HCBS Access Act

H.R. 547/S.100, the Better Care Better Jobs Act H.R. 670/ S. 4174, the Think Differently Database Act H.R. 1493/S. 762, the HCBS Access Act H.R. 4315, the Medicare Orthotics and Prosthetics Patient-Centered Care Act H.R. 6029/S. 3120, the Disaster Relief Medicaid Act H.R. 8018/S. 3109, the Alleviating Barriers for Caregivers (ABC) Act S. 3118, the HCBS Relief Act of 2023 Discussions: Interaction between Medicare Part B and Tricare for medically retired veterans Discussions: Definition of Medicare in the Home for DME purposes Discussions: Right to repair DME products - ensure providers of DME and prosthetics are reimbursed by Medicare when doing repairs and preventative maintenance

Client expense: $87,752 · Firm income: Not reported

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

Research into spinal muscular atrophy, timely access to care, treatments, medical devices, and home and community-based services, newborn screening, newborn screening funding, coverage of rare disease treatments, care, and devices, including intermittent catheter (IC) coding, HCBS Access Act (H.R. 1493, S. 762), BENEFIT Act (H.R. 1092, S. 526), Safe Step Act (S. 652, H.R. 2630), Protecting Health Care for All Patients Act of 2023 (H.R. 485), Supporting Our Direct Care Workforce & Family Caregivers Act (S. 1298), Long-Term Care Workforce Support Act (S.4120/H.R.7994); HCBS Relief Act (S. 3118, H.R. 6296); Recognizing the Role of Direct Support Professionals Act (S. 1332), Medicaid unwinding protections for people with SMA and other disabilities, direct care workforce shortage, healthcare discrimination (i.e., quality adjusted life years), Ensuring Patient Access to Critical Breakthrough Products Act (H.R. 1691); Creating Hope Reauthorization Act (H.R.7384/ S. 4583) - FDA priority review voucher program, healthcare utilization protocols (i.e., prior authorization and step therapy), Patient Protection and Affordable Care Act (111-148), Inflation Reduction Act (P.L. 117-169), Supporting accessible medical diagnostic equipment, Charlotte Woodward Organ Transplant Discrimination Prevention Act (H.R. 2706/S. 1183), Lifespan Respite Reauthorization Act (H.R. 6160), Stop Unfair Medicaid Recoveries Act (H.R. 7573), accessible medical diagnostic equipment, durable medical equipment, intermittent catheter coding, FDA Rare Disease Center of Excellence, Think Differently Database Act (H.R.670/ S. 4174), Accelerating Kids Access to Care Act ((H.R.4758/S.2372); Ensuring Access to Medicaid Buy-In Programs Act (H.R.8107/ S.5070); Defense Health Research Programs (Congressionally Directed Medical Research Programs)

Client expense: $75,000 · 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), Natl Institutes of Health (NIH), SENATE

Medicaid home and community-based services, continuation of HCBS services following the public health emergency, Medicaid unwinding, healthcare access and coverage, including to patient preferred treatment, assistive technology devices, accessible diagnostic equipment, and durable medical equipment, such as power wheelchairs and power wheelchair features such as seat elevators and standing systems, intermittent catheter coding, HCBS Access Act (H.R. 1493, S. 762), HCBS Relief Act (S. 3118, H.R. 6296), Supporting Our Direct Care Workforce & Family Caregivers Act (S. 1298), Recognizing the Role of Direct Support Professionals Act (S.1332), Stop Unfair Medicaid Recoveries Act (H.R. 7573), Long-term Care Workforce Support Act ((S.4120/H.R.7994), Creating Hope Reauthorization Act (H.R.7384/ S. 4583); Think Differently Database Act (H.R.670/ S. 4174); Ensuring Access to Medicaid Buy-In Programs Act (H.R.8107 / S. 5070)

Client expense: $75,000 · Firm income: Not reported

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

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost-sharing subsidies under part D of the Medicare program 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. 1638, Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill 15. Proposals regarding the Medicare Low Income Subsidy program 16. H.R. 7513, Protecting Americas Seniors Access to Care Act, entire 17. S. 3410, Protecting Rural Seniors Access to Care Act, entire bill 18. H.R. 8106, To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver, entire bill 19. H.R. 8107, Ensuring Access to Medicaid Buy-in Programs Act of 2024, entire bill 20. H.R. 8109, Money Follows the Person Permanency Act of 2024, entire bill 21. H.R. 8110, Protecting Married Seniors from Impoverishment Act of 2024, entire bill 22. H.R. 8018, Alleviating Barriers for Caregivers Act, entire bill 23. S. 3109, Alleviating Barriers for Caregivers Act, entire bill 24. H.R. 7573, Stop Unfair Medicaid Recoveries Act, entire bill 25. Proposals for $2 per month generic drug prescription co-pays under Medicare

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

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

Research into spinal muscular atrophy, timely access to care, treatments, medical devices, and home and community-based services, newborn screening, newborn screening funding, coverage of rare disease treatments, care, and devices, including intermittent catheter (IC) coding, HCBS Access Act (H.R. 1493, S. 762), BENEFIT Act (H.R. 1092, S. 526), Safe Step Act (S. 652, H.R. 2630), Protecting Health Care for All Patients Act of 2023 (H.R. 485), Supporting Our Direct Care Workforce & Family Caregivers Act (S. 1298), Long-Term Care Workforce Support Act (S.4120/H.R.7994); HCBS Relief Act (S. 3118, H.R. 6296); Recognizing the Role of Direct Support Professionals Act (S. 1332), Medicaid unwinding protections for people with SMA and other disabilities, direct care workforce shortage, healthcare discrimination (i.e., quality adjusted life years), Ensuring Patient Access to Critical Breakthrough Products Act (H.R. 1691); Creating Hope Reauthorization Act (H.R.7384/ S. 4583), healthcare utilization protocols (i.e., prior authorization and step therapy), Patient Protection and Affordable Care Act (111-148), Inflation Reduction Act (P.L. 117-169), Supporting accessible medical diagnostic equipment, Charlotte Woodward Organ Transplant Discrimination Prevention Act (H.R. 2706/S. 1183), Lifespan Respite Reauthorization Act (H.R. 6160), Stop Unfair Medicaid Recoveries Act (H.R. 7573), accessible medical diagnostic equipment, durable medical equipment, intermittent catheter coding, FDA Rare Disease Center of Excellence, Think Differently Database Act (H.R.670/ S. 4174), Accelerating Kids Access to Care Act ((H.R.4758/S.2372)

Client expense: $75,000 · 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), Natl Institutes of Health (NIH), SENATE

Medicaid home and community-based services, continuation of HCBS services following the public health emergency, Medicaid unwinding, healthcare access and coverage, including to patient preferred treatment, assistive technology devices, accessible diagnostic equipment, and durable medical equipment, such as power wheelchairs and power wheelchair features such as seat elevators and standing systems, intermittent catheter coding, HCBS Access Act (H.R. 1493, S. 762), HCBS Relief Act (S. 3118, H.R. 6296), Supporting Our Direct Care Workforce & Family Caregivers Act (S. 1298), Recognizing the Role of Direct Support Professionals Act (S.1332), Stop Unfair Medicaid Recoveries Act (H.R. 7573), Long-term Care Workforce Support Act ((S.4120/H.R.7994), Creating Hope Reauthorization Act (H.R.7384/ S. 4583); Think Differently Database Act (H.R.670/ S. 4174)

Client expense: $75,000 · Firm income: Not reported

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

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost-sharing subsidies under part D of the Medicare program 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill 15. Proposals regarding the Medicare Low Income Subsidy program 16. H.R. 7513, Protecting Americas Seniors Access to Care Act, entire 17. S. 3410, Protecting Rural Seniors Access to Care Act, entire bill 18. H.J.Res. 139, providing for Congressional disapproval of the CMS rule Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting," entire resolution 19. H.R. 8106, To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver, entire bill 20. H.R. 8107, Ensuring Access to Medicaid Buy-in Programs Act of 2024, entire bill 21. H.R. 8109, Money Follows the Person Permanency Act of 2024, entire bill 22. H.R. 8110, Protecting Married Seniors from Impoverishment Act of 2024, entire bill 23. H.R. 8018, Alleviating Barriers for Caregivers Act, entire bill 24. S. 3109, Alleviating Barriers for Caregivers Act, entire bill

