Supporting Safety Net Hospitals Act

Sustainability of safety net health systems; social determinants of health; promoting coordinated care; support of telehealth policies; 340B Protect Act, H.R. 4390; H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 3281, the Transparent PRICE Act; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; and H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R. 5378, the Lower Costs, More Transparency Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net Act; H.R. 10337, Expanding the Health Care Workforce Act; and H.R. 4392, Uterine Fibroid Intervention and Gynecological Health Treatment Act of 2025.

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

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

Funding for Disproportionate Share Hospitals (Medicaid DSH); Funding for Medicare graduate medical education (GME); Medicare site neutrality policies; support of telehealth policies, including for audio-only telehealth services; H.R. 7053/S. 3792 - acute hospital care at home waiver flexibility; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R.3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 5378, the Lower Costs, More Transparency Act; H.R. 5860, the Continuing Appropriations Act, 2024 and Other Extensions Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 7327, the Protecting Front Line Multimission Hospitals Act of 2024; S. 3450, the Mental and Physical Health Care Comorbidities Act of 2023; and H.R. 10337, Expanding the Health Care Workforce Act.

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

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

Sustainability of safety net health systems; social determinants of health; promoting coordinated care; support of telehealth policies; 340B Protect Act, H.R. 4390; H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 3281, the Transparent PRICE Act; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; and H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R. 5378, the Lower Costs, More Transparency Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 8247, the Uterine Fibroid Intervention and Gynecological Health Treatment Act of 2024; H.R. 8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net Act; and H.R. 10337, Expanding the Health Care Workforce Act.

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

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

Funding for Disproportionate Share Hospitals (Medicaid DSH); Funding for Medicare graduate medical education (GME); Medicare site neutrality policies; support of telehealth policies, including for audio-only telehealth services; H.R. 7053/S. 3792 - acute hospital care at home waiver flexibility; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R.3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 5378, the Lower Costs, More Transparency Act; H.R. 5860, the Continuing Appropriations Act, 2024 and Other Extensions Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 7327, the Protecting Front Line Multimission Hospitals Act of 2024; S. 3450, the Mental and Physical Health Care Comorbidities Act of 2023; and H.R. 10337, Expanding the Health Care Workforce Act.

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

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

Sustainability of safety net health systems; social determinants of health; promoting coordinated care; support of telehealth policies; 340B Protect Act, H.R. 4390; H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 3281, the Transparent PRICE Act; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; and H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R. 5378, the Lower Costs, More Transparency Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 8247, the Uterine Fibroid Intervention and Gynecological Health Treatment Act of 2024; H.R. 8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net Act; and H.R. 10337, Expanding the Health Care Workforce Act.

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

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

Sustainability of safety net health systems; social determinants of health; promoting coordinated care; support of telehealth policies; 340B Protect Act, H.R. 4390; H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 3281, the Transparent PRICE Act; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; and H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R. 5378, the Lower Costs, More Transparency Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 8247, the Uterine Fibroid Intervention and Gynecological Health Treatment Act of 2024; H.R. 8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net Act; and H.R. 10337, Expanding the Health Care Workforce Act.

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

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

Funding for Disproportionate Share Hospitals (Medicaid DSH); Funding for Medicare graduate medical education (GME); Medicare site neutrality policies; support of telehealth policies, including for audio-only telehealth services; H.R. 7053/S. 3792 - acute hospital care at home waiver flexibility; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R.3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 5378, the Lower Costs, More Transparency Act; H.R. 5860, the Continuing Appropriations Act, 2024 and Other Extensions Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 7327, the Protecting Front Line Multimission Hospitals Act of 2024; S. 3450, the Mental and Physical Health Care Comorbidities Act of 2023; and H.R. 10337, Expanding the Health Care Workforce Act.

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

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

H.R.2665, Supporting Safety Net Hospitals Act H.R.2389, the Resident Physician Shortage Reduction Act of 2023 H.R.3561 - PATIENT Act of 2023 H.R. 3887, the Childrens Hospital GME Support Reauthorization Act of 2023 H.R. 3561, PATIENT Act of 2023 H.R. 5378, The Lower Costs, More Transparency Act S. 2719 Directing our Countrys Transfer of Residency Slots (DOCTORS) Act of 2023 S. 3196 - Ensuring Medicaid Continuity for Children in Foster Care Act H.R. 2829 Chronic Care Management Improvement Act of 2023 H.R. 7397 -Reinforcing Essential Health Systems for Communities Act H.R. 6929 & S.3565, Affordable Connectivity Program Extension Act of 2024 Strengthening Pathways to Health Professions Act Fiscal Year 2025 Children's Hospitals Graduate Medical Education (CHGME) Appropriations Support Issues related to Section 203 of the Consolidated Appropriations Act of 2021 Issues related to the Medicare/Medicaid dual eligible population Issues related to Medicare Site-neutral payment cuts Issues related to Medicaid DSH Cuts

Client expense: $630,000 · Firm income: Not reported

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

Medicare program general; S.230 and H.R.834 Rural Physician Workforce Production Act; H.R.2665 Supporting Safety Net Hospitals Act; H.R.5378 Lower Costs, More Transparency Act; Site Neutrality issues;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Protect the Medicaid system and oppose efforts to cut Medicaid, including support for legislation to repeal or delay statutory Medicaid DSH cuts for FY 2025-FY 2027, including HR 2665, the Supporting Safety Net Hospitals Act and related legislation. Advocate for including a DSH cut fix in an end-of-year health extenders package or a CR. Support for reforming the Medicaid inmate exclusion, including HR 2400/S 1165, the Reentry Act, and HR 3074/ S 971, the Due Process, Continuity of Care Act, and related legislation.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for H.R.7327 - Protecting Front Line Multimission Hospitals Act of 2024. Sustainability of safety net health systems. Social determinants of health. Support of telehealth policies, including for audio-only telehealth services. 340B Protect Act, H.R.4390. H.R.3290, To amend Title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. H.R.2665, Supporting Safety Net Hospitals Act. H.R.3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023. Support for policies to enhance health care workforce programs. H.R.5378, Lower Costs, More Transparency Act. S.3548, Health Care Prices Revealed and Information to Consumers Explained Transparency Act. S.3450, Mental and Physical Health Care Comorbidities Act of 2023. H.R. 10337, Expanding the Healthcare Workforce Act.

