of Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity Extension of Medicare and Medicaid waivers beyond the COVID-19 public health emergency Medicare and Medicaid restrictions related to telehealth services Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures H.R. 1025, Kids Access to Primary Care Act of 2021 H.R. 1956/S. 1986, Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021 H.R. 4040, Advancing Telehealth Beyond COVID-19 Act of 2021 Implementation of the Inflation Reduction Act (P.L. 117-169) provisions related to Affordable Care Act premium subsidies and health care coverage H.R. 6020, Supporting Medicare Providers Act of 2021 H.R. 8812/S. 5212, Improving Care and Access to Nurses (I CAN) Act H.R. 8876, Jackie Walorski Maternal Child Home Visiting Reauthorization Act of 2022 S. 646/H.R. 1738, Stabilize Medicaid and CHIP Coverage Act S. 800, Promoting Access to Diabetic Shoes Act S. 2315/H.R. 4595, Medicaid Saves Lives Act

Client expense: Not reported · Firm income: $24,000

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

Issues surrounding telehealth, including removal of Medicare originating site and rural area restrictions Issues surrounding temporary flexibilities and waivers stemming from public health emergency S.3018/H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 H.R. 8812 - Improving Care and Access to Nurses (ICAN) Act S. 5212 - Improving Care and Access to Nurses (ICAN) Act Issues surrounding nurse staffing levels and payment S.5157 - Nurse Overtime and Patient Safety Act Medicare payment reforms

Client expense: $423,637 · Firm income: Not reported

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

Support for public health infrastructure Personal Protective Equipment Standards and access to Personal Protective Equipment, including supply chain issues Mental health resources for nurses S.308/H.R.1436 ‐ PPE in America Act H.R. 1384/S.445 - Mainstreaming Addiction Treatment (MAT) Act Issues surrounding telehealth, including removal of Medicare originating site and rural area restrictions S.610/H.R.1667 ‐ Dr. Lorna Breen Health Care Provider Protection Act H.R. 851/S.246 ‐ Future Advancement of Academic Nursing (FAAN) Act Issues surrounding nurse staffing shortages and remedies to address this crisis Pandemic preparedness S.3799 ‐ PREVENT Pandemics Act Extension of COVID‐19 public health emergency H.R. 7666 - Restoring Hope for Mental Health and Well‐Being Act of 2022 H.R. 8812 - Improving Care and Access to Nurses (ICAN) Act S.5212 - Improving Care and Access to Nurses (ICAN) Act Issues surrounding federal Monkeypox response

Client expense: $423,637 · Firm income: Not reported

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

- Strong opposition to H.R. 8812, the Improving Care and Access to Nurses Act, or the I CAN Act. In general, we are deeply concerned that this broad, sweeping bill endangers the care of Medicare and Medicaid patients by expanding the types of services NPPs can perform and removing physician involvement in patient care under expanded scope of practice. - Request for Information on the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.Suggest actions Congress should take to stabilize the Medicare payment system while ensuring successful value-based care incentives are available for specialty physicians. ASDSA has serious concerns about structural and mounting instability in Medicare payments to physicians and request assistance in urging the committees of jurisdiction to hold hearings to begin the process of stabilizing and improving Medicare physician reimbursement and performance programs. - Applauds the introduction of H.R. 8800, the Supporting Medicare Providers Act of 2022. ASDSA strongly supports H.R. 8800 as an essential step toward providing clinicians with financial stability and ensuring patients have access to critical services our members provide. Steps must be taken to identify and advance systemic Medicare payment reforms designed to ensure longer‐term stability for clinicians, promote and reward value‐based care, advance health equity and reduce disparities within the Medicare system. - Letter to FDA, Center for Drug Evaluation and Research (CDER). We strongly ask that CDER office nominate a candidate who is board certified in dermatology when the time comes to fill the position of director of the Division of Dermatology and Dentistry at the FDA. We take note that few dermatologists currently serve in the Division and have specific concerns about how this may affect future decisions made regarding dermatologic surgery and patient safety. - Letter supporting the FDA as they work to finalize its proposed rules entitled General and Plastic Surgery Devices: Restricted Sale, Distribution, and Use of Sunlamp Products (Docket No. FDA-2015-N-1765); and the Sunlamp Products; Proposed Amendment to Performance Standard (Docket No. FDA-1998-N-0880) We are deeply concerned that the publics health continues to be at risk due to insufficient sunlamp regulation and believe the public would greatly benefit from FDAs finalizing these proposed rules. We strongly encourage the FDA to expeditiously finalize rules to restrict minors use of sunlamps, to require risk acknowledgement certification from adults, and to strengthen the sunlamp performance standards. - Alongside National Council on Skin Cancer Prevention (NCSCP), ASDSA requests that the Food and Drug Administration, working with the Department of Health and Human Services, finalize the proposed rules entitled General and Plastic Surgery Devices: Restricted Sale, Distribution, and Use of Sunlamp Products (Docket No. FDA-2015-N-1765); and the Sunlamp Products; Proposed Amendment to Performance Standard (Docket No. FDA-1998-N-0880) published by the FDA in the Federal Register on December 22, 2015. We request to meet with FDA and look forward to continuing our collaboration in furtherance of protecting the publics health.