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

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

Kids Online Safety Act (S. 1409/H.R. 7891); Children and Teens Online Privacy Protection Act (S. 1418/H.R. 7890); Legislation to Protect Young People Online; Pediatric Subspecialty Loan Repayment Program Funding and Program Implementation (HRSA); Adolescent Health Issues (Department of Health and Human Services Office of the Assistant Secretary for Health; Regulation of Tobacco Products (including Proposed Menthol Cigarette and Flavored Cigar Prohibition) (FDA); Innovation in Pediatric Drugs Act (H.R. 6664) Child passenger safety; Appropriations for the Indian Health Service (IHS); Appropriations for Environmental Programs (including EPA); Maternal, Infant, and Early Childhood Home Visiting Program Reauthorization & Implementation (HRSA, CMS, HHS, ACF); Infant sleep product safety (CPSC); Lead exposure prevention (EPA, CDC, HUD); Food safety (FDA, EPA, CDC); Paid family and medical leave; Regulation of high-powered magnet sets (CPSC); Climate change, Inflation Reduction Act Implementation (CPSC); Vehicle emissions standards (EPA, NHTSA); Button battery ingestions (CPSC); Early childhood education (HHS); Child protection safety and injury prevention (CPSC); Furniture tip-overs (CPSC); Child Abuse Prevention and Treatment Act (CAPTA) Reauthorization; CAPTA Plans of safe care grants (ACF, HHS ASPE); Family First Prevention Services Act implementation (ACF); CAPTA Fatalities Prevention and Response (HHS); Title IV-B Reauthorization (including H.R. 9076: Protecting Americas Children by Strengthening Families Act) (ACF); Congregate care reform (HHS, ACF); Mental health supports for foster youth/former foster youth (HHS); Mercury and Air Toxics Standards, ozone and particulate matter NAAQS, EPA greenhouse gas regulation (EPA); QRTP/IMDs (including H.R. 4056 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023) (ACF); Firearm Violence Prevention (Including Research Funding; Background Checks) (WH Domestic Policy Council; WH Office of Gun Violence Prevention; CDC; NIH; DOJ); Pregnant Workers Fairness Act Implementation (EEOC); Childcare Funding & Resources (HHS); Native American Child Health (DOI, EPA, HHS); Water Beads (including H.R. 4648: Ban Water Beads Act; S. 4298: Esthers Law (CPSC) Continuous Eligibility for Children in Medicaid and CHIP (including H.R. 9688 - Keep Kids Covered Act) (HHS/CMS); Medicaid Payment Parity (including H.R. 952 - Kids Access to Primary Care Act) (HHS/CMS); Access to Care in Medicaid/CHIP (HHS/CMS); Postpartum Medicaid Extension and Maternal Health Improvements; Medicaid/CHIP renewal policies (HHS/CMS); QRTP/IMDs (including H.R. 4056 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023, and S. 3196 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023); Accelerating Kids Access to Care Act (HR 4758, S 2372); Medicaid Early and Periodic Screening, Diagnostic, and Treatment requirement (HHS/CMS); Vaccines for Children program improvements (HHS/CMS, CDC); Medicaid prior authorization and medical necessity determinations Standards in ORR Custody (ORR, HHAS); Licensure of ORR Shelters (ORR, HHS); Public Charge; Child Nutrition Reauthorization/WIC (USDA); SNAP/Farm Bill (USDA); Mental Health for Children (HRSA); H.R. 6, DREAM Act; Medical Nutrition Equity Act; Lift the Bar Act (H.R. 4170/S. 2038); PAHPA Reauthorization; CARE for Families Act HR 3107; WIC Act (S. 1604/H.R. 3364); MODERN WIC Act (S. 984/H.R. 2424) FY25 Labor, Health and Human Services, and Education Appropriations Bill: Pediatric Subspecialty Loan Repayment Program, Firearm Injury and Mortality Prevention Research, Pediatric Mental Health Care Access Program, Emergency Medical Services for Children, National Center for Birth Defects and Developmental Disabilities, Global Immunization, Sudden Unexpected Infant Death and Sudden Death in Childhood, Vaccine Injury Compensation Program, VACCINES Act, Antimicrobial Resistance, Maternal and Child Health, School Based Health Centers, Healthy Start, Section 317 Immunization Grants; FY25 Agriculture, Rural Development, Food and Drug Administration Appropriations Bill: Pediatric Device Consortia; Newborn Screening Saves Lives Reauthorization Act; FY25 National Defense Authorization Act (Department of Defense / Defense Health Agency); Defense Health Agency - Autism Care Demonstration (Department of Defense / Defense Health Agency); Defense Health Agency - Fluoride varnish (Department of Defense / Defense Health Agency); Improving the Health of Children Act; Strengthening the Vaccines for Children Program Act; Banning Electronic Stimulation Devices (FDA); SSI Savings Penalty Elimination Act (S.2767/H.R.5408); HCBS Access Act (S.762/H.R. 1493); Better Care Better Jobs Act (S.100/H.R. 547); Autism Family Caregivers Act; PREVENT HPV Cancers Act (H.R. 3633); Supplemental Security Income Equality Act (H.R. 256); IDEA Full Funding Act (S.2217/H.R.4519); Promoting Physical Activity for Americans Act (S.397); Pandemic and All Hazards Preparedness Act (PAHPA); PREEMIE Reauthorization Act (H.R. 3226/S. 1573); Autism CARES Act of 2024 (H.R. 7213/S.4762); Supplemental Security Income/Social Security (Social Security Administration); School Access to Naloxone Act (H.R. 3065); HEADs UP Act (H.R. 3380); Preventing Maternal Deaths Reauthorization Act of 2023 (S. 2415/H.R.3838); SHINE for Autumn Act (H.R.5012/S.2647); Artificial Intelligence; Congenital Heart Futures Reauthorization Act (S.3757/H.R.7189); HERO Act (H.R. 6251); SSI Restoration Act (H.R. 7138); NURSE Act (S. 3953/H.R. 3197); Vaccines for Children coverage of Nirsevimab and COVID-19 immunizations (CDC, HHS); WEAR IT Act (H.R. 6279); Probiotic use in the NICU (FDA, CDC, NIH) Strengthening Efforts to End Violence Against Children Act (H.R. 4798); MINDS Act (H.R. 1570/S. 767); Implementation of the Global Child Thrive Act (USAID); FY26 Appropriations - global child health accounts impacting children and youth at USAID (Vulnerable Children, International Basic Education, Maternal and Child Health, Nutrition), Combating Child, Early and Forced Marriage, McGovern-Dole International Food for Education and Child Nutrition Program, Department of State Child Protection Compact (CPC) Partnership, Violence Against Children and Youth Surveys, CEIU, ILAB, UNICEF, IDA, MRA, PEPFAR (OMB); Violence Against Children Ministerial Meeting (HHS, NSC, USAID); U.S. Government pledge at the 2025 Nutrition for Growth Summit (USAID)

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

Government targets: Administration for Children & Families (ACF), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Consumer Product Safety Commission (CPSC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Agency for International Development (USAID), White House Office

Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act (Public Law No: 117-169). Medicare and Medicaid Prescription Drugs. (No bill): Joined comments with 19 other organizations urging HHS to use its existing authority to license competition in order to lower consumer and taxpayer costs for semaglutide drugs treating diabetes and weight management (e.g., Ozempic and Wegovy). Medicare Prescription Drugs. The PACE Part D Choice Act (H.R. 3549 and S. 1703): Proposal to increase the affordability of the Program of All-Inclusive Care for the Elderly (PACE) for Medicare beneficiaries by lowering the cost of Part D premiums substantially for Medicare-only enrollees, thus opening up the PACE program to this population. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Trustees Report (No bill). Review of the findings on economic, legislative and other developments affecting the actuarial soundness of the Medicare Part A (Hospital Insurance) Trust Fund and the Trust Funds for Parts B and D coverage. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Help Extend Auditory Relief Act of 2024 (H.R. 8064): Proposal to expand Medicare coverage to include hearing examinations and diagnoses, fittings and hearing aids. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home and Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes. The Building Americas Health Care Workforce Act (H.R. 9067): Proposal to allow time spent working in a nursing home (prior to any formal training, and permitted during the COVID-19 pandemic) to count toward a 75-hour minimum federal training standard that is required for certified nursing assistants. Medicare, Medicaid Nursing Homes. The Ensuring Seniors Access to Quality Care Act (H.R. 3227): Proposal to repeal regulations that prohibit certified nursing assistant training and competency evaluation programs in skilled nursing facilities that have a record of health and safety deficiencies and have incurred penalties (e.g., civil monetary penalties for substandard quality of care). Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposals to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposals to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities. Oversight of Health Care Industry Owned by Private Equity Firms. (No bill): Joined with other organizations in submitting comments (April 2024) to HHS, the Federal Trade Commission and the Department of Justice urging sustained, stepped up and rigorous oversight be extended to health care industry transactions that are financed by private equity company companies and other types of private investors.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Meeting with House and Senate Offices in support of the Better Care, Better Jobs Act (S 100/HR 547), HCBS Access Act (S 762/H.R.1493), and HCBS Relief Act (S. 3118/H.R. 6296). Nursing Home Minimum Staffing Regulation.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 547/S.100, the Better Care Better Jobs Act H.R. 1493/S. 762, the HCBS Access Act H.R. 4315, the Medicare Orthotics and Prosthetics Patient-Centered Care Act H.R. 6029/S. 3120, the Disaster Relief Medicaid Act H.R. 8018/S. 3109, the Alleviating Barriers for Caregivers (ABC) Act S. 3118, the HCBS Relief Act of 2023 Discussions: Interaction between Medicare Part B and Tricare for medically retired veterans Discussions: Definition of Medicare in the Home for DME purposes Discussions: Right to repair DME products - ensure providers of DME and prosthetics are reimbursed by Medicare when doing repairs and preventative maintenance