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

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

340B Drug Discount Program, eligibility waiver H.R. 3290 H.R. 2389, S.1302 - Resident Physician Shortage Reduction Act H.R. 3561 - PATIENT Act H.R. 2665 - Supporting Safety-Net Hospitals Act HR 7635 - 340B PATIENTS Act SUSTAIN 340B Act ACCESS 340B Act Graduate Medical Education Disproportionate Share Hospital (DSH) payments Childrens Health Insurance Program Medicare Dependent Hospital Program (MDH) Medicaid Low Volume Payments (LV) Federal Medical Assistance Percentage Extension Inpatient Prospective Payment System Outpatient Prospective Payment System Bad debt/charity care Hospital Outpatient Department payments Site Neutral Payment Policies Acute Hospital Care at Home Program Telehealth coverage

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Acute Hospital Care at Home - Recommended Congress make certain flexibilities related to the Acute Hospital Care at Home Program permanent or, pass an extension before flexibilities expired. Home Infusion - Shared concerns regarding changes to Medicare reimbursement for certain Home Infusion Treatments, encouraged passage of the Preserving Patient Access to Home Infusion Act (S.1976/H.R.4104) Issues related to hospital and provider payment Medicaid Disproportionate Share Hospital (DSH) Program - Urged Congress to avert the cuts to Medicaid DSH payments set to take place at the end of the year; encouraged passage of legislation to preserve DSH payments on a longer-term basis, endorsed passage of the Supporting Safety Net Hospitals Act (H.R.2665) Medicare Drug Price Negotiation Program (MDPNP) - Responded to the Centers for Medicare & Medicaid Services (CMS) on CMSs ICR on implementation of Medicare Drug Price Negotiation Program. Encouraged the agency to continue considering provider perspectives as it works to implement the MDPNP Medicare Prospective Payment System Updates - Urged Congress to consider additional financial support for hospitals beyond increases in the IPPS and OPPS payment rules to more adequately adjust for increased provider costs. PAYGO Budget Cuts - Encouraged congress to act to avert statutory Pay-As-You-Go (PAYGO) cuts set to go into effect in 2025 Physician Payment - Encouraged Congress to avoid enacting the reimbursement reduction for physicians and other clinicians treating Medicare patients included in the CY 2025 Medicare Physician Fee Schedule (MPFS) Proposed Rule; Urged Congress to consider long-term legislative solutions to refine the current Medicare physician payment system Prior Authorization - Provided feedback to improve prior authorization (PA) processes for various plans and payers, including Medicare Advantage (MA) organizations and Medicaid managed care plans. Endorsed legislation to streamline the prior authorization process in the Improving Seniors Timely Access to Care Act (S.4532/H.R.8702) Rural Emergency Hospital (REH) Designation - Urged corrective action to allow REHs to bill both the Medicare and Medicaid programs. Advocated for increased eligibility among REHs to allow for future Medicaid DSH payments to certain hospital facilities. Site-Neutral Payment Policies - Opposed adoption of site-neutral payment policies for drug administration and increased fines related to price transparency requirements for hospitals. Urged Congress to redirect its focus from site-neutral payment policies to reducing administrative burdens and increasing, rather than reducing, payments for care delivery in rural areas. Monitoring development of the Lower Costs, More Transparency Act (H.R. 5378)

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

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

Sustainability of safety net health systems; social determinants of health; promoting coordinated care; support of telehealth policies; 340B Protect Act, H.R. 4390; H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 3281, the Transparent PRICE Act; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; and H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R. 5378, the Lower Costs, More Transparency Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 8247, the Uterine Fibroid Intervention and Gynecological Health Treatment Act of 2024; H.R. 8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net Act; and H.R. 10337, Expanding the Health Care Workforce Act.

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

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

Funding for Disproportionate Share Hospitals (Medicaid DSH); Funding for Medicare graduate medical education (GME); Medicare site neutrality policies; support of telehealth policies, including for audio-only telehealth services; H.R. 7053/S. 3792 - acute hospital care at home waiver flexibility; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R.3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 5378, the Lower Costs, More Transparency Act; H.R. 5860, the Continuing Appropriations Act, 2024 and Other Extensions Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 7327, the Protecting Front Line Multimission Hospitals Act of 2024; S. 3450, the Mental and Physical Health Care Comorbidities Act of 2023; and H.R. 10337, Expanding the Health Care Workforce Act.

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

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

H.R.2665, Supporting Safety Net Hospitals Act H.R.2389, the Resident Physician Shortage Reduction Act of 2023 H.R.3561 - PATIENT Act of 2023 H.R. 3887, the Childrens Hospital GME Support Reauthorization Act of 2023 H.R. 3561, PATIENT Act of 2023 H.R. 5378, The Lower Costs, More Transparency Act S. 2719 Directing our Countrys Transfer of Residency Slots (DOCTORS) Act of 2023 S. 3196 - Ensuring Medicaid Continuity for Children in Foster Care Act H.R. 2829 Chronic Care Management Improvement Act of 2023 H.R. 7397 -Reinforcing Essential Health Systems for Communities Act H.R. 6929 & S.3565, Affordable Connectivity Program Extension Act of 2024 Strengthening Pathways to Health Professions Act Fiscal Year 2025 Children's Hospitals Graduate Medical Education (CHGME) Appropriations Support Issues related to Section 203 of the Consolidated Appropriations Act of 2021 Issues related to the Medicare/Medicaid dual eligible population Issues related to Medicare Site-neutral payment cuts Issues related to Medicaid DSH Cuts

Client expense: $870,000 · Firm income: Not reported

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

Medicare/Medicaid reimbursement Accountable, value-based care CMMI to discuss payment models. Health insurer practices (denials, prior authorization) Telehealth flexibilities HR 2389 Resident Physician Shortage Reduction Act HR 468 Building America's Healthcare Workforce Act HR 2665 Supporting Safety Net Hospitals Act S. 1869 SITE Act S. 2016/HR 4189 Connect for Health Act S. 2187/HR 5128 Preserving Access to Home Health Act HR 3561 Patient Act S. 1845 Expanding Access to Palliative Care Act HR 5013 Value in Health Care Act HR 3459, S. 1703 PACE Part D Choice Act HR 2474 Strengthening Medicare for Patients and Providers Act Minimum staffing standards for LTC facilities HR 6545 Physician Fee Schedule Update and Improvements Act HR 6683 Preserving Seniors Access to Physicians Act HR 6590 PACE Expanded Act S. 3892 Community Health Worker Access Act HR 7513 Protecting America's Seniors' Access to Care Act S. 4330 Radiation Oncology Case Rate (ROCR) Value Based Program Act S. 4532/HR 8702 Improving Seniors Timely Access to Care Act Medicare Advantage star ratings S. 3967/HR 7623Telehealth Modernization Act

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

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

Issues related to rural health, including Low-Volume Hospital and Medicare Dependent Hospital programs, hospital reimbursement, including sequestration, prescription drug pricing, surprise billing, telehealth, 1115 Medicaid Waiver, health care workforce, maternal health, and freestanding ERs; H.R.1694 - Emergency Care Improvement Act; Implementation of the Consolidated Appropriations Act, 2023 (P.L. 117-328); Disproportionate Share Hospital (DSH) payments; H.R.2665 - Supporting Safety Net Hospitals Act; Site-neutral payment policies; H.R.3561 - PATIENT Act of 2023; H.R.5378 - Lower Costs, More Transparency Act; S.2840 - Bipartisan Primary Care and Health Workforce Act; S.3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to rural health, including Low-Volume Hospital and Medicare Dependent Hospital programs, hospital reimbursement, including sequestration, prescription drug pricing, surprise billing, telehealth, 1115 Medicaid Waiver, health care workforce, maternal health, and freestanding ERs; H.R.1694 - Emergency Care Improvement Act; Implementation of the Consolidated Appropriations Act, 2023 (P.L. 117-328); Disproportionate Share Hospital (DSH) payments; H.R.2665 - Supporting Safety Net Hospitals Act; Site-neutral payment policies; H.R.3561 - PATIENT Act of 2023; H.R.5378 - Lower Costs, More Transparency Act; S.2840 - Bipartisan Primary Care and Health Workforce Act; S.3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