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA)

Medicare home health payment policy. Oppose home health and hospice payment cuts and co-pays. Home health rural add-on payment adjustment. CMMI VBID Medicare Advantage Carve-in proposal. H.R. 2898/S. 1399, Homecare for Seniors Act. Medicaid payment and eligibility policy. Medicaid Money Follows the Person program. Medicaid protections against spousal impoverishments. H.R. 3371/S. 1309, Home Health Emergency Access to Telehealth Act. Hospice Face to Face Telehealth recertification. Patient Choice and Quality Care Act (draft legislation). Medicaid HCBS FMAP increase. Increased minimum wage legislative proposals. H.R. 2903/S. 1512, CONNECT for Health Act of 2021. H.R. 3321/S. 1670, Credit for Caring Act of 2021. H.R. 2565, Expanding Access to Palliative Care Act. H.R. 5514/S. 2562, Choose Home Care Act of 2021. H.R. 4131/S.2210, Better Care Better Jobs Act. Health information technology funding and standards for long-term post-acuter care providers. Palliative dialysis payment policy in Medicare hospice. Medicare Sequestration Moratoria. Hospice concurrent care policy. Community-based palliative care in CMMI alternative payment model demonstrations. H.R. 3173/S. 3018, Improving Seniors' Timely Access to Care Act. H.R. 8812, The Improving Care and Access to Nurses (ICAN) Act. H.R. 432, Mental Health Access Improvement Act of 2021. S. 4873, Improving Access to Advance Care Planning Act. H.R. 8581/S. 4605, Preserving Access to Home Health Act of 2022. H.R. 4040, Advancing Telehealth Beyond COVID-19 Act of 2021. H.R. 5067/S. 2652, Preserving Patient Access to Home Infusion Act. H.R. 2617, Consolidated Appropriations Act, FY2023. Hospice aggregate cap. Hospice program integrity concerns. Hospice payment reform/benefit redesign.

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

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

Support for public health infrastructure Personal Protective Equipment Standards and access to Personal Protective Equipment, including supply chain issues Mental health resources for nurses S.308/H.R.1436 ‐ PPE in America Act H.R. 1384/S.445 - Mainstreaming Addiction Treatment (MAT) Act Issues surrounding telehealth, including removal of Medicare originating site and rural area restrictions S.610/H.R.1667 ‐ Dr. Lorna Breen Health Care Provider Protection Act H.R. 851/S.246 ‐ Future Advancement of Academic Nursing (FAAN) Act Issues surrounding nurse staffing shortages and remedies to address this crisis Pandemic preparedness S.3799 ‐ PREVENT Pandemics Act Extension of COVID‐19 public health emergency H.R. 7666 - Restoring Hope for Mental Health and Well‐Being Act of 2022 H.R. 8812 - Improving Care and Access to Nurses (ICAN) Act S.5212 - Improving Care and Access to Nurses (ICAN) Act Issues surrounding federal Monkeypox response

Client expense: $380,000 · Firm income: Not reported

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

Issues surrounding telehealth, including removal of Medicare originating site and rural area restrictions Issues surrounding temporary flexibilities and waivers stemming from public health emergency S.3018/H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 H.R. 8812 - Improving Care and Access to Nurses (ICAN) Act S. 5212 - Improving Care and Access to Nurses (ICAN) Act Issues surrounding nurse staffing levels and payment S.5157 - Nurse Overtime and Patient Safety Act Medicare payment reforms

Client expense: $380,000 · Firm income: Not reported

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

Issues related to health care workforce including Healthcare Workforce Resilience Act (H.R. 2255 / S. 1024) and the Provider Training in Palliative Care Act (S. 2890). S. 4260, Palliative Care and Hospice Education & Training Act. and H.R. 8812, the Improving Care and Access to Nurses (ICAN) Act. Issues related to community based palliative care and advanced care illness management. H.R. 9109, The Grief Resilience Investment and Education Fund (GRIEF) Act and issues regarding bereavement care. Issues related to safe opioid disposal and implementing the Support Act (H.R. 2379).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