Client expense: $86,378 · Firm income: Not reported

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

HCBS Access Act, S.762/H.R.1493. Recognizing the Role of Peer Support Professionals Act, H.R. 2941/S. 1332. Disability Community Act of 2023, H.R. 7267.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HCBS Access Act, S.762/H.R.1493. Recognizing the Role of Peer Support Professionals Act, H.R. 2941/S. 1332. Disability Community Act of 2023, H.R. 7267.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Opposing Better Care Better Jobs Act, S. 100, H.R. 547; opposing HCBS Access Act, S. 762, H.R. 1493.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HCBS Access Act, S.762/H.R.1493. Recognizing the Role of Peer Support Professionals Act, H.R. 2941/S. 1332. Disability Community Act of 2023, H.R. 7267.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HCBS Access Act, S.762/H.R.1493. Recognizing the Role of Peer Support Professionals Act, H.R. 2941/S. 1332. Disability Community Act of 2023, H.R. 7267.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Standards in ORR Custody ORR, HHS; Licensure of ORR Shelters ORR, HHS; Public Charge; Child Nutrition Reauthorization/WIC USDA; SNAP/Farm Bill USDA; Mental Health for Children HRSA; H.R. 6, DREAM Act; Medical Nutrition Equity Act; Lift the Bar Act (H.R. 4170/S. 2038); PAHPA Reauthorization; CARE for Families Act HR 3107; WIC Act (S. 1604/H.R. 3364); MODERN WIC Act (S. 984/H.R. 2424) Child passenger safety; Appropriations for the Indian Health Service HIS; Appropriations for Environmental Programs (including EPA) EPA; Maternal, Infant, and Early Childhood Home Visiting Program Reauthorization & Implementation HRSA, CMS, HHS, ACF; Infant sleep product safety CPSC; Lead exposure prevention EPA, CDC; Food safety FDA; Paid family and medical leave; Regulation of high-powered magnet sets CPSC; Climate change, Inflation Reduction Act Implementation EPA; Vehicle emissions standards EPA, NHTSA ; Button battery ingestions CPSC; Early childhood education HHS; Child product safety and injury prevention CPSC; Furniture tip-overs CPSC; Child Abuse Prevention and Treatment Act (CAPTA) Reauthorization; CAPTA Plans of safe care grants ACF, HHS ASPE; Family First Prevention Services Act implementation ACF; CAPTA Fatalities Prevention and Response HHS; Title IV-B Reauthorization ACF; Congregate care reform HHS, ACF; Mental health supports for foster youth/former foster youth HHS; Mercury and Air Toxics Standards, ozone and particulate matter NAAQS, EPA greenhouse gas regulation EPA; QRTP/IMDs (including H.R. 4056 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023) ACF; Firearm Violence Prevention (Including Research Funding; Background Checks); WH Domestic Policy Council; CDC; NIH; DOJ; Pregnant Workers Fairness Act Implementation EEOC; Childcare Funding & Resources HHS; Native American Child Health DOI; EPA Strengthening Efforts to End Violence Against Children Act (H.R. 4798); PEPFAR Reauthorization; MINDS Act (H.R. 1570/S. 767); Implementation of the Global Child Thrive Act; FY24 Appropriations - SFOPS bill focused on specifically on global child health subaccounts at USAID (Vulnerable Children, Nutrition, Maternal and Child Health, and PEPFAR); FY25 Appropriations - SFOPS bill focused specifically on global child health subaccounts at USAID (Vulnerable Children, Nutrition, HIV/AIDS, Maternal and Child Health (including Gavi), WASH, PEPFAR), Department of State Child Protection Compacts, Efforts to end Child Marriage, IDA, MRA; FY24 Appropriations - LHHS bill focused specifically on CDCs global health account (Global Immunization Division), Violence Against Children Surveys, Bureau of International Labor Affairs; FY25 Appropriations - LHHS bill focused on CDCs global health account, Violence Against Children Surveys, Bureau of International Labor Affairs; USAID Advancing Protection and Care for Children in Adversity Strategy 2024-2028 Kids Online Safety Act (S. 1409/H.R. 7891); Children and Teens Online Privacy Protection Act (S. 1418/H.R. 7890); Legislation to Protect Young People Online; Pediatric Subspecialty Loan Repayment Program Funding and Program Implementation Health Resources and Services Administration; Adolescent Health Issues Department of Health and Human Services Office of the Assistant Secretary for Health; Regulation of Tobacco Products (including Proposed Menthol Cigarette and Flavored Cigar Prohibition); Food and Drug Administration; Innovation in Pediatric Drugs Act (H.R. 6664) Continuous Eligibility for Children in Medicaid and CHIP HHS/CMS; Medicaid Payment Parity HHS/CMS; The Kids Access to Primary Care Act (HR 952); Access to Care in Medicaid/CHIP HHS/CMS; Postpartum Medicaid Extension and Maternal Health Improvements; Medicaid/CHIP Eligibility Redeterminations HHS/CMS; Ex Parte Medicaid Unwinding Issues HHS/CMS; Medicaid for Every Child Act (S. 2816); QRTP/IMDs (including H.R. 4056 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023, and S. 3196 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023); Accelerating Kids Access to Care Act (HR 4758, S 2372); Childrens oral health; Medicaid Early and Periodic Screening, Diagnostic, and Treatment benefit HHS/CMS; Medicaid payment for family caregivers HHS/CMS; Vaccines for Children program improvements HHS/CMS, CDC FY25 Labor, Health and Human Services, and Education Appropriations Bill: Pediatric Subspecialty Loan Repayment Program, Firearm Injury and Mortality Prevention Research, Pediatric Mental Health Care Access Program, Emergency Medical Services for Children, National Center for Birth Defects and Developmental Disabilities, Global Immunization, Sudden Unexpected Infant Death and Sudden Death in Childhood, Vaccine Injury Compensation Program, VACCINES Act, Antimicrobial Resistance, Maternal and Child Health, School Based Health Centers, Healthy Start, Section 317 Immunization Grants; FY25 Agriculture, Rural Development, Food and Drug Administration Appropriations Bill: Pediatric Device Consortia; Newborn Screening Saves Lives Reauthorization Act; FY25 National Defense Authorization Act; Department of Defense / Defense Health Agency; Defense Health Agency - Autism Care Demonstration; Department of Defense / Defense Health Agency; Defense Health Agency - Fluoride varnish; Department of Defense/Defense Health Agency; Improving the Health of Children Act; Strengthening the Vaccines for Children Program Act; Banning Electronic Stimulation Devices FDA; SSI Savings Penalty Elimination Act (S.2767/H.R.5408); HCBS Access Act (S.762/H.R. 1493); Better Care Better Jobs Act (S.100/H.R. 547); Autism Family Caregivers Act; PREVENT HPV Cancers Act (H.R. 3633); Supplemental Security Income Equality Act (H.R. 256); IDEA Full Funding Act (S.2217/H.R.4519); Promoting Physical Activity for Americans Act (S.397); COVID-19 Commercialization CDC, HHS; Pandemic and All Hazards Preparedness Act (PAHPA); PREEMIE Reauthorization Act (H.R. 3226/S. 1573); Autism CARES Reauthorization Act; Supplemental Security Income/Social Security; Social Security Administration; School Access to Naloxone Act (H.R. 3065); HEADs UP Act (H.R. 3380); Preventing Maternal Deaths Reauthorization Act of 2023 (S. 2415/H.R.3838); Youth Sports Facilities Act; SHINE for Autumn Act (H.R.5012/S.2647); Artificial Intelligence; Congenital Heart Futures Reauthorization Act (S.3757); HERO Act (H.R. 6251); SSI Restoration Act (H.R. 7138); NURSE Act (S. 3953/H.R. 3197); Vaccines for Children coverage of Nirsevimab CDC, HHS

Client expense: $204,000 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Consumer Product Safety Commission (CPSC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Agency for International Development (USAID), White House Office