(S.3138/H.R.5434) - Stabilize Medicaid and CHIP Coverage Act - Urged Congress to pass the Stabilize Medicaid and CHIP Coverage Act. This legislation ensures 12-month continuous eligibility for adults in Medicaid and the Children's Health Insurance Program (CHIP). (H.J. Res.139) - Expressed support for H.J. Res. 139 a joint resolution for congressional disapproval of the rule related to Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. The rule would establish minimum staffing standards for Medicare- and Medicaid-certified long-term care facilities and require them to have a registered nurse on site 24 hours per day. (H.R. 7858) Telehealth Enhancement for Mental Health Act - Expressed support for the Telehealth Enhancement for Mental Health Act. This legislation would revolutionize access to mental health care by changing Medicare reimbursement policies for mental health services provided via telehealth. (H.R. 8261) Preserving Telehealth, Hospital and Ambulance Access Act: Expressed support for the Preserving Telehealth, Hospital and Ambulance Access Act. This legislation would expand Medicare telehealth for two years, hospital-at-home flexibilities for five years, and Medicare supplemental payments for rural hospitals and ambulatory services. (H.R. 5378) Lower Costs, More Transparency Act - Urged Congress to reject policies that reduce reimbursements under the Medicare program, especially site-neutral proposals. (S. 4137/H.R. 5138) - Improving Access Medicare Coverage Act - Expressed support for the Improving Access Medicare Coverage Act. This legislation will make days spent in observation count towards Medicare's three-day inpatient stay requirement for Skilled Nursing Facility (SNF) coverage. Urged the Centers for Medicare and Medicaid Services (CMS) to take action to prevent millions of Medicaid beneficiaries from losing coverage as states unwind the temporary Medicaid provisions in place during the pandemic. (H.R. 2665) - Supporting Safety Net Hospitals Act - Expressed support for the Supporting Safety Net Hospitals Act. The legislation would address spending cuts to Medicaid DSH payments. Urged Congress to address the Medicaid disproportionate share hospital (DSH) cuts scheduled to begin in fiscal year (FY) 2025.

Client expense: $166,785 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program (H.R. 3290) Rural health care innovation (PA Rural Health Model) Public Health Emergency designation SAVE Act (H.R. 2584) Fairness for Rural Teaching Hospitals Act (H.R.2433) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Behavioral health PATIENT Act of 2023 (H.R.3561) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (S.1113, H.R.2530) CHGME Youth behavioral health Electronic health records Pandemic and All-Hazards Preparedness Reauthorization Act Nursing and allied health education (NAHE) program Bipartisan Primary Care and Health Workforce Act (S.2840) Transparent PRICE Act (H.R.3281) Save Americas Rural Hospitals Act (H.R.833) Supporting Safety Net Hospitals Act (H.R.2665) Patient Access to Higher Quality Care Act (H.R.977/S.470) FEMA Covid-19 reimbursement Health Care Price Transparency Act (H.R.4822) Providers and Payers Compete Act (H.R.3284) Lower Costs, More Transparency Act (H.R.5378) Health Care Prices Revealed and Information to Consumers Explained Transparency Act (S.3548) Medical and Nurse Licensure Compact Health care consolidation, mergers and acquisitions Accelerating Kids Access to Care Act (H.R. 4758, S.2372)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Rural hospital policies Rural Hospital Support Act (S.1110) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act (S.1302, H.R.2389) Metropolitan Anchor Hospitals Telehealth Prior Authorization Reform (Improving Seniors Timely Access to Care Act; CMS proposed Medicare Advantage rule) Annual Prospective Payment System Rules (inpatient market basket payment) Medicaid Disproportionate Share Hospital payments (H.R.2665) Site neutral payments Lower Cost, More Transparency Act (H.R. 5378) 190-day lifetime limit on inpatient psychiatric hospital care Medicaid Institutions for Mental Disease (IMD) exclusion Certified Community Behavioral Health Clinics Long Term Acute Care Hospital Prospective Payment System Medicare Dependent and Low Volume Hospital Programs

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

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

Support HR 2665, the Supporting Safety Net Hospitals Act, which would repeal cuts to the Medicaid Disproportionate Share Hospital Program. Request congressional member sign on to bi-partisan letter expressing support for Medicaid Disproportionate Share hospital program and addressing scheduled cuts. Support the Rural Hospital Support Act (S. 1110) and the Assistance for Rural Community Hospitals Act (H.R. 6430), which extend or make permanent the Low Volume Adjustment and Medicare Dependent Hospital programs. Support the Improving Seniors Timely Access to Care Act (H.R. 8702/S. 4532), which would streamline prior authorization in Medicare Advantage and improve access to care. Support for the Hospital Inpatient Modernation Act (S. 4350/H.R. 8260), which extends telehealth flexibilities and the Hospital at Home program. Oppose efforts to advance Medicare site neutral payment policies, as seen in the Lower Costs, More Transparency Act (HR 5378). Support the Telehealth Modernization Act (H.R. 7623), which extends COVID telehealth flexibilities for two years and Hospital at Home for five years.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 2665, The Supporting Safety Net Hospitals Act HR 2584, Safety from Violence for Healthcare Employees (Save) Act S 923, Better Mental Health Care for Americans Act HR 3046, Medical Student Education Authorization Act S 1133, the 340B Accountability Act of 2023 HR 3746, Fiscal Responsibility Act of 2023 HR 6833, Continuing Appropriations Act of 2023 HR 9747, Continuing Appropriations and Extensions Act, 2025 HR 3290, Transparency and Oversight of the 340B Drug Discount Program Act HR 3841, To reauthorize the program of payments to children's hospitals that operate graduate medical education programs HR 3887, The Children's Hospital GME Support Reauthorization Act of 2023 HR 4509 The Transparency in Billing Act HR 4507 The Transparency in Coverage Act of 2023 HR 4527 The Health DATA Act HR 4508 Hidden Fees Disclosure Act HR 4822 The Health Care Price Transparency Act of 2023 HR 1613 The Drug Transparency Act S 1038 The Drug Transparency Act HR 3561 The Patient Act HR 2534 Protect 340B Act of 2023 HR 3226 The PREEMIE Act of 2023 S 1573 The PREEMIE Act of 2023 HR 5378 The Lower Costs, More Transparency Act HR 6664 Innovation in Pediatric Drugs Act of 2023 HR 7635 The 340B Pharmaceutical Access to Invest in Essential, Needed Treatments & Support Act of 2024 HR 8574 340B Affording Care for Communities and Ensuring a Strong Safety-net Act HR 8260, Hospital Inpatient Services Modernization Act S 2768, Hospital Inpatient Services Modernization Act HR 10545 American Relief Act of 2025 S 2372 Accelerating Kids Access to Care Act HR 4758 Accelerating Kids Access to Care Act CDC Injury Control Research Centers Funding NIH Pediatric Medical Research Prioritization FDA Proposed Rule Titles "Medical Device Laboratory Developed Tests"