December 22, 2022, Alliance of Specialty Medicine letter to Representative Richard Hudson expressing our support for H.R. 9584, the Accessible Care by Curbing Excessive lawSuitS Act of 2022, which sets conditions for lawsuits arising from health care liability claims. December 21, 2022, Alliance of Specialty Medicine letter to Speaker Nancy Pelosi, House Republican Leader Kevin McCarthy, Senate Majority Leader Charles Schumer and Senate Republican Leader Mitch McConnell expressing our concern about pending cuts to Medicare physician payment rates in the Fiscal Year 2023 Omnibus Appropriations bill. December 20, 2022, coalition letter to Speaker Nancy Pelosi, House Republican Leader Kevin McCarthy, Senate Majority Leader Charles Schumer, Senate Republican Leader Mitch McConnell, Senators Ron Wyden and Mike Crapo, and Representatives Frank Pallone and Cathy McMorris Rodgers, urging Congress to modify the omnibus legislation and stop the full 4.5 percent cut to Medicare physician payment rates for Fiscal Year 2023. December 16, 2022, Alliance of Specialty Medicine letter to Senator John Kennedy expressing our support for S. 5194, the Protecting Medicare Patients and Physicians Act, which would mitigate pending cuts to Medicare physician payment rates in Fiscal Year 2023. December 6, 2022, Alliance of Specialty Medicine letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure in response to CMS request for information (RFI) soliciting public comment on establishing a National Directory of Healthcare Providers & Services (NDH). December 5, 2022, coalition letter to Speaker Nancy Pelosi, House Republican Leader Kevin McCarthy, Senate Majority Leader Charles Schumer and Senate Republican Leader Mitch McConnell urging Congress to prevent the entire 4.5 percent reduction to Medicare physician payment rates from being implemented on January 1, 2023. November 21, 2022, coalition letter to Federal Trade Commission (FTC) Chair Lina Khan commenting on the FTCs advance notice of proposed rulemaking (ANPR) entitled Trade Regulation Rule on Commercial Surveillance and Data Security, which pertains to clinical data registries. November 2, 2022, coalition letter to Representatives Richard Neal, Kevin Brady, Frank Pallone, Cathy McMorris Rodgers, Lucille Roybal-Allard and David Joyce expressing our opposition to H.R. 8812, the Improving Care and Access to Nurses Act or the I CAN Act. This legislation would expand the scope of practice for non-physician practitioners (NPPs) under Medicare and Medicaid. October 31, 2022, coalition letter to Representatives Ami Bera, MD, Larry Bucshon, MD, Kim Schrier, MD, Michael Burgess, MD, Earl Blumenauer, Brad Wenstrup, DPM, Bradley Schneider and Mariannette Miller-Meeks, MD in response to a congressional request for information (RFI) on the Centers for Medicare & Medicaid Services (CMS) implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). October 28, 2022, letter to Representatives Ami Bera, MD, Larry Bucshon, MD, Kim Schrier, MD, Michael Burgess, MD, Earl Blumenauer, Brad Wenstrup, DPM, Bradley Schneider and Mariannette Miller-Meeks, MD in response to a congressional request for information (RFI) on the Centers for Medicare & Medicaid Services (CMS) implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issues pertaining to the scope of practice legislation, related to H.R. 1587/S. 1731, H.R. 8812, H.R. 6087, and in general. Issues pertaining to prior authorization, related to H.R. 3173/H.R. 8487/S. 3018 and H.R. 7995, and in general. Issues pertaining to the Early Hearing Detection and Intervention Program, related to H.R. 5561/S. 4052, and in general. Issues pertaining to Medicare physician reimbursement, related to H.R. 8800 and S. 5194, and in general. Issues related to hearing healthcare, in general. Issues pertaining to health information technology and electronic health records, in general. Issues pertaining to Language Equality and Acquisition for Deaf Kids (LEAD-K) and parent choice, in general. Issues pertaining to Graduate Medical Education, in general. Issues pertaining to COVID-19, in general. Issues pertaining to healthcare liability reform, related to H.R. 9584, and in general. Issues pertaining to healthcare practice and the Federal Supremacy Clause at the Department of Veterans Affairs, in general. Issues related to the potential expansion of Medicare to cover hearing health benefits in potential reconciliation legislation. Issues pertaining to the "Magnet Injury Prevention Act," H.R. 8199/S. 4479. Issues pertaining to clinical data registries, in general.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE

December 21, 2022, Alliance of Specialty Medicine letter to Speaker Nancy Pelosi, House Republican Leader Kevin McCarthy, Senate Majority Leader Charles Schumer and Senate Republican Leader Mitch McConnell expressing our concern about pending cuts to Medicare physician payment rates in the Fiscal Year 2023 Omnibus Appropriations bill. December 20, 2022, coalition letter to Speaker Nancy Pelosi, House Republican Leader Kevin McCarthy, Senate Majority Leader Charles Schumer, Senate Republican Leader Mitch McConnell, Senators Ron Wyden and Mike Crapo, and Representatives Frank Pallone and Cathy McMorris Rodgers, urging Congress to modify the omnibus legislation and stop the full 4.5 percent cut to Medicare physician payment rates for Fiscal Year 2023. December 16, 2022, Alliance of Specialty Medicine letter to Senator John Kennedy expressing our support for S. 5194, the Protecting Medicare Patients and Physicians Act, which would mitigate pending cuts to Medicare physician payment rates in Fiscal Year 2023. December 6, 2022, Alliance of Specialty Medicine letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure in response to CMS request for information (RFI) soliciting public comment on establishing a National Directory of Healthcare Providers & Services (NDH). December 5, 2022, coalition letter to Speaker Nancy Pelosi, House Republican Leader Kevin McCarthy, Senate Majority Leader Charles Schumer and Senate Republican Leader Mitch McConnell urging Congress to prevent the entire 4.5 percent reduction to Medicare physician payment rates from being implemented on January 1, 2023. November 2, 2022, coalition letter to Representatives Richard Neal, Kevin Brady, Frank Pallone, Cathy McMorris Rodgers, Lucille Roybal-Allard and David Joyce expressing our opposition to H.R. 8812, the Improving Care and Access to Nurses Act or the I CAN Act. This legislation would expand the scope of practice for non-physician practitioners (NPPs) under Medicare and Medicaid. October 31, 2022, coalition letter to Representatives Ami Bera, MD, Larry Bucshon, MD, Kim Schrier, MD, Michael Burgess, MD, Earl Blumenauer, Brad Wenstrup, DPM, Bradley Schneider and Mariannette Miller-Meeks, MD in response to a congressional request for information (RFI) on the Centers for Medicare & Medicaid Services (CMS) implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). October 28, 2022, letter to Representatives Ami Bera, MD, Larry Bucshon, MD, Kim Schrier, MD, Michael Burgess, MD, Earl Blumenauer, Brad Wenstrup, DPM, Bradley Schneider and Mariannette Miller-Meeks, MD in response to a congressional request for information (RFI) on the Centers for Medicare & Medicaid Services (CMS) implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issues pertaining to the scope of practice legislation, related to H.R. 1587/S. 1731, H.R. 8812, and in general. Issues pertaining to prior authorization, related to H.R. 3173/H.R. 8487/S. 3018 and H.R. 7995, and in general. Issues pertaining to the Early Hearing Detection and Intervention Program, related to H.R. 5561/S. 4052, and in general. Issues pertaining to Medicare physician reimbursement, related to H.R. 8800, S. 5194, and in general. Issues related to hearing healthcare, in general. Issues pertaining to health information technology and electronic health records, in general. Issues pertaining to COVID-19, in general. Issues related to the potential expansion of Medicare to cover hearing health benefits in potential reconciliation legislation.

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

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

Lobby members of Congress regarding issues related to telemedicine. Advocate for increased transparency regarding drug pricing. Advocate for reducing barriers to entry of generic drugs into the marketplace. Advocate for transparency on the part of pharmaceutical benefit managers. Advocate for patient access to compounded medications. Advocate for reducing the burdens of utilization management tools, including step therapy and prior authorization for pharmaceuticals and services. Advocate for a stable supply of medications and mitigate drug shortages. Lobby members of the House to join the Congressional Skin Cancer Caucus. Advocate for adequate and accurate network coverage for dermatologic care within health insurance exchange networks. Support H. Res 436, sense of the House supporting state, local and community initiatives to curb incidences of skin cancer beginning with childhood skin cancer. Support H. Res 718, designating October 17, 2021 as National Vitiligo Awareness Day Support H.R. 2163/S. 464, Safe Step Act. Support S. 989, Ensuring Childrens Access to Specialty Care Act Support H.R. 153, Protecting Consumer Access to Generic Drugs Act Support S. 898, Fair Accountability & Innovative Research (FAIR) Drug Pricing Act Support H.R. 3662, Patient Access to Urgent-Use Pharmacy Compounding Act Support H.R. 1916/S. 754, Ensuring Lasting Smiles Act Advocate for relief from prior authorization requirements under Medicare Advantage and Medicare Part D plans. Advocate for the continued and increased funding of Community Health Centers. Advocate for implementation of surprise medical billing legislation (enacted as part of P.L. 116-260, Consolidated Appropriations Act, 2021, H.R. 133) as intended by Congress. Support H.R. 1677/S. 620, the KEEP Telehealth Options Act. Support H.R. 2903/S. 1512 the CONNECT for Health Act of 2021 Support the Dr. Lorna Breen Health Care Provider Protection Act (S. 610/H.R. 1667). Support H.R. 3173/S. 3018, Improving Seniors Timely Access to Care Act of 2021 Support H.R. 8437, the Improving Seniors Timely Access to Care Act of 2022 Support H.R. 4122/S. 3645, Resident Education Deferred Interest Act or the REDI Act Support the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256) Advocate for the FDA to implement the 2015 rule, General and Plastic Surgery Devices: Restricted Sale, Distribution, and Use of Sunlamp Products; and the Sunlamp Products Proposed; Amendment to Performance Standard, which would ban minors under the age of 18 from using tanning beds. Support H.R. 5054, Keep Physicians Serving Patients Act Support H.R. 5394, the Meaningful Access to Federal Health Plan Claims Data Act Advocate for legislative solution to access problems to iPLEDGE/REMS program for isotretinoin (H.R. 7667, Food and Drug Amendments of 2022/S. 4348 FDASLA Act of 2022, H.R. 2617, Consolidated Appropriations Act). Support H.R. 7649, a bill to direct the Secretary of Health and Human Services to open a public docket for the submission of public comments regarding factors that should be taken into consideration when reviewing a proposed modification to an approved risk evaluation and mitigation strategy, and for other purposes. Support H.R. 5030/S. 2706, the Diversifying Investigations and Equitable Research Studies for Everyone (DIVERSE) Trials Act Support H.R. 7995, GOLD CARD Act of 2022 Advocate to provide relief from the 2% Medicare sequester, replace scheduled and anticipated cuts in payments with positive, inflationary-based updates, eliminate the nearly 4.5% conversion factor cut in the CMS proposed rule for the 2023 Medicare Physician Fee Schedule (MPFS) associated with budget neutrality adjustments tied to Evaluation & Management (E/M) Code MPFS policy changes, and waive the 4% PAYGO sequester to Medicare physician payment reimbursement due to enactment of H.R. 1319, American Recovery Act, P.L. 117-2 (H.R. 2617, Consolidated Appropriations Act). Support H.R. 8800, Supporting Medicare Providers Act of 2022 Advocate against H.R 6708, Improving Access to Workers Compensation for Injured Federal Workers Act, which expands the role of nurse practitioners and physician assistants in providing services to injured federal workers under the federal workers' compensation program. Oppose H.R. 8812, the Improving Care & Access to Nurses Act (I CAN Act)