Kids Online Safety Act (S. 1409/H.R. 7891); Children and Teens Online Privacy Protection Act (S. 1418/H.R. 7890); Legislation to Protect Young People Online; Pediatric Subspecialty Loan Repayment Program Funding and Program Implementation-Health Resources and Services Administration; Adolescent Health Issues-Department of Health and Human Services Office of the Assistant Secretary for Health; Regulation of Tobacco Products (including Proposed Menthol Cigarette and Flavored Cigar Prohibition)-Food and Drug Administration; Innovation in Pediatric Drugs Act (H.R. 6664). Continuous Eligibility for Children in Medicaid and CHIP-HHS/CMS; Medicaid Payment Parity-HHS/CMS; The Kids Access to Primary Care Act (HR 952); Access to Care in Medicaid/CHIP-HHS/CMS; Postpartum Medicaid Extension and Maternal Health Improvements; Medicaid/CHIP Eligibility Redeterminations-HHS/CMS; Ex Parte Medicaid Unwinding Issues-HHS/CMS; Medicaid for Every Child Act (S. 2816); QRTP/IMDs (including H.R. 4056-Ensuring Medicaid Continuity for Children in Foster Care Act of 2023, and S. 3196-Ensuring Medicaid Continuity for Children in Foster Care Act of 2023); Accelerating Kids Access to Care Act (HR 4758, S 2372); Medicaid Early and Periodic Screening, Diagnostic, and Treatment benefit-HHS/CMS; Medicaid payment for family caregivers-HHS/CMS; Vaccines for Children program improvements-HHS/CMS, CDC. Standards in ORR Custody-ORR, HHS; Licensure of ORR Shelters-ORR, HHS; Public Charge; Child Nutrition Reauthorization/WIC-USDA; SNAP/Farm Bill-USDA; Mental Health for Children-HRSA; H.R. 6, DREAM Act; Medical Nutrition Equity Act; Lift the Bar Act (H.R. 4170/S. 2038); PAHPA Reauthorization; CARE for Families Act HR 3107; WIC Act (S. 1604/H.R. 3364); MODERN WIC Act (S. 984/H.R. 2424); Breastfeeding Peer Counseling Program-USDA; Public Health Preparedness and Response-ASPR; National Advisory Committee on Children and Disasters; Research for Pregnant and Lactating Women-FDA, HHS, NIH; Advancing Safe Medications for Moms and Babies Act; Funding for Pediatric Device Consortia; Funding for Emergency Medical Services for Children Program; Funding for HRSA Pediatric Mental Health Care Access Program; Funding for WIC-OMB, USDA; Donor Milk (S. 2819/H.R. 5486); Dietary Guidelines-USDA, HHS; Child Poverty; Child Poverty Reduction Act (H.R. 5629/S. 2906); Suicide Prevention-SAMHSA; School Meal Standards-USDA; WIC Food Packages-USDA; Universal School Meals (H.R. 3204/S. 1568)-USDA, White House; Early Childhood Nutrition Improvement Act (H.R. 6067); Unaccompanied Children (Fair Day in Court for Kids Act of 2023 - S. 3065); Equality Act; Mental Health Services for Students Act (H.R. 3713); Youth Mental Health and Suicide Prevention Act; Child Tax Credit (H.R. 7024); Supporting Children's Mental Health Care Access Act; Gender Affirming Care-HHS; Safety of Pediatricians and Children's Hospitals-DOJ, HHS; Same Day Billing Restrictions in Mental Health (S. 2556/H.R. 7996); Emergency Vacating of Aircraft Cabin (EVAC) Act; FAA Reauthorization/ Emergency Medical Kits; Drug Shortage Prevention Act; Prevention and Early Intervention Set-Aside in Mental Health Block Grant (H.R. 7808); Child Poverty Reduction Act (S. 2906/H.R. 5629); Compact Impact Fairness Act (S. 792/H.R. 1571); Improving Mental Health and Wellness in Schools Act (H.R. 3331/S. 754); Pride in Mental Health Act (H.R. 7644); Therapeutic Fraud Prevention Act (S. 2176/H.R. 4340); Cady Housh and Gemesha Thomas Student Suicide Prevention Act (H.R. 3778); School Meals Expansion Act (H.R. 2567); Pursuing Equity in Mental Health Act (H.R. 3713); EMSC Reauthorization Act of 2024 (H.R. 6960, S. 3765); CARE for Kids Act; School Hunger Elimination Act; Nutrition Red Tape Reduction Act; No Hungry Kids in Schools Act; Expanding Access to School Meals Act; Innovation in Pediatric Drugs Act; US Senate Commission on Mental Health Act of 2024. FY25 Labor, Health and Human Services, and Education Appropriations Bill: Pediatric Subspecialty Loan Repayment Program, Firearm Injury and Mortality Prevention Research, Pediatric Mental Health Care Access Program, Emergency Medical Services for Children, National Center for Birth Defects and Developmental Disabilities, Global Immunization, Sudden Unexpected Infant Death and Sudden Death in Childhood, Vaccine Injury Compensation Program, VACCINES Act, Antimicrobial Resistance, Maternal and Child Health, School Based Health Centers, Healthy Start, Section 317 Immunization Grants; FY25 Agriculture, Rural Development, Food and Drug Administration Appropriations Bill: Pediatric Device Consortia; Newborn Screening Saves Lives Reauthorization Act; FY25 National Defense Authorization Act-Department of Defense/Defense Health Agency; Defense Health Agency-Autism Care Demonstration-Department of Defense/Defense Health Agency; Defense Health Agency-Fluoride varnish-Department of Defense/Defense Health Agency; Improving the Health of Children Act; Strengthening the Vaccines for Children Program Act; Banning Electronic Stimulation Devices-FDA; SSI Savings Penalty Elimination Act (S.2767/H.R.5408); HCBS Access Act (S.762/H.R. 1493); Better Care Better Jobs Act (S.100/H.R. 547); Autism Family Caregivers Act; PREVENT HPV Cancers Act (H.R. 3633); Supplemental Security Income Equality Act (H.R. 256); IDEA Full Funding Act (S.2217/H.R.4519); Promoting Physical Activity for Americans Act (S.397); Pandemic and All Hazards Preparedness Act (PAHPA); PREEMIE Reauthorization Act (H.R. 3226/S. 1573); Autism CARES Act of 2024 (H.R. 7213); Supplemental Security Income/Social Security Social Security Administration School Access to Naloxone Act (H.R. 3065); HEADs UP Act (H.R. 3380); Preventing Maternal Deaths Reauthorization Act of 2023 (S. 2415/H.R.3838); Youth Sports Facilities Act; SHINE for Autumn Act (H.R.5012/S.2647); Artificial Intelligence; Congenital Heart Futures Reauthorization Act (S.3757); HERO Act (H.R. 6251); SSI Restoration Act (H.R. 7138); NURSE Act (S. 3953/H.R. 3197); Vaccines for Children coverage of Nirsevimab and COVID-19 immunizations-CDC, HHS; WEAR IT Act (H.R. 6279). Child passenger safety; Appropriations for the Indian Health Service-IHS; Appropriations for Environmental Programs (including EPA)-EPA; Maternal, Infant, and Early Childhood Home Visiting Program Reauthorization & Implementation-HRSA, CMS, HHS, ACF; Infant sleep product safety-CPSC; Lead exposure prevention-EPA, CDC; Food safety-FDA; Paid family and medical leave; Regulation of high-powered magnet sets-CPSC; Climate change, Inflation Reduction Act Implementation-EPA; Vehicle emissions standards-EPA, NHTSA; Button battery ingestions-CPSC; Early childhood education-HHS; Child product safety and injury prevention-CPSC; Furniture tip-overs-CPSC; Child Abuse Prevention and Treatment Act (CAPTA) Reauthorization; CAPTA Plans of safe care grants-ACF, HHS ASPE; Family First Prevention Services Act implementation-ACF; CAPTA Fatalities Prevention and Response-HHS; Title IV-B Reauthorization-ACF; Congregate care reform-HHS, ACF; Mental health supports for foster youth/former foster youth-HHS; Mercury and Air Toxics Standards, ozone and particulate matter NAAQS, EPA greenhouse gas regulation-EPA; QRTP/IMDs (including H.R. 4056 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023)-ACF; Firearm Violence Prevention (Including Research Funding; Background Checks)-WH Domestic Policy Council, WH Office of Gun Violence Prevention, CDC, NIH, DOJ; Pregnant Workers Fairness Act Implementation-EEOC; Childcare Funding & Resources-HHS; Native American Child Health-DOI, EPA; Water Beads (including Ban Water Beads Act)-CPSC. Strengthening Efforts to End Violence Against Children Act (H.R. 4798); MINDS Act (H.R. 1570/S. 767); Implementation of the Global Child Thrive Act-USAID; FY25 Appropriations - SFOPS bill (overall foreign assistance funding: Vulnerable Children, Nutrition, Maternal and Child Health (including Gavi), WASH, Department of State Child Protection Compacts, Efforts to end Child Marriage, IDA, MRA); FY25 Appropriations - LHHS bill focused on CDCs global immunization account, Violence Against Children Surveys, Bureau of International Labor Affairs; FY26 Appropriations - global child health accounts impacting children and youth at USAID (Vulnerable Children, International Basic Education, Maternal and Child Health, Nutrition), Combating Child, Early and Forced Marriage, McGovern-Dole International Food for Education and Child Nutrition Program, Department of State Child Protection Compact (CPC) Partnership, ILAB, UNICEF, IDA, MRA, PEPFAR-OMB; Violence Against Children Ministerial Meeting-HHS, NSC, USAID; Supporting U.S. Program to Protect Vaccines and Immunizations in Low-Income Countries through Gavi, the Vaccine Alliance (H. Res. 1286 / S. Res. 684); Advocacy on the unique humanitarian needs of children in Gaza-USAID.

Client expense: $323,000 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Consumer Product Safety Commission (CPSC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Agency for International Development (USAID), White House Office

Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 244): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Medicare Part B. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home And Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposal to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A proposed final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposal to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities.