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

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

HR 2665, The Supporting Safety Net Hospitals Act HR 2584, Safety from Violence for Healthcare Employees (Save) Act S 923, Better Mental Health Care for Americans Act HR 3046, Medical Student Education Authorization Act S 1133, the 340B Accountability Act of 2023 HR 3746, Fiscal Responsibility Act of 2023 HR 6833, Continuing Appropriations Act of 2023 HR 9747, Continuing Appropriations and Extensions Act, 2025 HR 3290, Transparency and Oversight of the 340B Drug Discount Program Act HR 3841, To reauthorize the program of payments to children's hospitals that operate graduate medical education programs HR 3887, The Children's Hospital GME Support Reauthorization Act of 2023 HR 4509 The Transparency in Billing Act HR 4507 The Transparency in Coverage Act of 2023 HR 4527 The Health DATA Act HR 4508 Hidden Fees Disclosure Act HR 4822 The Health Care Price Transparency Act of 2023 HR 1613 The Drug Transparency Act S 1038 The Drug Transparency Act HR 3561 The Patient Act HR 2534 Protect 340B Act of 2023 HR 3226 The PREEMIE Act of 2023 S 1573 The PREEMIE Act of 2023 HR 5378 The Lower Costs, More Transparency Act HR 6664 Innovation in Pediatric Drugs Act of 2023 HR 7635 The 340B Pharmaceutical Access to Invest in Essential, Needed Treatments & Support Act of 2024 HR 8574 340B Affording Care for Communities and Ensuring a Strong Safety-net Act HR 8260, Hospital Inpatient Services Modernization Act S 2768, Hospital Inpatient Services Modernization Act HR 10545 American Relief Act of 2025 S 2372 Accelerating Kids Access to Care Act HR 4758 Accelerating Kids Access to Care Act CDC Injury Control Research Centers Funding NIH Pediatric Medical Research Prioritization FDA Proposed Rule Titles "Medical Device Laboratory Developed Tests"

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

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

legislation relative to Hospitals and patient care. H.R.814 Protect Social Security and Medicare Act; H.Res.118 Maintaining Medicare; H.R.1618 Commission on Sustaining Medicare and Social Security Act of 2023; H.Res.178 Affirming the House of Representatives' commitment to protect and strengthen Social Security and Medicare; . H.R.1746 Preventing Medicare Telefraud Act; H.R.33 Medicare Dental, Vision, and Hearing Benefit Act of 2023; H.R.1129 -To direct the Secretary of Health and Human Services to revise regulations to remove the requirement under the Medicare program that an off-campus facility or organization shall be located within a 35-mile radius of a hospital or critical access hospital.H.R.34 Assuring Medicares Promise Act of 2023; H.R.2474 Strengthening Medicare for Patients and Providers Act; H.R.2863 Preventing Hospital Overbilling of Medicare; H.R.2665 Supporting Safety Net Hospitals Act; H.R.3417 FAIR Act;S3403 Medicare Patient Empowerment Act of 2023; HR 5854 Medicare Advantage Consumer Protection and Transparency Act; HR4411 Medicare Advantage Integrity Act of 2023; HR4146 Medicare Dental Benefit Act of 2023.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Rural hospital policies Rural Hospital Support Act (S. 1110) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act (S.1302, H.R.2389) Telehealth Prior Authorization Reform (Improving Seniors Timely Access to Care Act; CMS proposed Medicare Advantage rule) Medicare Physician Fee Schedule Medicaid Disproportionate Share Hospital payments (H.R.2665) Site neutral payments Medicare Dependent and Low Volume Hospital Programs

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Incentivizing domestic manufacturing of critical medical supplies Issues related to health care costs and transparency Electronic prior authorization and administrative simplification Health care supply chain resiliency 340B Drug discount program Reauthorization of Pandemic and All Hazards Preparedness Act Hospital finance issues Healthcare workforce issues (graduate medical education, health professional training, recruitment and retention, minimum staffing requirements) Medicare payment policies Alternative payment models and related policies Medicare home infusion policy Reauthorization of Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act Expanding access to interoperable health tech in long term and post-acute care settings Maternal and infant health Health care workplace violence and worker safety S. 148 Stop STALLING Act S. 150 Affordable Prescriptions for Patients Act Medicaid Disproportionate Hospital Share cuts S. 2115, H.R. 4307 Medical Supply Chain Resiliency Act H.R. 4104, S. 1976 Preseving Patients Access to Home Infusion Act H.R. 2584, S. 2768 SAVE Act H.R. 3577 Medical and Health Stockpile Accountability Act H.R. 2665 Supporting Safety Net Hospitals Act H.R. 2389, S. 1302 Resident Physician Shortage Reduction Act H.R. 3346 IMPACT to Save Moms Act H.R. 5378 Lower Costs, More Transparency Act S. 2840 Bipartisan Primary Care and Health Workforce Act H.R. 5013, S. 3503 Value in Health Care Act H.R. 4942, S. 665 Conrad State 30 and Physician Access Reauthorization Act Artificial intelligence in healthcare H.R.766, S. 114 Preventive Health Savings Act H.R. 6205, S. 3211 Healthcare Workforce Resilience Act H.R. 7050 Substance Use Disorder Workforce Act H.R. 8702, S. 4532 Improving Seniors' Timely Access to Care Act H.R. 7855 Rural Residency Planning and Development Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Q4 Lobbying Report (Oct.1 -Dec. 31) HCR Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program Resident Physician Shortage Act of 2023 (H.R. 2389) No Surprises Act regulations Food and Drug Amendments No Surprise Bills for New Moms Act (H.R. 3387) Securing the U.S. Organ Procurement and Transplantation Network Act (H.R. 2544) Promoting Access to Treatments and Increasing Extremely Needed Transparency Act (H.R. 3561) Medicaid VBPs for Patients (MVP) Act (H.R. 2666) Providers and Payers COMPETE Act (H.R. 3284) To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program (H.R. 3290) Transparent PRICE Act (H.R. 3281/H.R. 2691)) Resident Physician Shortage Reduction (S. 1302) Medical Student Education Authorization Act (H.R. 3046) Save Americas Rural Hospitals Act (H.R. 833) Chronic Care Management Improvement Act (H.R. 2829) Safety From Violence for Healthcare Employees Act (H.R. 2584) Supporting Safety Net Hospitals Act (H.R. 2665) Patient Access to Higher Quality Health Care Act (H.R. 977/S.470) FEMA re: COVID-19 related reimbursement Public Health Guidance Transparency and Accountability Act of 2023 (H.R. 4529) Public Health Emergency Congressional Review Act (H.R. 4381) CDC Leadership Accountability Act of 2023 (H.R. 3813) Preparing for All Hazards and Pathogens Reauthorization Act (H.R. 4421) Preparedness and Response Reauthorization Act (H.R. 4420) Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887) Health Care Price Transparency Act of 2023 (H.R. 4822) Providers and Payers COMPETE Act (H.R. 3284) Lower Costs, More Transparency Act (H.R. 5378 Transparency in Coverage Act (H.R. 4507) GOLD Card Act of 2023 (H.R. 4968) No Fees for EFTs Act (H.R.6487) Rural Health Care Facilities Revitalization Act (H.R. 5989) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (H.R. 7153) To amend title XVIII of the Social Security Act to establish a definition of essential health system in statute (H.R. 7397) Substance Use Disorder Workforce Act (H.R. 7050) 340B PATIENTS Act (H.R. 7635) The 340B Affording Care for Communities and Ensuring a Strong Safety-net (ACCESS) Act (H.R. 8574) Improving Seniors Access to Timely Care Act (H.R. 8702/S.4532) The Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931) Rural Health Care Facilities Revitalization Act (H.R. 5989) MMM Accelerated and Advance Payment Program repayment flexibility Graduate Medical Education (GME) funding Telehealth flexibilities and payment Annual Prospective Payment System Rules Organ acquisition payment policies Californias Medicaid Hospital Quality Assurance Fee Program Medicare Advantage BUD FY 2025 Appropriations bills Nursing and allied health workforce funding FY 2025 budget request Further Continuing Appropriations and Other Extensions Act (H.R. 6363) Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (H.R. 5894) Tax Relief for American Families and Workers Act of 2024 (H.R. 7024) Extension of Continuing Appropriations and Other Matters Act, 2024 (H.R. 7463) Submitted Comments Regulatory Comment Letters SUBJECT: CMS-10913, Medicare Part C Utilization Management Annual Data Submission and Audit Protocol Data Request; Notice, Agency Information Collection Activities: Proposed Collection; Comment Request; Federal Register (Vol 89, No 145), September 10, 2024