Client expense: $410,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Federal response to COVID-19, Medicare reimbursement and incident to billing, Medicare hospice restrictions, telehealth, transparency, healthcare competition, coverage and access to mental health services, Promoting Access to Diabetic Shoes Act (S 800, HR 4870), the Mainstreaming Addiction Treatment Act (S 445, HR 1384), the Increasing Access to Quality Cardiac Rehabilitation Care Act (S 1986, HR 1956), the Improving Care and Access to Nurses Act (HR 8812), training requirements included in the Medication Access and Training Expansion Act (HR 2067), the Restoring Hope for Mental Health and Well-Being Act (HR 7666), ACO Assignment Improvement Act (HR 6308), PA Educational and Workforce Training Programs, federal workers compensation exams and covered treatment (HR 6087), Consolidated Appropriations Act, 2023 (HR 2617), federal PA workforce issues at the Departments of Veterans Affairs, Indian Health Services, expanding access to primary care and behavioral health services.

Client expense: $160,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Indian Health Service, SENATE, Veterans Affairs, Dept of (VA), White House Office

S.800/H.R. 4870 - Promoting Access to Diabetic Shoes Act H.R. 1956/S. 1986 - Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021 H.R. 2067/S. 2235 - Medication Access and Training Expansion (MATE) Act S. 987 - Comprehensive Addiction and Recovery Act (CARA) 3.0 H.R. 1319 - American Rescue Plan Act [Public Law No: 117-2] H.R. 1716 - COVID-19 Mental Health Research Act H.R. 1195 - the Workplace Violence Prevention for Health Care and Social Service Workers Act S. 54 - Strengthening Americas Health Care Readiness Act H.R. 851/S. 246 - the Future Advancement of Academic Nursing (FAAN) Act H.R. 959/S.346 - Black Maternal Health Momnibus Act of 2021 H.R. 1384 - the Mainstreaming Addiction Treatment Act of 2021 H.R. 955 - the Medicaid Reentry Act of 2021 H.R. 1025 - the Kids Access to Primary Care Act of 2021 S. 1315/H.R. 3630 - the Lymphedema Treatment Act S. 1833 - the Ensuring Access to Primary Care for Women & Children Act H.R. 3550/S. 4905 - the Primary and Behavioral Health Care Access Act S. 1512/H.R. 2903 - the CONNECT for Health Act of 2021 S. 287/H.R. 945 - the Perinatal Workforce Act S. 1536/H.R. 3108 - the Medical Nutrition Therapy Act of 2021 H.R. 1667/S. 610 - the Dr. Lorna Breen Health Care Provider Protection Act H.R. 736 - the Community Immunity During COVID-19 Act of 2021 H.R. 3087/S. 2051 - Breast Cancer Patient Equity Act H.R. 6000 - the Cures 2.0 Act S. 2652/H.R. 5067 - the Preserving Patient Access to Home Infusion Act S. 3149/H.R. 5848 - the Rural Health Equity Act H.R. 6308 - the ACO Assignment Improvement Act of 2021 H.R. 5248 - the Temporary Responders for Immediate Aid in Grave Emergencies (TRIAGE) Act of 2021 H.R. 5376 - the Build Back Better Act H.R.3925 - the Reducing Barriers to Substance Use Treatment Act S. Res. 626 and H. Res. 1100 - honoring and recognizing May 6 through 12, 2022 as National Nurses Week S.3098/H.R. 7617 - Preventive Care Awareness Act S.4182 - the Workplace Violence Prevention for Health Care and Social Service Workers Act H.R. 7236 - the Strengthen Kids Mental Health Now Act of 2022 H.R. 2376 - the Excellence in Recovery Housing Act H.R. 4944 - the Helping Kids Cope Act of 2021 H.R. 5218 - the Collaborate in an Orderly and Cohesive Manner Act H.R. 7076 - the Supporting Childrens Mental Health Care Access Act of 2022 H.R. 7232 - the 9-8-8 and Parity Assistance Act of 2022 H.R.7666 - Restoring Hope for Mental Health and Well-Being Act of 2022 S.4170 - the Mental Health Reform Reauthorization Act H.R. 8812/S. 5212 - Improving Care and Access to Nurses (ICAN) Act H.R. 8454 - Medical Marijuana and Cannabidiol Research Expansion Act [Public Law No: 117-215] H.R. 3352/S. 1697 - Midwives for MOMs Act H.R. 8817/S. 4844 - the National Nursing Workforce Center Act of 2022 H.R. 3259/S. 586 - the NOPAIN Act H.R. 2617 - Consolidated Appropriations Act, 2023 The Senate Finance Committee Bipartisan Mental Health Workforce Discussion Draft National Healthcare Provider Directory Department of Labor independent contractor classification