Client expense: $210,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost-sharing subsidies under part D of the Medicare program 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill 15. Proposals regarding the Medicare Low Income Subsidy program 16. H.R. 7513, Protecting Americas Seniors Access to Care Act, entire 17. S. 3410, Protecting Rural Seniors Access to Care Act, entire bill 18. H.J.Res. 139, providing for Congressional disapproval of the CMS rule Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting," entire resolution 19. H.R. 8106, To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver, entire bill 20. H.R. 8107, Ensuring Access to Medicaid Buy-in Programs Act of 2024, entire bill 21. H.R. 8109, Money Follows the Person Permanency Act of 2024, entire bill 22. H.R. 8110, Protecting Married Seniors from Impoverishment Act of 2024, entire bill 23. H.R. 8018, Alleviating Barriers for Caregivers Act, entire bill 24. S. 3109, Alleviating Barriers for Caregivers Act, entire bill 25. Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program rule, entire rule

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

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

H.R. 547/S.100, the Better Care Better Jobs Act H.R. 1493/S. 762, the HCBS Access Act H.R. 4315, the Medicare Orthotics and Prosthetics Patient-Centered Care Act H.R. 6029/S. 3120, the Disaster Relief Medicaid Act H.R. 8018/S. 3109, the Alleviating Barriers for Caregivers (ABC) Act S. 3118, the HCBS Relief Act of 2023 Discussions: Interaction between Medicare Part B and Tricare for medically retired veterans Discussions: Definition of Medicare in the Home for DME purposes Discussions: Right to repair DME products - ensure providers of DME and prosthetics are reimbursed by Medicare when doing repairs and preventative maintenance

Client expense: $75,053 · Firm income: Not reported

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

United Spinal Association supports: Better Care Better Jobs Act (H.R. 547/S. 100), the HCBS Access Act (H.R. 1493/S. 762), the HCBS Relief Act (H.R. 6296/S. 3118). United Spinal raised the need to introduce federal legislation to address wheelchair repair reform, and legislation or report language to improve spinal cord injury rehabilitation outcomes. Follow up contacts with members of Congress on United Spinals Virtual Advocacy Day included recommendations for our members to advocate for the following policy issues with their members of Congress: Increase funding for SCI Model Systems. United Spinal policy staff advocated for Senators and Representatives to sign onto respective Dear Colleague letters for funding supporting increased funding for the Model Systems program and the Model Systems Knowledge Translational Center (MSKTC), funded by the National Institute on Disability, Independent Living, Rehabilitation Research (NIDILRR) at the U.S. Department of Health and Human Services and housed under the Administration for Community Living (ACL) in the FY 2025 Labor, Health and Human Services, Education Appropriations. The letter was addressed to the bipartisan leadership of the Senate Labor HHS Education Subcommittee on Appropriations. The letter read in part: The Model Systems program provides the entirety of the rehabilitation process from emergency services at the time of an injury through a persons return to full participation in the community for people with spinal cord injury (SCI), traumatic brain injury (TBI), and burn injury. The Model Systems program has not seen an increase in funding since 2006. Advocate for support of a House Dear Colleague letter as well for increaed funding for Spinal Cord Injury Model Systems. Continued raising support for FY2025 report language to direct the Centers for Medicare and Medicaid Services (CMS) to add and/or in the community to CMS policy for mobility assistive equipment and add and/or in the community to Social Security Act 1861 (n) which states that durable medical equipment including wheelchairs be used in the patients home only and support Medicare coverage for standing systems in power wheelchairs to facilitate increased options for independent and community living for all wheelchair users. As a member of the Disability and Rehabilitation Research Coalition, United Spinal, along with numerous other disability organizations, signed on to a letter of thanks to Anjali Forber-Pratt, Ph.D. director, National Institute on Disability, Independent Living, and Rehabilitation Research for the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) 2024-2028 Long Range Plan. United Spinal helped draft a United Spinal letter of interest for an Administration for Community Living grant: Disability and Rehabilitation Research Projects (DRRP) Program: Enhancing the Accessibility of Air Travel. As a member of the Disability & Rehabilitation on Research Coalition (DRRC), United Spinal, along with numerous other disability organizations, signed on to a letter to Chiquita Brooks-LaSure, Administrator, Centers for Medicare and Medicaid Services to provide comments in response to the request for information on Research Data Request and Access Policy Changes. As a member of the Consortium for Constituents with Disabilities Technology and Telecommunications Task Force, United Spinal, along with numerous other disability organizations sent a letter to the bipartisan leadership of the Senate and House Labor, Health and Human Services and Education Appropriations Committees in support for the inclusion of $42 million in the Fiscal Year (FY) 2025 Senate Labor, Health and Human Services and Education Appropriations (LHHS) bill for the Assistive Technology (AT) Act Programs. United Spinal supports H.R 1691 - Ensuring Patient Access to Critical Breakthrough Products Act. Wrote letters with CMS and met with CMS to talk about the need for Medicare coverage of transanal irrigation. Wrote letter to CMS DME MACS regarding needed reform in ostomy supplies coverage under Medicare. Health equity issues - Met with CMS, NIH, ACL and the White House at the Danish Embassy discussing the challenges of health equity concerns in the medical supplies sector. As part of the Coalition to Preserve Rehabilitation, United Spinal signed onto the FY2025 in-patient rehab proposed rule and the RFI on Medicare Advantage data. As part of the ITEM Coalition, United Spinal also submitted a letter to CMS in support of standing systems (power wheelchairs) and another letter in support of coding reform for catheters. United Spinal also signed on to a letter to President Biden, with multiple care support groups, in support of the creation of an Office for Caregiver Health.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Council on Disability, Natl Institutes of Health (NIH), SENATE, White House Office

HCBS Access Act, S.762/H.R.1493. Recognizing the Role of Peer Support Professionals Act, H.R. 2941/S. 1332. Disability Community Act of 2023, H.R. 7267.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HCBS Access Act, S.762/H.R.1493. Recognizing the Role of Peer Support Professionals Act, H.R. 2941/S. 1332. Disability Community Act of 2023, H.R. 7267.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Opposing Better Care Better Jobs Act, S. 100, H.R. 547; opposing HCBS Access Act, S. 762, H.R. 1493.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid home and community-based services, continuation of HCBS services following the public health emergency, Medicaid unwinding, healthcare access and coverage, including to patient preferred treatment, assistive technology devices, accessible diagnostic equipment, and durable medical equipment, such as power wheelchairs and power wheelchair features such as seat elevators and standing systems, intermittent catheter coding, HCBS Access Act (H.R. 1493, S. 762), HCBS Relief Act (S. 3118, H.R. 6296), Supporting Our Direct Care Workforce & Family Caregivers Act (S. 1298), Recognizing the Role of Direct Support Professionals Act (S.1332), Stop Unfair Medicaid Recoveries Act (H.R. 7573), Long-term Care Workforce Support Act ((S.4120/H.R.7994), Creating Hope Reauthorization Act (H.R.7384/ S. 4583)

Client expense: $75,000 · Firm income: Not reported

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

Research into spinal muscular atrophy, timely access to care, treatments, medical devices, and home and community-based services, newborn screening, newborn screening funding, coverage of rare disease treatments and care, HCBS Access Act (H.R. 1493, S. 762), BENEFIT Act (H.R. 1092, S. 526), Safe Step Act (S. 652, H.R. 2630), Protecting Health Care for All Patients Act of 2023 (H.R. 485), Supporting Our Direct Care Workforce & Family Caregivers Act (S. 1298), Long-Term Care Workforce Support Act (S.4120/H.R.7994); HCBS Relief Act (S. 3118, H.R. 6296); Recognizing the Role of Direct Support Professionals Act (S. 1332), Medicaid unwinding protections for people with SMA and other disabilities, direct care workforce shortage, healthcare discrimination (i.e., quality adjusted life years), Ensuring Patient Access to Critical Breakthrough Products Act (H.R. 1691); Creating Hope Reauthorization Act (H.R.7384/ S. 4583), healthcare utilization protocols (i.e., prior authorization and step therapy), Patient Protection and Affordable Care Act (111-148), Inflation Reduction Act (P.L. 117-169), Supporting accessible medical diagnostic equipment, Charlotte Woodward Organ Transplant Discrimination Prevention Act (H.R. 2706/S. 1183), Lifespan Respite Reauthorization Act (H.R. 6160), Stop Unfair Medicaid Recoveries Act (H.R. 7573), accessible medical diagnostic equipment, durable medical equipment, intermittent catheter coding, FDA Rare Disease Center of Excellence, Think Differently Database Act (H.R.670), Accelerating Kids Access to Care Act ((H.R.4758/S.2372)

Client expense: $75,000 · 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), Natl Institutes of Health (NIH), SENATE