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

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

H.R.2389/S.1302 - Resident Physician Shortage Reduction Act of 2023 H.R.7050 - Substance Use Disorder Workforce Act Issue: Support increased Medicare funding for graduate medical education (GME). Draft Bipartisan Senate Medicare GME Expansion proposal Issue: Support increased Medicare funding for GME. Oppose duplicative teaching health system and hospital reporting and policies that increase regulatory burden. H.R.751 - Fair Access in Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. H.R.834/S.230 - Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals. GME Data Transparency Act of 2024 Issue: Educate Congress on teaching health system and hospital GME data collection practices and concerns related to duplicative reporting requirements. H.R.2584/S.2768 - Safety From Violence for Healthcare Employees (SAVE) Act Issue: Support legislation providing protection for health care workers by creating a criminal offense for knowingly assaulting or intimidating hospital workers and providing grants to reduce violence in hospitals. H.R.5378 - Lower Costs, More Transparency Act Issue: Oppose legislation that pays for workforce investments and mitigation of DSH cuts paid for by cuts to hospital outpatient departments. H.R.5013 - Value in Health Care Act Issue: Support legislation that ensures the continued move to value-based care. H.R.8235 - Rural Physician Workforce Preservation Act Issue: Educate Congress about the likely impact of legislation that would alter the distribution of Medicare-supported GME slots from the CAA, 2021 and 2023. Issue: Educate Congress on status of CMS distribution of the 1,000 new GME slots authorized by the Consolidated Appropriations Act, 2021 (P.L.116-260). Support CMS changing its distribution methodology to end the practice of super prioritization. Issue: Support Medicare GME per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose reduction of Medicare DGME/IME payments. Issue: Oppose the redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare. Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create budget neutral IME payments for outpatient services. Draft Senate Finance Medicare Physician Fee Schedule request for information Issue: Support efforts to reform the Medicare physician fee schedule. H.R.2474 - Strengthening Medicare for Patients and Providers Act Issue: Support legislation that reforms the Medicare Physician Fee Schedule by providing an annual inflation-based payment update based on the Medicare Economic Index (MEI). S.4338 - Pay PCPs Act Issue: Respond to Senate request for information on hybrid payments for Medicare physicians. P.L.118-42 - Consolidated Appropriations Act, 2024 H.R. 10445 - Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 P.L. 118-158 American Relief Act, 2025 Issues: Oppose reduction in Medicare hospital outpatient department reimbursement for drug administration and other services. Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital, and provider cuts. Support mitigation of Medicare Physician Fee Schedule cuts. Support delaying or eliminating scheduled cuts to the Medicaid disproportionate share hospital (DSH) program. Support extension of alternative payment model (APM) bonus. Support allowing hospitals to count costs and reimbursements for Medicaid patients with third-party coverage towards their DSH cap. Support extensions of Acute Hospital at Home program waiver of 24/7 nursing requirement and Medicare telehealth waivers and efforts to expand patient access to telehealth. H.R.2665 - The Supporting Safety Net Hospitals Act Issue: Support elimination of two years of scheduled reductions to the Medicaid DSH program. H.R.9351 - The Save Our Safety-Net Hospitals (SOS) Act Issue: Support allowing hospitals to count costs and reimbursements for Medicaid patients with third-party coverage towards their DSH cap. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives. Issue: Protect patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issue: Educate Congress and policymakers on the financial challenges facing teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Educate Congress on potential financial implications of entitlement reform on teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Support policies to close the Medicaid coverage gap and ensure access to coverage in non-expansion states, as well as financial incentives to help states maintain existing expansions. Support mandatory 12-month Medicaid coverage for post-partum individuals. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support extension of Medicare telehealth waivers and efforts to expand patient access to telehealth. Issue: Support policy to permanently remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services. H.R.1397 - The Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP. Issue: Support increased access to behavioral health and substance use disorder treatment services under Medicare and Medicaid. Support the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). H.R.2377/S.1000 - The Saving Access to Laboratory Services (SALSA) Act Issue: Support legislation to modify Medicare payment rates for clinical diagnostic laboratory services to avoid statutory cuts to these payments. Issue: Support authorization of Medicare advance and accelerated payments in the wake of cyberattacks on providers. H.R.2829 - Chronic Care Management Improvement Act of 2023 Issue: Support removing cost-sharing obligations from the chronic care management (CCM) code in Medicare.

Client expense: $632,324 · Firm income: Not reported

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

Financial health of California hospitals and need for relief. HR 2665 Medicaid DSH

Client expense: Not reported · Firm income: $27,149

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Protect the Medicaid system and oppose efforts to cut Medicaid, including support for legislation to repeal or delay statutory Medicaid DSH cuts for FY 2025-FY 2027, including HR 2665, the Supporting Safety Net Hospitals Act and related legislation. Support for reforming the Medicaid inmate exclusion, including HR 2400/S 1165, the Reentry Act, and HR 3074/ S 971, the Due Process, Continuity of Care Act, and related legislation.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Rural hospital policies Rural Hospital Support Act (S.1110) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act (S.1302, H.R.2389) Metropolitan Anchor Hospitals Telehealth Prior Authorization Reform (Improving Seniors Timely Access to Care Act; CMS proposed Medicare Advantage rule) Annual Prospective Payment System Rules (inpatient market basket payment) Medicaid Disproportionate Share Hospital payments (H.R.2665) Site neutral payments Lower Cost, More Transparency Act (H.R. 5378) 190-day lifetime limit on inpatient psychiatric hospital care Medicaid Institutions for Mental Disease (IMD) exclusion Certified Community Behavioral Health Clinics Long Term Acute Care Hospital Prospective Payment System Medicare Dependent and Low Volume Hospital Programs