Issues pertaining to White House Hunger, Nutrition, and Health Conference Issues surrounding federal Monkeypox response Clinical Laboratory Improvement Amendments (CLIA) Replenish the COVID-19 Uninsured Relief Fund Nursing faculty shortage Nursing Education Use of telehealth to prescribe controlled substances under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 [Public Law No: 110-425] Rural health care issues, including rural workforce, COVID-19 vaccination, and reimbursement Medicare sequestration Medicare restrictions pertaining to telehealth Include nurses, APRNs, and nursing students in all National Public Health Plans Provide resources to support nurses, APRNs, and nursing students mental health needs, especially for those responding to the pandemic Funding to ensure childcare coverage Increased Federal Medical Assistance Percentage (FMAP) funding to states Access to personal protective equipment Extension of CMS waivers beyond public health emergency Skilled Nursing Facility admitting examination and assessment requirements COVID-19 Pandemic relief: funding, removal of barriers, telehealth, mental health, personal protective equipment, and testing Telehealth, remote patient monitoring and other forms of health technology COVID-19 Pandemic Reducing Regulatory Burdens, including those relating to home infusion therapy, Medicare Conditions of Participation, and hospice certification Medication-Assisted Treatment (MATs) Opioid Abuse Epidemic Documentation of medical records Health plan coverage and program requirements including provider non-discrimination Issues relating to Mental and Substance Use Disorder Workforce Addressing Health Equity Medicare Provider Reimbursement Clinical labor pricing update Tobacco flavors and menthol Site specific restrictions on providers under DEA controlled substances policy

Client expense: $320,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Nuclear Regulatory Commission (NRC), Office of Special Counsel, SENATE, Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

S. 800/H.R. 4870 - the Promoting Access to Diabetic Shoes Act H.R. 1956/S. 1986 - the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021 S. 987 - the Comprehensive Addiction and Recovery Act (CARA) 3.0 H.R. 955 - the Medicaid Reentry Act of 2021 H.R. 1025 - the Kids Access to Primary Care Act of 2021 S. 1315/H.R. 3630 - the Lymphedema Treatment Act S. 1833 - the Ensuring Access to Primary Care for Women & Children Act S. 1512/H.R. 2903 - the CONNECT for Health Act of 2021 S. 1536/H.R. 3108 - the Medical Nutrition Therapy Act of 2021 H.R. 5376 - the Build Back Better Act H.R. 6308 - the ACO Assignment Improvement Act of 2021 H.R. 3925 - the Reducing Barriers to Substance Use Treatment Act H.R. 7236 - the Strengthen Kids Mental Health Now Act of 2022 H.R. 7666 - Restoring Hope for Mental Health and Well-Being Act of 2022 S. 4170 - the Mental Health Reform Reauthorization Act H.R. 8812/S. 5212 - Improving Care and Access to Nurses (ICAN) Act H.R. 3259/S. 586 - the NOPAIN Act The Senate Finance Committee Bipartisan Mental Health Workforce Discussion Draft Medicare Provider Reimbursement Clinical Laboratory Improvement Amendments (CLIA) Nursing Education Use of telehealth to prescribe controlled substances under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 [Public Law No: 110-425] Increased Federal Medical Assistance Percentage (FMAP) funding to states Rural health care issues, including rural workforce, COVID-19 vaccination, and reimbursement. Medicare sequestration Medicare restrictions pertaining to telehealth Extension of CMS waivers beyond public health emergency Skilled nursing facility admitting examination and assessment requirements Preserving Patient Access to Home Infusion Act COVID-19 Pandemic relief: funding, removal of barriers, telehealth, mental health, personal protective equipment, and testing Telehealth, remote patient monitoring and other forms of health technology Reducing Regulatory Burdens, including those relating to home infusion therapy, Medicare Conditions of Participation, and hospice certification Expanded Medicare benefit provisions related to NPs Addressing Health Equity Clinical labor pricing update