Standards in ORR Custody ORR, HHS; Licensure of ORR Shelters ORR, HHS; Public Charge; Child Nutrition Reauthorization/WIC USDA; SNAP/Farm Bill USDA; Mental Health for Children HRSA; H.R. 6, DREAM Act; Medical Nutrition Equity Act; Lift the Bar Act (H.R. 4170/S. 2038); PAHPA Reauthorization; CARE for Families Act HR 3107; WIC Act (S. 1604/H.R. 3364); MODERN WIC Act (S. 984/H.R. 2424) Child passenger safety; Appropriations for the Indian Health Service HIS; Appropriations for Environmental Programs (including EPA) EPA; Maternal, Infant, and Early Childhood Home Visiting Program Reauthorization & Implementation HRSA, CMS, HHS, ACF; Infant sleep product safety CPSC; Lead exposure prevention EPA, CDC; Food safety FDA; Paid family and medical leave; Regulation of high-powered magnet sets CPSC; Climate change, Inflation Reduction Act Implementation EPA; Vehicle emissions standards EPA, NHTSA ; Button battery ingestions CPSC; Early childhood education HHS; Child product safety and injury prevention CPSC; Furniture tip-overs CPSC; Child Abuse Prevention and Treatment Act (CAPTA) Reauthorization; CAPTA Plans of safe care grants ACF, HHS ASPE; Family First Prevention Services Act implementation ACF; CAPTA Fatalities Prevention and Response HHS; Title IV-B Reauthorization ACF; Congregate care reform HHS, ACF; Mental health supports for foster youth/former foster youth HHS; Mercury and Air Toxics Standards, ozone and particulate matter NAAQS, EPA greenhouse gas regulation EPA; QRTP/IMDs (including H.R. 4056 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023) ACF; Firearm Violence Prevention (Including Research Funding; Background Checks); WH Domestic Policy Council; CDC; NIH; DOJ; Pregnant Workers Fairness Act Implementation EEOC; Childcare Funding & Resources HHS; Native American Child Health DOI; EPA Strengthening Efforts to End Violence Against Children Act (H.R. 4798); PEPFAR Reauthorization; MINDS Act (H.R. 1570/S. 767); Implementation of the Global Child Thrive Act; FY24 Appropriations - SFOPS bill focused on specifically on global child health subaccounts at USAID (Vulnerable Children, Nutrition, Maternal and Child Health, and PEPFAR); FY25 Appropriations - SFOPS bill focused specifically on global child health subaccounts at USAID (Vulnerable Children, Nutrition, HIV/AIDS, Maternal and Child Health (including Gavi), WASH, PEPFAR), Department of State Child Protection Compacts, Efforts to end Child Marriage, IDA, MRA; FY24 Appropriations - LHHS bill focused specifically on CDCs global health account (Global Immunization Division), Violence Against Children Surveys, Bureau of International Labor Affairs; FY25 Appropriations - LHHS bill focused on CDCs global health account, Violence Against Children Surveys, Bureau of International Labor Affairs; USAID Advancing Protection and Care for Children in Adversity Strategy 2024-2028 Kids Online Safety Act (S. 1409/H.R. 7891); Children and Teens Online Privacy Protection Act (S. 1418/H.R. 7890); Legislation to Protect Young People Online; Pediatric Subspecialty Loan Repayment Program Funding and Program Implementation Health Resources and Services Administration; Adolescent Health Issues Department of Health and Human Services Office of the Assistant Secretary for Health; Regulation of Tobacco Products (including Proposed Menthol Cigarette and Flavored Cigar Prohibition); Food and Drug Administration; Innovation in Pediatric Drugs Act (H.R. 6664) Continuous Eligibility for Children in Medicaid and CHIP HHS/CMS; Medicaid Payment Parity HHS/CMS; The Kids Access to Primary Care Act (HR 952); Access to Care in Medicaid/CHIP HHS/CMS; Postpartum Medicaid Extension and Maternal Health Improvements; Medicaid/CHIP Eligibility Redeterminations HHS/CMS; Ex Parte Medicaid Unwinding Issues HHS/CMS; Medicaid for Every Child Act (S. 2816); QRTP/IMDs (including H.R. 4056 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023, and S. 3196 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023); Accelerating Kids Access to Care Act (HR 4758, S 2372); Childrens oral health; Medicaid Early and Periodic Screening, Diagnostic, and Treatment benefit HHS/CMS; Medicaid payment for family caregivers HHS/CMS; Vaccines for Children program improvements HHS/CMS, CDC FY25 Labor, Health and Human Services, and Education Appropriations Bill: Pediatric Subspecialty Loan Repayment Program, Firearm Injury and Mortality Prevention Research, Pediatric Mental Health Care Access Program, Emergency Medical Services for Children, National Center for Birth Defects and Developmental Disabilities, Global Immunization, Sudden Unexpected Infant Death and Sudden Death in Childhood, Vaccine Injury Compensation Program, VACCINES Act, Antimicrobial Resistance, Maternal and Child Health, School Based Health Centers, Healthy Start, Section 317 Immunization Grants; FY25 Agriculture, Rural Development, Food and Drug Administration Appropriations Bill: Pediatric Device Consortia; Newborn Screening Saves Lives Reauthorization Act; FY25 National Defense Authorization Act; Department of Defense / Defense Health Agency; Defense Health Agency - Autism Care Demonstration; Department of Defense / Defense Health Agency; Defense Health Agency - Fluoride varnish; Department of Defense/Defense Health Agency; Improving the Health of Children Act; Strengthening the Vaccines for Children Program Act; Banning Electronic Stimulation Devices FDA; SSI Savings Penalty Elimination Act (S.2767/H.R.5408); HCBS Access Act (S.762/H.R. 1493); Better Care Better Jobs Act (S.100/H.R. 547); Autism Family Caregivers Act; PREVENT HPV Cancers Act (H.R. 3633); Supplemental Security Income Equality Act (H.R. 256); IDEA Full Funding Act (S.2217/H.R.4519); Promoting Physical Activity for Americans Act (S.397); COVID-19 Commercialization CDC, HHS; Pandemic and All Hazards Preparedness Act (PAHPA); PREEMIE Reauthorization Act (H.R. 3226/S. 1573); Autism CARES Reauthorization Act; Supplemental Security Income/Social Security; Social Security Administration; School Access to Naloxone Act (H.R. 3065); HEADs UP Act (H.R. 3380); Preventing Maternal Deaths Reauthorization Act of 2023 (S. 2415/H.R.3838); Youth Sports Facilities Act; SHINE for Autumn Act (H.R.5012/S.2647); Artificial Intelligence; Congenital Heart Futures Reauthorization Act (S.3757); HERO Act (H.R. 6251); SSI Restoration Act (H.R. 7138); NURSE Act (S. 3953/H.R. 3197); Vaccines for Children coverage of Nirsevimab CDC, HHS

Client expense: $204,000 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Consumer Product Safety Commission (CPSC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Agency for International Development (USAID), White House Office

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost-sharing subsidies under part D of the Medicare program 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill 15. Proposals regarding the Medicare Low Income Subsidy program

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

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

Medicare Observation Stays. Improving Access to Medicare Coverage Act of 2023 (H.R. 5138): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. Assuring Medicares Promise Act (H.R. 34) and Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Dental Coverage. Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 244): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Medicare Part B. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home And Community-Based Services. HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Medicare and Medicaid Nursing Homes. Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. Protecting Americas Seniors Access to Care Act (H.R. 7513): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes, Assisted Living and Other LTSS Settings. Long-Term Care Workforce Support Act (No bill number): Proposal to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A proposed final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): A proposed CMS final regulations for establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposal to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

HCBS Access Act, S.762/H.R.1493. Recognizing the Role of Peer Support Professionals Act, H.R. 2941/S. 1332. Disability Community Act of 2023, H.R. 7267.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HCBS Access Act, S.762/H.R.1493. Recognizing the Role of Peer Support Professionals Act, H.R. 2941/S. 1332. Disability Community Act of 2023, H.R. 7267.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HCBS Settings rule implementation Funding for the Direct Care Workforce and addressing worker shortages H.R. 547/S. 100 Better Care Better Jobs Act S. 762/H.R. 1493 the HCBS Access Act Expanding Medicare benefits S. 3118/HR 6296 The HCBS Relief Act

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

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

Opposing Better Care Better Jobs Act, S. 100, H.R. 547; opposing HCBS Access Act, S. 762, H.R. 1493.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid home and community-based services, continuation of HCBS services following the public health emergency, Medicaid unwinding, healthcare access and coverage, including to patient preferred treatment, assistive technology devices, and durable medical equipment, such as power wheelchairs and power wheelchair features such as seat elevators and standing systems, HCBS Access Act (H.R. 1493, S. 762), HCBS Relief Act (S. 3118, H.R. 6296), Supporting Our Direct Care Workforce & Family Caregivers Act (S. 1298), Recognizing the Role of Direct Support Professionals Act (S.1332), Stop Unfair Medicaid Recoveries Act (H.R. 7573), Long-term Care Workforce Support Act

Client expense: $75,000 · Firm income: Not reported

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

Research into spinal muscular atrophy, timely access to care, treatments, medical devices, and home and community-based services, newborn screening, newborn screening funding, coverage of rare disease treatments and care, HCBS Access Act (H.R. 1493, S. 762), BENEFIT Act (H.R. 1092, S. 526), Safe Step Act (S. 652, H.R. 2630), Protecting Health Care for All Patients Act of 2023 (H.R. 485), Supporting Our Direct Care Workforce & Family Caregivers Act (S. 1298), HCBS Relief Act (S. 3118, H.R. 6296); Recognizing the Role of Direct Support Professionals Act (S. 1332), Medicaid unwinding protections for people with SMA and other disabilities, direct care workforce shortage, healthcare discrimination (i.e., quality adjusted life years), Ensuring Patient Access to Critical Breakthrough Products Act (H.R. 1691); healthcare utilization protocols (i.e., prior authorization and step therapy), Patient Protection and Affordable Care Act (111-148), Inflation Reduction Act (P.L. 117-169), Supporting accessible medical diagnostic equipment, Charlotte Woodward Organ Transplant Discrimination Prevention Act (H.R. 2706/S. 1183), Lifespan Respite Reauthorization Act (H.R. 6160), Stop Unfair Medicaid Recoveries Act (H.R. 7573)

Client expense: $75,000 · 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), Natl Institutes of Health (NIH), SENATE