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

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

Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program (H.R. 3290) Rural health care innovation (PA Rural Health Model) Public Health Emergency designation SAVE Act (H.R. 2584) Fairness for Rural Teaching Hospitals Act (H.R.2433) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Behavioral health PATIENT Act of 2023 (H.R.3561) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (S.1113, H.R.2530) CHGME Youth behavioral health Electronic health records Pandemic and All-Hazards Preparedness Reauthorization Act Nursing and allied health education (NAHE) program Bipartisan Primary Care and Health Workforce Act (S.2840) Transparent PRICE Act (H.R.3281) Save Americas Rural Hospitals Act (H.R.833) Supporting Safety Net Hospitals Act (H.R.2665) Patient Access to Higher Quality Care Act (H.R.977/S.470) FEMA Covid-19 reimbursement Health Care Price Transparency Act (H.R.4822) Providers and Payers Compete Act (H.R.3284) Lower Costs, More Transparency Act (H.R.5378) Health Care Prices Revealed and Information to Consumers Explained Transparency Act (S.3548) Medical and Nurse Licensure Compact Health care consolidation, mergers and acquisitions Accelerating Kids Access to Care Act (H.R. 4758, S.2372)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for H.R.7327 - Protecting Front Line Multimission Hospitals Act of 2024. Sustainability of safety net health systems. Social determinants of health. Support of telehealth policies, including for audio-only telehealth services. 340B Protect Act, H.R.4390. H.R.3290, To amend Title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. H.R.2665, Supporting Safety Net Hospitals Act. H.R.3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023. Support for policies to enhance health care workforce programs. H.R.5378, Lower Costs, More Transparency Act. S.3548, Health Care Prices Revealed and Information to Consumers Explained Transparency Act. S.3450, Mental and Physical Health Care Comorbidities Act of 2023.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Incentivizing domestic manufacturing of critical medical supplies Issues related to health care costs and transparency Electronic prior authorization and administrative simplification Health care supply chain resiliency 340B Drug discount program Reauthorization of Pandemic and All Hazards Preparedness Act Hospital finance issues Healthcare workforce issues (graduate medical education, health professional training, recruitment and retention, minimum staffing requirements) Medicare payment policies Alternative payment models and related policies Medicare home infusion policy Reauthorization of Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act Expanding access to interoperable health tech in long term and post-acute care settings Maternal and infant health Health care workplace violence and worker safety S. 148 Stop STALLING Act S. 150 Affordable Prescriptions for Patients Act Medicaid Disproportionate Hospital Share cuts S. 2115, H.R. 4307 Medical Supply Chain Resiliency Act H.R. 4104, S. 1976 Preseving Patients Access to Home Infusion Act H.R. 2584, S. 2768 SAVE Act H.R. 3577 Medical and Health Stockpile Accountability Act H.R. 2665 Supporting Safety Net Hospitals Act H.R. 2389, S. 1302 Resident Physician Shortage Reduction Act H.R. 3346 IMPACT to Save Moms Act H.R. 5378 Lower Costs, More Transparency Act S. 2840 Bipartisan Primary Care and Health Workforce Act H.R. 5013, S. 3503 Value in Health Care Act H.R. 4942, S. 665 Conrad State 30 and Physician Access Reauthorization Act Artificial intelligence in healthcare H.R.766, S. 114 Preventive Health Savings Act H.R. 6205, S. 3211 Healthcare Workforce Resilience Act H.R. 7050 Substance Use Disorder Workforce Act H.R. 8702, S. 4532 Improving Seniors' Timely Access to Care Act H.R. 7855 Rural Residency Planning and Development Act

Client expense: $173,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

(S.3138/H.R.5434) - Stabilize Medicaid and CHIP Coverage Act - Urged Congress to pass the Stabilize Medicaid and CHIP Coverage Act. This legislation ensures 12-month continuous eligibility for adults in Medicaid and the Children's Health Insurance Program (CHIP). (H.J. Res.139) - Expressed support for H.J. Res. 139 a joint resolution for congressional disapproval of the rule related to Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. The rule would establish minimum staffing standards for Medicare- and Medicaid-certified long-term care facilities and require them to have a registered nurse on site 24 hours per day. Urged CMS to issue guidance on the DACA eligibility rule which would expand eligibility for recipients of the Deferred Action for Childhood Arrivals program to enroll in qualified health plans through the Affordable Care Act Health Insurance Marketplace and qualify for subsidies and cost-sharing reductions based on income. (H.R. 7858) Telehealth Enhancement for Mental Health Act - Expressed support for the Telehealth Enhancement for Mental Health Act. This legislation would revolutionize access to mental health care by changing Medicare reimbursement policies for mental health services provided via telehealth. (H.R. 8261) Preserving Telehealth, Hospital and Ambulance Access Act: Expressed support for the Preserving Telehealth, Hospital and Ambulance Access Act. This legislation would expand Medicare telehealth for two years, hospital-at-home flexibilities for five years, and Medicare supplemental payments for rural hospitals and ambulatory services. (H.R. 5378) Lower Costs, More Transparency Act - Urged Congress to reject policies that reduce reimbursements under the Medicare program, especially site-neutral proposals. Urged the Centers for Medicare and Medicaid Services (CMS) to revise its rule for Medicaid managed care programs. The rule includes significant provisions related to state directed payments (SDPs), supplemental payments states can utilize for managed care. Urged the Centers for Medicare and Medicaid Services (CMS) CMS to continue providing vital information about Medicaid redeterminations, including making information and data pertaining to Medicaid renewals publicly available and to work with states to provide information about Medicaid beneficiaries whose coverage has been reinstated after being previously terminated, as well as breaking the information down by race and ethnicity. (S. 4137/H.R. 5138) - Improving Access Medicare Coverage Act - Expressed support for the Improving Access Medicare Coverage Act. This legislation will make days spent in observation count towards Medicare's three-day inpatient stay requirement for Skilled Nursing Facility (SNF) coverage. Urged the Centers for Medicare and Medicaid Services (CMS) to take action to prevent millions of Medicaid beneficiaries from losing coverage as states unwind the temporary Medicaid provisions in place during the pandemic. (H.R. 2665) - Supporting Safety Net Hospitals Act - Expressed support for the Supporting Safety Net Hospitals Act. The legislation would address spending cuts to Medicaid DSH payments. Urged Congress to address the Medicaid disproportionate share hospital (DSH) cuts scheduled to begin in fiscal year (FY) 2025.

Client expense: $165,062 · Firm income: Not reported

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

Medicare reimbursement Accountable, value-based care CMMI to discuss payment models. HR 2389 Resident Physician Shortage Reduction Act HR 468 Building America's Healthcare Workforce Act HR 2665 Supporting Safety Net Hospitals Act S. 1869 SITE Act S. 2016/HR 4189 Connect for Health Act S. 2187/HR 5128 Preserving Access to Home Health Act HR 3561 Patient Act S. 1845 Expanding Access to Palliative Care Act HR 5013 Value in Health Care Act HR 3459, S. 1703 PACE Part D Choice Act HR 2474 Strengthening Medicare for Patients and Providers Act Minimum staffing standards for LTC facilities HR 6545 Physician Fee Schedule Update and Improvements Act HR 6683 Preserving Seniors Access to Physicians Act HR 6590 PACE Expanded Act S. 3892 Community Health Worker Access Act HR 7513 Protecting America's Seniors' Access to Care Act S. 4330 Radiation Oncology Case Rate (ROCR) Value Based Program Act S. 4532/HR 8702 Improving Seniors Timely Access to Care Act Medicare Advantage star ratings S. 3967/HR 7623Telehealth Modernization Act

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

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

Sustainability of safety net health systems; social determinants of health; promoting coordinated care; support of telehealth policies; 340B Protect Act, H.R. 4390; H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 3281, the Transparent PRICE Act; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; and H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R. 5378, the Lower Costs, More Transparency Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 8247, the Uterine Fibroid Intervention and Gynecological Health Treatment Act of 2024; and H.R. 8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net Act.