Client expense: $320,000 · 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: $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)

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)

Scope of Practice, Supervision Requirements, and Reimbursement issues S. 5212/H.R. 8812 - Improving Care and Access to Nurses (ICAN) Act Issues surrounding rural emergency hospitals Extension of COVID-19 Flexibilities

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

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

Provider Non-Discrimination Rural access to care S. 5212/H.R. 8812 - Improving Care and Access to Nurses (ICAN) Act

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

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

Support for public health infrastructure Personal Protective Equipment Standards and access to Personal Protective Equipment, including supply chain issues Mental health resources for nurses S.308/H.R.1436 - PPE in America Act H.R. 1384/S.445 - Mainstreaming Addiction Treatment (MAT) Act Issues surrounding telehealth, including removal of Medicare originating site and rural area restrictions S.610/H.R.1667 - Dr. Lorna Breen Health Care Provider Protection Act H.R. 851/S.246 - Future Advancement of Academic Nursing (FAAN) Act Issues surrounding nurse staffing shortages and remedies to address this crisis Pandemic preparedness S.3799 - PREVENT Pandemics Act Extension of COVID-19 public health emergency H.R. 7666 - Restoring Hope for Mental Health and Well-Being Act of 2022 S. 5212/H.R. 8812 - Improving Care and Access to Nurses (ICAN) Act Issues surrounding federal Monkeypox response

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

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

Issues surrounding telehealth, including removal of Medicare originating site and rural area restrictions Issues surrounding temporary flexibilities and waivers stemming from public health emergency S.3018/H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 S. 5212/H.R. 8812 - Improving Care and Access to Nurses (ICAN) Act Issues surrounding nurse staffing levels and payment S.5157 - Nurse Overtime and Patient Safety Act Medicare payment reforms

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

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

H.R.851/S.246 - Future Advancement of Academic Nursing (FAAN) Act H.R.9200 - Stop Nurse Shortages Act S.2114/H.R. 5699- Student Assisted Vaccination Effort (SAVE) Act H.R.8481/S. 3913-Improving DATA in Public Health Act H.R.8817/S.4844- National Nursing Workforce Center Act of 2022 H.R. 6087- Improving Access to Workers Compensation for Injured Federal Workers Act H.R. 7565- NIH IMPROVE Act H.R. 5721 VIPER Act S.4764/H.R.9040 - Reproductive Health Care Accessibility Act of 2022 H.R. 7666 - Restoring Hope for Mental Health and Well-Being Act of 2022 S.104/H.R.379 - Improving the Social Determinants of Health Act S.167/H.R.736 - Community Immunity During COVID-19 Act S.289/H.R.869- RISE Act S.346/H.R.959 - Black Maternal Health Momnibus Act of 2021 S.586/H.R. 3259 - NOPAIN Act S.1697/H.R.3352- Midwives for Maximizing Optimal Maternity Services (MOMS) Act H.R. 3337/S.1716- The Birth Access Benefiting Improved Essential Facility Services Act (BABIES) Act S.2235/H.R. 2067 - Medication Access and Training Expansion (MATE) Act S.1568/H.R.4407 - The Technical Reset to Advance the Instruction of Nurses (TRAIN) Act H.R. 8812/S.5212- Improving Care and Access to Nurses (I CAN) Act S.4182 - Workplace Violence Prevention for Health Care and Social Service Workers Act S.674- Public Health Infrastructure Saves Lives Act S.2187/H.R.4124- National Biomedical Research Act S.467/H.R.1324- Effective Suicide Screening and Assessment in the Emergency Department Act S.3799 - PREVENT Pandemics Act H.R. 831 - Health STATISTICS Act of 2021 H.R.1195 - Workplace Violence Prevention for Health Care and Social Service Workers Act H.R. 3550/S. 4905- Primary and Behavioral Health Care Access Act Support for clinical education, including graduate nursing education, and faculty Ensuring a Sustainable Public Health Workforce Title VIII Nursing Workforce Development Programs Nursing Education, Workforce, Research, and Public Health Infrastructure Needs Nursing faculty shortage Support Mental Health Programs for Nursing Students and the Workforce PPE, telehealth, mental health, and other resources and services to support Nursing Education, Practice, and the Workforce Safety and health of nurse educators and nursing students Public Health Emergency Waivers Ensure equity in COVID-19 efforts and health care Federal monkeypox response Comments on provider nondiscrimination Comments on the establishment of a National Directory of Healthcare Providers and Services

Client expense: $69,000 · 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), Natl Institutes of Health (NIH), Office of Natl Drug Control Policy (NDCP), SENATE, Treasury, Dept of