H.R. 547/S.100, the Better Care Better Jobs Act H.R. 1493/S. 762, the HCBS Access Act H.R. 4315, the Medicare Orthotics and Prosthetics Patient-Centered Care Act H.R. 6029/S. 3120, the Disaster Relief Medicaid Act S. 3109, the Alleviating Barriers for Caregivers (ABC) Act S. 3118, the HCBS Relief Act of 2023 Discussions: Interaction between Medicare Part B and Tricare for medically retired veterans Discussions: Definition of Medicare in the Home for DME purposes Discussions: Right to repair DME products - ensure providers of DME and prosthetics are reimbursed by Medicare when doing repairs and preventative maintenance

Client expense: $74,465 · Firm income: Not reported

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

Gun Violence Prevention Research Funding Child passenger safety Appropriations for the Indian Health Service Maternal, Infant, and Early Childhood Home Visiting Program Reauthorization & Implementation Infant sleep product safety Lead exposure prevention Food safety Paid family and medical leave Regulation of high-powered magnet sets Climate change, Inflation Reduction Act Vehicle emissions standards Button battery ingestions (H.R. 5313, S. 3278) Early childhood education Access to genetic sequencing Child product safety and injury prevention Furniture tip-overs Child Abuse Prevention and Treatment Act (CAPTA) Reauthorization CAPTA Plans of safe care grants Family First Prevention Services Act implementation CAPTA Fatalities Prevention and Response Title IV-B Reauthorization Ensuring Medicaid continuity for Children in Foster Care Congregate care reform Mental health supports for foster youth/former foster youth Mercury and Air Toxics Standards, ozone and particulate matter NAAQS, EPA greenhouse gas regulation Appropriations - global child and youth-focused global health subaccounts at USAID (Vulnerable Children, Maternal and Child Health (includes Gavi), Nutrition), State Department (PEPFAR), and CDC (Global Immunization Division) Global Child Thrive Act Implementation  Strengthening Efforts to End Violence Against Children Act  Reach Every Mother and Child Act  PEPFAR Reauthorization MINDS Act 12-Month Continuous Eligibility for Children in Medicaid/CHIP Medicaid Payment Parity Standards in ORR Custody Licensure of ORR Shelters Public Charge Child Nutrition Reauthorization/WIC SNAP Mental Health for Children H.R. 6, DREAM Act Medical Nutrition Equity Act Donor Human Milk Lift the Bar Act PAHPA Reauthorization CARE for Families Act HR 3107 WIC Act MODERN WIC Act Breastfeeding Peer Counseling Program Public Health Preparedness and Response Research for Pregnant and Lactating Women Advancing Safe Medications for Moms and Babies Act Funding for Pediatric Device Consortia Funding for Emergency Medical Services for Children Program Funding for HRSA Pediatric Mental Health Care Access Program Donor Milk DEMAND Act Dietary Guidelines Child Poverty Child Poverty Reduction Act Suicide Prevention Child Nutrition Waivers School Meal Standards WIC Food Packages Universal School Meals Equality Act Mental Health Services for Students Act Youth Mental Health and Suicide Prevention Act Child Tax Credit Supporting Childrens Mental Health Care Access Act Infant Formula Shortage White House Conference on Hunger, Nutrition, and Health Mental Health Reform Reauthorization Act Restoring Hope for Mental Health and Well-Being Act Gender Affirming Care Safety of Pediatricians and Childrens Hospitals Emergency Vacating of Aircraft Cabin (EVAC) Act Same Day Billing Restrictions in Mental Health Senate Finance Committee Mental Health Discussion Drafts Drug Shortage Prevention Act Kids Online Safety Act Children and Teens Online Privacy Protection Act Online Privacy and Design Protections for Children and Adolescents Pediatric Subspecialty Loan Repayment Program FY 2024 Appropriations and Program Implementation Tobacco Riders? FDA Regulation of Tobacco Products (Non-Menthol Cigarettes) FY24 Labor, Health and Human Services, and Education Appropriations Bill: Pediatric Subspecialty Loan Repayment Program, Firearm Injury and Mortality Prevention Research, Pediatric Mental Health Care Access Program, Emergency Medical Services for Children, National Center for Birth Defects and Developmental Disabilities, Global Immunization, Sudden Unexpected Infant Death and Sudden Death in Childhood, Vaccine Injury Compensation Program, VACCINES Act, Antimicrobial Resistance, Maternal and Child Health, School Based Health Centers FY24 Agriculture, Rural Development, Food and Drug Administration Appropriations Bill: Pediatric Device Consortia Newborn Screening Saves Lives Reauthorization Act FY24 National Defense Authorization Act Defense Health Agency - Autism Care Demonstration Improving the Health of Children Act Strengthening the Vaccines for Children Program Act Childrens Literacy Initiative on Military Bases (CLIMB) Act of 2022 (Reach Out and Read) Banning Electronic Stimulation Devices SSI Savings Penalty Elimination Act HCBS Access Act (S.762/H.R. 1493) Better Care Better Jobs Act (S.100/H.R. 547) Protection of Women and Girls in Sports Act (H.R. 734) Access to AEDs Act (S.1024/H.R.2370) Autism Family Caregivers Act

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

Government targets: Administration for Children & Families (ACF), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Consumer Product Safety Commission (CPSC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Agency for International Development (USAID), White House Office

FY24 Labor, Health and Human Services, and Education Appropriations Bill: Pediatric Subspecialty Loan Repayment Program, Firearm Injury and Mortality Prevention Research, Pediatric Mental Health Care Access Program, Emergency Medical Services for Children, National Center for Birth Defects and Developmental Disabilities, Global Immunization, Sudden Unexpected Infant Death and Sudden Death in Childhood, Vaccine Injury Compensation Program, VACCINES Act, Antimicrobial Resistance, Maternal and Child Health, School Based Health Centers; FY24 Agriculture, Rural Development, Food and Drug Administration Appropriations Bill: Pediatric Device Consortia; Newborn Screening Saves Lives Reauthorization Act; FY24 National Defense Authorization Act; Defense Health Agency - Autism Care Demonstration; Defense Health Agency - Fluoride varnish; Improving the Health of Children Act; Strengthening the Vaccines for Children Program Act; Childrens Literacy Initiative on Military Bases (CLIMB) Act of 2022 (Reach Out and Read); Banning Electronic Stimulation Devices; SSI Savings Penalty Elimination Act (S.2767/H.R.5408); HCBS Access Act (S.762/H.R. 1493); Better Care Better Jobs Act (S.100/H.R. 547); Autism Family Caregivers Act; Equitable Community Access to Pharmacist Services Act (H.R. 1770); PREVENT HPV Cancers Act (H.R. 3633); Supplemental Security Income Equality Act (H.R. 256); IDEA Full Funding Act (S.2217/H.R.4519); Promoting Physical Activity for Americans Act (S.397); COVID-19 Commercialization; Pandemic and All Hazards Preparedness Act (PAHPA); PREEMIE Reauthorization Act (H.R. 3226/S. 1573); Autism CARES Reauthorization Act; Supplemental Security Income/Social Security; School Access to Naloxone Act (H.R. 3065); HEADs UP Act (H.R. 3380); Preventing Maternal Deaths Reauthorization Act of 2023 (S. 2415/H.R.3838); Youth Sports Facilities Act; SHINE for Autumn Act (H.R.5012/S.2647); Artificial Intelligence Child passenger safety; Appropriations for the Indian Health Service; Appropriations for Environmental Programs (including EPA); Maternal, Infant, and Early Childhood Home Visiting Program Reauthorization & Implementation; Infant sleep product safety (including weighted infant sleep products); Lead exposure prevention; Food safety; Paid family and medical leave; Regulation of high-powered magnet sets; Climate change, Inflation Reduction Act Implementation; Vehicle emissions standards; Button battery ingestions; Early childhood education; Access to genetic sequencing; Child product safety and injury prevention; Furniture tip-overs; Child Abuse Prevention and Treatment Act (CAPTA) Reauthorization; CAPTA Plans of safe care grants; Family First Prevention Services Act implementation; CAPTA Fatalities Prevention and Response; Title IV-B Reauthorization; Congregate care reform; Mental health supports for foster youth/former foster youth; Mercury and Air Toxics Standards, ozone and particulate matter NAAQS, EPA greenhouse gas regulation; QRTP/IMDs (including H.R. 4056 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023); Firearm Violence Prevention (Including Research Funding; Background Checks); Pregnant Workers Fairness Act Implementation; Childcare Funding & Resources; Native American Child Health Standards in ORR Custody; Licensure of ORR Shelters; Public Charge; Child Nutrition Reauthorization/WIC; SNAP/Farm Bill; Mental Health for Children; H.R. 6, DREAM Act; Medical Nutrition Equity Act; Lift the Bar Act (H.R. 4170/S. 2038); PAHPA Reauthorization; CARE for Families Act HR 3107; WIC Act (S. 1604/H.R. 3364); MODERN WIC Act (S. 984/H.R. 2424) Kids Online Safety Act (S. 1409); Children and Teens Online Privacy Protection Act (S. 1418); Protecting Kids on Social Media Act (S. 1291); Legislation to Protect Children and Teens Online; Pediatric Subspecialty Loan Repayment Program FY24 Funding and Program Implementation; Youth Prevention and Recovery Reauthorization Act; Healthcare Workforce Resilience Act; Eunice Kennedy Shriver National Institute of Child Health and Human Development Funding Strengthening Efforts to End Violence Against Children Act (H.R. 4798); PEPFAR reauthorization; MINDS Act (H.R. 1570 / S. 767); Implementation of the Global Child Thrive Act; International Children with Disabilities Protection Act (H.R. 5847 / S. 847); FY 2024 Appropriations - SFOPS bill focused specifically on global child health subaccounts at USAID (Vulnerable Children, Nutrition, HIV/AIDS, Maternal and Child Health (including Gavi), WASH, PEPFAR), Department of State Child Protection Compacts, Efforts to end Child Marriage, IDA, MRA; FY 2024 Appropriations - LHHS bill focused specifically on CDCs global health account (Global Immunization Division), Violence Against Children Surveys, and Bureau of International Labor Affairs 12-Month Continuous Eligibility for Children in Medicaid/CHIP; Medicaid Payment Parity