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

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

Funding for Disproportionate Share Hospitals (Medicaid DSH); Funding for Medicare graduate medical education (GME); Medicare site neutrality policies; support of telehealth policies, including for audio-only telehealth services; H.R. 7053/S. 3792 - acute hospital care at home waiver flexibility; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2665, the Supporting Safety Net Hospitals Act; H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023; H.R.3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 5378, the Lower Costs, More Transparency Act; H.R. 5860, the Continuing Appropriations Act, 2024 and Other Extensions Act; S.3548, the Health Care Prices Revealed and Information to Consumers Explained Transparency Act; H.R.6363, the Further Continuing Appropriations and Other Extensions Act, 2024; H.R. 2872, Further Additional Continuing Appropriations and Other Extensions Act, 2024; H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024; H.R. 7327, the Protecting Front Line Multimission Hospitals Act of 2024; and S. 3450, the Mental and Physical Health Care Comorbidities Act of 2023.

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

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

H.R.2389/S.1302 - Resident Physician Shortage Reduction Act of 2023 H.R.7050 - Substance Use Disorder Workforce Act Issue: Support increased Medicare funding for graduate medical education (GME). Draft Bipartisan Senate Medicare GME Expansion proposal Issue: Support increased Medicare funding for GME. Oppose duplicative teaching health system and hospital reporting and policies that increase regulatory burden. H.R.751 - Fair Access in Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. H.R.834/S.230 - Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals. H.R.2584/S.2768 - Safety From Violence for Healthcare Employees (SAVE) Act Issue: Support legislation providing protection for health care workers by creating a criminal offense for knowingly assaulting or intimidating hospital workers and providing grants to reduce violence in hospitals. H.R.5378 - Lower Costs, More Transparency Act Issue: Oppose legislation that pays for workforce investments and mitigation of DSH cuts paid for by cuts to hospital outpatient departments. H.R.5013 - Value in Health Care Act Issue: Support legislation that ensures the continued move to value-based care. H.R.8235 - Rural Physician Workforce Preservation Act Issue: Educate Congress about the likely impact of legislation that would alter the distribution of Medicare-supported GME slots from the CAA, 2021 and 2023. Issue: Educate Congress on status of CMS distribution of the 1,000 new GME slots authorized by the Consolidated Appropriations Act, 2021 (P.L.116-260). Support CMS changing its distribution methodology to end the practice of super prioritization. Issue: Support Medicare GME per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose reduction of Medicare DGME/IME payments. Issue: Oppose the redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare. Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create budget neutral IME payments for outpatient services. Draft Senate Finance Medicare Physician Fee Schedule request for information Issue: Support efforts to reform the Medicare physician fee schedule. H.R.2474 - Strengthening Medicare for Patients and Providers Act Issue: Support legislation that reforms the Medicare Physician Fee Schedule by providing an annual inflation-based payment update based on the Medicare Economic Index (MEI). S.4338 - Pay PCPs Act Issue: Respond to Senate RFI on hybrid payments for Medicare physicians. P.L.118-42 - Consolidated Appropriations Act, 2024 Issues: Oppose reduction in Medicare hospital outpatient department reimbursement for drug administration and other services. Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital, and provider cuts. Support mitigation of Medicare Physician Fee Schedule cuts. Support delaying or eliminating scheduled cuts to the Medicaid disproportionate share hospital (DSH) program. Support extension of alternative payment model (APM) bonus. H.R.2665 - The Supporting Safety Net Hospitals Act Issue: Support eliminating two years worth of scheduled reductions to the Medicaid DSH program. H.R.9351 - The Save Our Safety-Net Hospitals (SOS) Act Issue: Support allowing hospitals to count costs and reimbursements for Medicaid patients with third-party coverage towards their DSH cap. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives. Issue: Protect patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issue: Educate Congress and policymakers on the financial challenges facing teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Educate Congress on potential financial implications of entitlement reform on teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Support policies to close the Medicaid coverage gap and ensure access to coverage in non-expansion states, as well as financial incentives to help states maintain existing expansions. Support mandatory 12-month Medicaid coverage for post-partum individuals. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support extension of Medicare telehealth waivers and efforts to expand patient access to telehealth. Issue: Support policy to permanently remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services. H.R.1397 - The Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP. Issue: Support increased access to behavioral health and substance use disorder treatment services under Medicare and Medicaid. Support the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). H.R.2377/S.1000 - The Saving Access to Laboratory Services (SALSA) Act Issue: Support legislation to modify Medicare payment rates for clinical diagnostic laboratory services to avoid statutory cuts to these payments. Issue: Support authorization of Medicare advance and accelerated payments in the wake of cyberattacks on providers. H.R.2829 - Chronic Care Management Improvement Act of 2023 Issue: Support removing cost-sharing obligations from the chronic care management (CCM) code in Medicare.

Client expense: $617,103 · Firm income: Not reported

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

H.R.2389/S.1302 - Resident Physician Shortage Reduction Act of 2023 H.R.7050 - Substance Use Disorder Workforce Act Issue: Support increased Medicare funding for graduate medical education (GME). Draft Bipartisan Senate Medicare GME Expansion proposal Issue: Support increased Medicare funding for GME. Oppose duplicative teaching health system and hospital reporting and policies that increase regulatory burden. H.R.751 - Fair Access in Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. H.R.834/S.230 - Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals. H.R.2584/S.2768 - Safety From Violence for Healthcare Employees (SAVE) Act Issue: Support legislation providing protection for health care workers by creating a criminal offense for knowingly assaulting or intimidating hospital workers and providing grants to reduce violence in hospitals. H.R.5378 - Lower Costs, More Transparency Act Issue: Oppose legislation that pays for workforce investments and mitigation of DSH cuts paid for by cuts to hospital outpatient departments. H.R.5013 - Value in Health Care Act Issue: Support legislation that ensures the continued move to value-based care. H.R.8235 - Rural Physician Workforce Preservation Act Issue: Educate Congress about the likely impact of legislation that would alter the distribution of Medicare-supported GME slots from the CAA, 2021 and 2023. Issue: Educate Congress on status of CMS distribution of the 1,000 new GME slots authorized by the Consolidated Appropriations Act, 2021 (P.L.116-260). Support CMS changing its distribution methodology to end the practice of super prioritization. Issue: Support Medicare GME per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose reduction of Medicare DGME/IME payments. Issue: Oppose the redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare. Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create budget neutral IME payments for outpatient services. Draft Senate Finance Medicare Physician Fee Schedule request for information Issue: Support efforts to reform the Medicare physician fee schedule. H.R.2474 - Strengthening Medicare for Patients and Providers Act Issue: Support legislation that reforms the Medicare Physician Fee Schedule by providing an annual inflation-based payment update based on the Medicare Economic Index (MEI). S.4338 - Pay PCPs Act Issue: Respond to Senate RFI on hybrid payments for Medicare physicians. P.L.118-42 - Consolidated Appropriations Act, 2024 Issues: Oppose reduction in Medicare hospital outpatient department reimbursement for drug administration and other services. Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital, and provider cuts. Support mitigation of Medicare Physician Fee Schedule cuts. Support delaying or eliminating scheduled cuts to the Medicaid disproportionate share hospital (DSH) program. Support extension of alternative payment model (APM) bonus. H.R.2665 - The Supporting Safety Net Hospitals Act Issue: Support eliminating two years worth of scheduled reductions to the Medicaid DSH program. H.R.9351 - The Save Our Safety-Net Hospitals (SOS) Act Issue: Support allowing hospitals to count costs and reimbursements for Medicaid patients with third-party coverage towards their DSH cap. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives. Issue: Protect patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issue: Educate Congress and policymakers on the financial challenges facing teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Educate Congress on potential financial implications of entitlement reform on teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Support policies to close the Medicaid coverage gap and ensure access to coverage in non-expansion states, as well as financial incentives to help states maintain existing expansions. Support mandatory 12-month Medicaid coverage for post-partum individuals. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support extension of Medicare telehealth waivers and efforts to expand patient access to telehealth. Issue: Support policy to permanently remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services. H.R.1397 - The Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP. Issue: Support increased access to behavioral health and substance use disorder treatment services under Medicare and Medicaid. Support the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). H.R.2377/S.1000 - The Saving Access to Laboratory Services (SALSA) Act Issue: Support legislation to modify Medicare payment rates for clinical diagnostic laboratory services to avoid statutory cuts to these payments. Issue: Support authorization of Medicare advance and accelerated payments in the wake of cyberattacks on providers. H.R.2829 - Chronic Care Management Improvement Act of 2023 Issue: Support removing cost-sharing obligations from the chronic care management (CCM) code in Medicare.