H.R. 2067/S.2235 - Medication Access and Training Expansion (MATE) Act H.R. 1384/S.445 - Mainstreaming Addiction Treatment (MAT) Act Reducing regulatory and legislative barriers for Nurse Practitioners Include nurses, APRNs, and nursing students in all National Public Health Plans Issues surrounding nurse faculty shortages H.R. 7666 - Restoring Hope for Mental Health and Well-Being Act of 2022 Rural health care access Issues pertaining to White House Hunger, Nutrition, and Health Conference Public Law No: 117-215 - Medical Marijuana and Cannabidiol Research Expansion Act (H.R. 8454) S. 5212/H.R. 8812 - Improving Care and Access to Nurses (ICAN) Act Issues surrounding federal Monkeypox response H.R.2617 - Consolidated Appropriations Act, 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4870/S.800 - Promoting Access to Diabetic Shoes Act H.R. 1956/S.1986 - Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021 H.R. 6308 - ACO Assignment Improvement Act of 2021 Reducing regulatory and legislative barriers for Nurse Practitioners Include nurses, APRNs, and nursing students in all National Public Health Plans Issues surrounding emergency declaration waivers S. 5212/H.R. 8812 - Improving Care and Access to Nurses (ICAN) Act Medicare Provider Reimbursement Enhancing the Mental Health Workforce discussion draft

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Improving Care and Access to Nurses Act of 2022 (H.R. 8812) - Issues pertaining to regulatory relief for advanced practice registered nurses Mental Health Workforce Enhancement Discussion Draft - Issues pertaining to CRNA practice and reimbursement CMS Request for Information on Making Your Voice Heard - Issues pertaining to CRNA practice and reimbursement CMS Request for Information on National Provider Directory - Issues pertaining to CRNA practice and reimbursement Extending/Making permanent certain temporary waivers put in place during the Public Health Emergency Medicare Reimbursement CRNA Scope of Practice Rural Healthcare issues Medicare teaching rules Provider nondiscrimination Medicare Local Coverage Determination process

Client expense: $305,712 · Firm income: Not reported

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

NIH Research Project Grant Program (R01) HR 8812, Increasing Access to Nurses (I CAN) Act

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

Government targets: SENATE

Monitoring the following bills HR22114- To amend titles XVIII and XIX of the Social Security Act to require skilled nursing facilities, nursing facilities, and intermediate care facilities for the intellectually disabled to permit certain essential caregiver visitors during a public health emergency under the Medicare and Medicaid programs. HR331- Nurses CARE Act of 2021 Nurses Certification And Recognition of Experience Act of 2021 HR828- PREPARE LTC Act Promoting Restoration of Emergency Preparedness and Advancing Response to Epidemics in Long-Term Care Act HR844-PROTECT Long Term Care Facilities Act Protecting Residents with Oversight, Transparency, and Enforcement for Compassionate Treatment in Long-Term Care Facilities Act S230 PREPARE LTC Act Promoting Restoration of Emergency Preparedness and Advancing Response to Epidemics in Long-Term Care Act S782 Nursing Home Reform Modernization Act of 2021 SRes151- A resolution calling on the President and the Secretary of Health and Human Services to take action to lower prescription drug costs. S274-Stronger Medicaid Response to the COVID-19 Pandemic Act H.R. 2455 The Resetting the IMPACT Act of 2021 Monitoring HR1868 To prevent across-the-board direct spending cuts, and for other purposes. Support HR 2455 Resetting the Impact Act of 2021 TRIA Act of 2021 Support HR 5376 Support HR 3617 Support HR 2768 Support S 3018 Monitoring S870 Improving Access to Mental Health Act of 2021 Monitoring HR 5563 Stop Penalizing Working Seniors Act Support HR 1868 To prevent across-the-board direct spending cuts, and for other purposes. Monitoring HR3173 Improving Seniors Timely Access to Care Act of 2022 Support HR8812 To amend titles XVIII and XIX of the Social Security Act and the Bipartisan Budget Act of 2018 to increase access to services provided by advanced practice registered nurses under the Medicare and Medicaid programs, and for other purpose Monitoring HR7755 John Lewis Equality in Medicare and Medicaid Treatment Act of 2022

Client expense: $47,954 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation and policies related to: Physician/nurse practitioner reimbursement Adoption of recommendations of the National Academy of Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Extension of Medicare and Medicaid waivers beyond the COVID-19 public health emergency Medicare and Medicaid restrictions related to telehealth services Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures H.R. 1025, Kids Access to Primary Care Act of 2021 H.R. 1353/S. 439, Coronavirus Medicaid Response Act H.R. 1738/S. 646, Stabilize Medicaid and CHIP Coverage Act H.R. 1956, Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021 H.R. 4040, Advancing Telehealth Beyond COVID-19 Act of 2021 H.R. 5376, Inflation Reduction Act - provisions related to Affordable Care Act premium subsidies and health care coverage H.R. 8812, Improving Care and Access to Nurses (ICAN) Act H.R. 8876, Jackie Walorski Maternal Child Home Visiting Reauthorization Act of 2022 S. 245, States Achieve Medicaid Expansion (SAME) Act of 2021 S. 800, Promoting Access to Diabetic Shoes Act S. 2315/H.R. 4595, Medicaid Saves Lives Act

Client expense: Not reported · Firm income: $26,600

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