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

Government targets: Administration for Children & Families (ACF), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Consumer Product Safety Commission (CPSC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Agency for International Development (USAID), White House Office

FY24 Labor, Health and Human Services, and Education Appropriations Bill: Pediatric Subspecialty Loan Repayment Program, Firearm Injury and Mortality Prevention Research, Pediatric Mental Health Care Access Program, Emergency Medical Services for Children, National Center for Birth Defects and Developmental Disabilities, Global Immunization, Sudden Unexpected Infant Death and Sudden Death in Childhood, Vaccine Injury Compensation Program, VACCINES Act, Antimicrobial Resistance, Maternal and Child Health, School Based Health Centers; FY24 Agriculture, Rural Development, Food and Drug Administration Appropriations Bill: Pediatric Device Consortia; Newborn Screening Saves Lives Reauthorization Act; FY24 National Defense Authorization Act; Defense Health Agency - Autism Care Demonstration; Defense Health Agency - Fluoride varnish; Improving the Health of Children Act; Strengthening the Vaccines for Children Program Act; Childrens Literacy Initiative on Military Bases (CLIMB) Act of 2022 (Reach Out and Read); Banning Electronic Stimulation Devices; SSI Savings Penalty Elimination Act (S.2767/H.R.5408); HCBS Access Act (S.762/H.R. 1493); Better Care Better Jobs Act (S.100/H.R. 547); Autism Family Caregivers Act; Equitable Community Access to Pharmacist Services Act (H.R. 1770); PREVENT HPV Cancers Act (H.R. 3633); Supplemental Security Income Equality Act (H.R. 256); IDEA Full Funding Act (S.2217/H.R.4519); Promoting Physical Activity for Americans Act (S.397); COVID-19 Commercialization; Pandemic and All Hazards Preparedness Act (PAHPA); PREEMIE Reauthorization Act (H.R. 3226/S. 1573); Autism CARES Reauthorization Act; Supplemental Security Income/Social Security; School Access to Naloxone Act (H.R. 3065); HEADs UP Act (H.R. 3380); Preventing Maternal Deaths Reauthorization Act of 2023 (S. 2415/H.R.3838); Youth Sports Facilities Act; SHINE for Autumn Act (H.R.5012/S.2647); Artificial Intelligence Child passenger safety; Appropriations for the Indian Health Service; Appropriations for Environmental Programs (including EPA); Maternal, Infant, and Early Childhood Home Visiting Program Reauthorization & Implementation; Infant sleep product safety (including weighted infant sleep products); Lead exposure prevention; Food safety; Paid family and medical leave; Regulation of high-powered magnet sets; Climate change, Inflation Reduction Act Implementation; Vehicle emissions standards; Button battery ingestions; Early childhood education; Access to genetic sequencing; Child product safety and injury prevention; Furniture tip-overs; Child Abuse Prevention and Treatment Act (CAPTA) Reauthorization; CAPTA Plans of safe care grants; Family First Prevention Services Act implementation; CAPTA Fatalities Prevention and Response; Title IV-B Reauthorization; Congregate care reform; Mental health supports for foster youth/former foster youth; Mercury and Air Toxics Standards, ozone and particulate matter NAAQS, EPA greenhouse gas regulation; QRTP/IMDs (including H.R. 4056 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2023); Firearm Violence Prevention (Including Research Funding; Background Checks); Pregnant Workers Fairness Act Implementation; Childcare Funding & Resources; Native American Child Health Standards in ORR Custody; Licensure of ORR Shelters; Public Charge; Child Nutrition Reauthorization/WIC; SNAP/Farm Bill; Mental Health for Children; H.R. 6, DREAM Act; Medical Nutrition Equity Act; Lift the Bar Act (H.R. 4170/S. 2038); PAHPA Reauthorization; CARE for Families Act HR 3107; WIC Act (S. 1604/H.R. 3364); MODERN WIC Act (S. 984/H.R. 2424) Kids Online Safety Act (S. 1409); Children and Teens Online Privacy Protection Act (S. 1418); Protecting Kids on Social Media Act (S. 1291); Legislation to Protect Children and Teens Online; Pediatric Subspecialty Loan Repayment Program FY24 Funding and Program Implementation; Youth Prevention and Recovery Reauthorization Act; Healthcare Workforce Resilience Act; Eunice Kennedy Shriver National Institute of Child Health and Human Development Funding Strengthening Efforts to End Violence Against Children Act (H.R. 4798); PEPFAR reauthorization; MINDS Act (H.R. 1570 / S. 767); Implementation of the Global Child Thrive Act; International Children with Disabilities Protection Act (H.R. 5847 / S. 847); FY 2024 Appropriations - SFOPS bill focused specifically on global child health subaccounts at USAID (Vulnerable Children, Nutrition, HIV/AIDS, Maternal and Child Health (including Gavi), WASH, PEPFAR), Department of State Child Protection Compacts, Efforts to end Child Marriage, IDA, MRA; FY 2024 Appropriations - LHHS bill focused specifically on CDCs global health account (Global Immunization Division), Violence Against Children Surveys, and Bureau of International Labor Affairs 12-Month Continuous Eligibility for Children in Medicaid/CHIP; Medicaid Payment Parity

Client expense: $65,000 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Consumer Product Safety Commission (CPSC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Agency for International Development (USAID), White House Office

Supports "Supporting Our Direct Care Workforce and Family Caregivers Act (S. 1298). Supports "Better Care Better Jobs Act" (H.R. 547/S. 100). Supports "Home and Community Based Services (HCBS) Access Act" (H.R. 1493/ S. 762). United Spinal Association provided comments on the proposed update to the National Institutes of Health (NIH) mission statement. United Spinal, along with numerous other disability organizations, as members of the Disability & Rehabilitation Research Coalition (DRRC) endorsed comments on the proposed update to the National Institutes of Health (NIH) mission statement. On November 20th, United Spinal policy staff, along with numerous other members of the Disability Rehabilitation Research Coalition (DRRC), met with representatives for the National Institutes of Health, National Institute for Neurological Disorders and Stroke to discuss medical rehabilitation programs and needs. United Spinal, along with numerous other disability organizations, as members of the Disability & Rehabilitation Research Coalition (DRRC) provided comments supporting a Limb Loss Preservation Registry (LLPR). United Spinal provided a letter of support for a proposed project from the University of Michigan Transportation Research Institute (UMTRI) for the National Institute on Disability, Independent Living and Rehabilitation Researchs (NIDILRR) request for proposals on field-Initialed Projects, Dynamic Comfort of Vehicle Occupants in Wheelchairs. United Spinal provided a letter of support for a proposed project from the University of Michigan Transportation Research Institute (UMTRI) for the National Institute on Disability, Independent Living and Rehabilitation Researchs (NIDILRR) request for proposals on field-Initialed Projects, Developing Education Modules to Promote Use of Crash Tested Wheelchairs".

Client expense: Not reported · Firm income: $75,000

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

Medicare Observation Stays. Improving Access to Medicare Coverage Act of 2023 (H.R. 5138): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and raise the income threshold for the low-income subsidy. Medicare Prescription Drugs. Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposes to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries with, based on specified criteria, large economies and high incomes. Medicare Prescription Drugs. (No bill) Supported an administrative proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill) Supported HHS promulgating robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act. Medicare Low-Income Subsidy (LIS) Program. (No bill) Supported increased funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. Assuring Medicares Promise Act (H.R. 34) and Medicare and Social Security Fair Share Act (S. 1174 and H.R 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Dental Coverage. Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 244): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Part B of the Medicare program. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage. (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home And Community-Based Services. Inflation Reduction Act (Public Law No: 117-169): Proposals to expand Medicaid home and community-based services and the Medicare savings programs. Medicaid Home And Community-Based Services. HCBS Access Act (H.R. 1493 and S. 762). Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Medicare and Medicaid Nursing Homes. Nursing Home Disclosure Act (H.R. 177). Proposal to direct HHS to establish a national registry of medical directors. Medicare and Medicaid Nursing Home Ownership. (No bill) Supporting the final HHS regulations for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Calling for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill) Support for CMS to promulgate improved final regulations for establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): To request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

HCBS Settings rule implementation Funding for the Direct Care Workforce and addressing worker shortages H.R. 547/S. 100 Better Care Better Jobs Act S. 762/H.R. 1493 the HCBS Access Act Expanding Medicare benefits S. 3118/HR 6296 The HCBS Relief Act

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

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

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost-sharing subsidies under part D of the Medicare program 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill

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

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