Client expense: $617,103 · Firm income: Not reported

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

340B Drug Discount Program, eligibility waiver H.R. 3290 H.R. 2389, S.1302 - Resident Physician Shortage Reduction Act H.R. 3561 - PATIENT Act H.R. 2665 - Supporting Safety-Net Hospitals Act HR 7635 - 340B PATIENTS Act SUSTAIN 340B Act ACCESS 340B Act Graduate Medical Education Disproportionate Share Hospital (DSH) payments Childrens Health Insurance Program Medicare Dependent Hospital Program (MDH) Medicaid Low Volume Payments (LV) Federal Medical Assistance Percentage Extension Inpatient Prospective Payment System Outpatient Prospective Payment System Bad debt/charity care Hospital Outpatient Department payments Site Neutral Payment Policies

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 2665, the Supporting Safety Net Hospitals Act, which would repeal cuts to the Medicaid Disproportionate Share Hospital Program. Provide feedback on reforms to the Rural Emergency Hospital designation program: The Second Chances for Rural Hospitals Act (H.R. 8246) and the Rural Emergency Hospital Designation Improvement Act (S. 4322). Support the Rural Hospital Support Act (S. 1110) and the Assistance for Rural Community Hospitals Act (H.R. 6430), which extend or make permanent the Low Volume Adjustment and Medicare Dependent Hospital programs. Support the Improving Seniors Timely Access to Care Act (H.R. 8702/S. 4532), which would streamline prior authorization in Medicare Advantage and improve access to care. Support for the Hospital Inpatient Modernation Act (S. 4350/H.R. 8260), which extends telehealth flexibilities and the Hospital at Home program. Oppose efforts to advance Medicare site neutral payment policies, as seen in the Lower Costs, More Transparency Act (HR 5378). Submit comments to CMS on CMS-10856: Agency Information Collection Activities: Proposed Collection, specifically about attestations for providers participating in state directed payment programs. Submit comments to CMS on Re: CMS-1809-P; Proposed Rule - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, Including the Hospital Inpatient Quality Reporting Program; specifically, provisions related to the market basket payment update, the four walls exception to clinic services in Medicaid, changes to prior authorization for outpatient services, and health and safety standards of obstetrical services in hospitals/critical access hospitals.

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

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

Q3 Lobbying Report (July 1-Sept. 10) HCR Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program Resident Physician Shortage Act of 2023 (H.R. 2389) No Surprises Act regulations Food and Drug Amendments No Surprise Bills for New Moms Act (H.R. 3387) Securing the U.S. Organ Procurement and Transplantation Network Act (H.R. 2544) Promoting Access to Treatments and Increasing Extremely Needed Transparency Act (H.R. 3561) Medicaid VBPs for Patients (MVP) Act (H.R. 2666) Providers and Payers COMPETE Act (H.R. 3284) To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program (H.R. 3290) Transparent PRICE Act (H.R. 3281/H.R. 2691)) Resident Physician Shortage Reduction (S. 1302) Medical Student Education Authorization Act (H.R. 3046) Save Americas Rural Hospitals Act (H.R. 833) Chronic Care Management Improvement Act (H.R. 2829) Safety From Violence for Healthcare Employees Act (H.R. 2584) Supporting Safety Net Hospitals Act (H.R. 2665) Patient Access to Higher Quality Health Care Act (H.R. 977/S.470) FEMA re: COVID-19 related reimbursement Public Health Guidance Transparency and Accountability Act of 2023 (H.R. 4529) Public Health Emergency Congressional Review Act (H.R. 4381) CDC Leadership Accountability Act of 2023 (H.R. 3813) Preparing for All Hazards and Pathogens Reauthorization Act (H.R. 4421) Preparedness and Response Reauthorization Act (H.R. 4420) Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887) Health Care Price Transparency Act of 2023 (H.R. 4822) Providers and Payers COMPETE Act (H.R. 3284) Lower Costs, More Transparency Act (H.R. 5378 Transparency in Coverage Act (H.R. 4507) GOLD Card Act of 2023 (H.R. 4968) No Fees for EFTs Act (H.R.6487) Rural Health Care Facilities Revitalization Act (H.R. 5989) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (H.R. 7153) To amend title XVIII of the Social Security Act to establish a definition of essential health system in statute (H.R. 7397) Substance Use Disorder Workforce Act (H.R. 7050) 340B PATIENTS Act (H.R. 7635) The 340B Affording Care for Communities and Ensuring a Strong Safety-net (ACCESS) Act (H.R. 8574) Improving Seniors Access to Timely Care Act (H.R. 8702/S.4532) The Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931) Rural Health Care Facilities Revitalization Act (H.R. 5989) MMM Accelerated and Advance Payment Program repayment flexibility Graduate Medical Education (GME) funding Telehealth flexibilities and payment Annual Prospective Payment System Rules Organ acquisition payment policies Californias Medicaid Hospital Quality Assurance Fee Program Medicare Advantage BUD FY 2024 Appropriations bills Nursing and allied health workforce funding FY 2024 budget request Further Continuing Appropriations and Other Extensions Act (H.R. 6363) Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (H.R. 5894) Tax Relief for American Families and Workers Act of 2024 (H.R. 7024) Extension of Continuing Appropriations and Other Matters Act, 2024 (H.R. 7463) Submitted Comments Regulatory Comment Letters SUBJECT: CMS-1809-P, Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities, (Vol 89, No 140), July 22, 2024 SUBJECT: CMS-1803-P, Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies, Federal Register (Vol. 89, No. 128), July 3, 2024 SUBJECT: CMS-5535-P, Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model, Federal Register (Vol. 89, No. 97), May 17, 2024 Legislative Comment Letters Letter to HHS on Johnson & Johnson's Proposed Changes to 340B Drug Discount Program, Sept. 19, 2024

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

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