Children’s Hospital GME Support Reauthorization Act of 2023

Ending Discrimination Against Gay and Bisexual Blood and Tissue Donors Funding for HIV/AIDS Education, Prevention, and Research Funding for and Education Regarding Comprehensive Sexual Health Education Implementation of Section 1557 Nondiscrimination regulations Implementation and Protection of the Patient Protection and Affordable Care Act Labor, HHS, and Education Appropriations PrEP Insurance Coverage Title X Family Planning Funding Access to Gender Affirming Care FDA Ban on Blood Donation by MSM Employment Benefits Surgical Exclusion to Gender Affirming Care through the Department of Veterans Affairs Conversion Therapy H.R. 12; S. 701: Womens Health Protection Act of 2023 H.R. 1723; S. 929: Abortion is Health Care Everywhere Act of 2023 H.R. 1399; H.R. 5636; S. 2357: Protect Children's Innocence Act H.R. 1276; S. 635: Protect Minors from Medical Malpractice Act of 2023 S. 457: Protecting Our Kids from Child Abuse Act H.R. 3131: To prohibit the use of funds to seek membership in the World Health Organization or to provide assessed or voluntary contributions to the World Health Organization. H.R. 3328; S. 1597: Protecting Children From Experimentation Act of 2023 H.R. 3850: Pride In Mental Health Act of 2023 H.R. 3887: Children's Hospital GME Support Reauthorization Act of 2023 H.R. 3583; S. 1697: Real Education and Access for Healthy Youth Act of 2023 H.R. 4340; S. 2176: Therapeutic Fraud Prevention Act of 2023 H.R. 3409; S. 1664: Healthy Families Act H.R. 4392; S. 2188: PrEP Access and Coverage Act of 2023 S. 2246: Gender-Affirming CARE Act S. 2797: Protecting Conscience in Our Health Care Act H.R. 5894; S. 2624: Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2024 H.R. 8423; S. 4613: Elder Pride Act of 2024 S. 4445: Right to IVF Act S. 4381: Right to Contraception Act H.J.Res. 160; S.J.Res. 90: A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Department of Health and Human Services relating to Nondiscrimination in Health Programs and Activities. H.R. 9029; S. 4942: Departments of Labor, Health and Human Services, Education, and Related Agencies Act, 2025 H.J.Res. 182; S.J.Res. 101: Disapproving the rule submitted by the Department of Health and Human Services relating to "Designated Placement Requirements for LGBTQI plus Children". H.R. 9369: Elder Pride Protection Act of 2024 H.R. 9874: To prohibit the performance of gender-related medical treatment on minors, to amend title XVIII of the Social Security Act to prohibit payment and participation under the Medicare program with respect to such treatment, and for other purposes. H.R. 9586: STOP WEIRD Act of 2024 H.R. 9344: Promotion of Youth Sports Act 2024 H.R. 9874: Childhood Genital Mutilation Prevention Act

Client expense: $181,310 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Natl AIDS Policy, SENATE, Veterans Affairs, Dept of (VA), White House Office

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

Medicaid program reforms, including telemedicine and prior authorization issues Section 340B Drug Pricing program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Drug pricing reforms generally Juvenile mental and behavioral health legislation generally "Food as medicine" nutrition programs generally H.R. 3884 and S. 1852 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023), all provisions H.R. 3391 (Gabriella Miller Kids First Research Act 2.0), all provisions H.R. 3887 (Children's Hospital GME Support Reauthorization Act of2023), all provisions Medicare "site neutral" payment policy generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 Pediatric cancer research generally Pediatric access to cell and gene therapies generally H.R. 4758 (Accelerating Kids' Access to Care Act), all provisions H.R. 7213 (Autism Collaboration, Accountability, Research, Education, and Support Act of2024), all provisions H.R. 8260 and S. 4350 (Hospital Inpatient Services Modernization Act), all provisions H.R. I 0545 (American Relief Act, 2025), regarding HHS program funding and Medicaid program reform provisions National Institutes of Health program reforms generally S. 904 (Sickle Cell Disease Comprehensive Care Act), all provisions

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

Government targets: Centers For Medicare and Medicaid Services (CMS), 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.3046/S.1403 - Medical Student Education Authorization Act of 2023 Issue: Support grants for primary care training in medically under-resourced communities. Draft Social Determinants Accelerator Act Issue: Support grants to address social determinants of health. H.R.9161/S.4773 - Health Equity and Accountability Act of 2024 Issue: Support programs to improve health equity and address social determinants of health. S.2333 - Pandemic and All-Hazards Preparedness and Response Act H.R.4420 - Preparedness and Response Reauthorization Act H.R.4421 - Preparing for All Hazards and Pathogens Reauthorization Act H.R.4697 - Protecting PAHPA Act of 2023 Issues: Support the reauthorization of the Pandemic and All-Hazards Preparedness Act with increased funding authorization levels. Issue: Support authorities to strengthen CDCs and ASPRs ability to prevent and respond to existing and emerging threats. S.1995 - Public Health Infrastructure Saves Lives Act Issue: Support investments in core public health infrastructure. Issue: Educate Congress on how the 340B Drug Pricing Program helps safety-net providers to fulfill their missions and care for patients and communities. Support measures to preserve and strengthen the 340B Drug Pricing Program. Oppose efforts to reduce the scope of the program and transition 340B into a rebate model. H.R.2534 - Preserving Rules Ordered for the Entities Covered Through 340B Act of 2023 (PROTECT 340B Act) Issue: Support measures to prevent pharmacy benefit managers and commercial insurers from imposing discriminatory reimbursement policies on 340B covered entities. H.R.7635 - 340B Pharmaceutical Access to Invest in Essential, Needed Treatments and Support (340B PATIENTS) Act Issue: Support amending the 340B statute to codify covered entities ability to use contract pharmacies. H.R.3290 - To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. Issue: Oppose efforts to impose additional reporting requirements on 340B hospitals. Draft Supporting Underserved and Strengthening Transparency, Accountability, and Integrity Now and for the Future of 340B (SUSTAIN 340B) Act Issue: Support efforts to prohibit pharmaceutical and pharmacy benefit manager (PBM) discrimination against covered entities. Oppose efforts to define patient in the context of the program. Oppose efforts to impose additional administrative and reporting requirements on 340B hospitals. H.R.8574 - 340B ACCESS Act Issue: Oppose efforts to restrict hospital eligibility for the 340B program. Issue: Oppose insurance plans that do not meet Affordable Care Act requirements. Issue: Support policies to improve maternal health outcomes through expanded Medicaid coverage, enhanced data collection, and improved access to behavioral health care during the perinatal period. P.L. 118-159 - Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Year 2025 S.4638 National Defense Authorization Act for Fiscal Year 2025 Issue: Oppose prohibition on coverage for gender affirming care. H.R.2369 - Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2023 Issue: Educate Congress on development of laboratory developed tests (LDTs) at academic medical centers and oppose policies that would increase burdensome regulations and negatively impact patients access to care by allowing FDA regulation of the development of LDTs at academic medical centers. Issue: Educate Congress on the medical education and training continuum, the annual residency Match, and the role of the National Resident Matching Program (NRMP) in medical education and residency. Issue: Provide guidance on the implementation of the No Surprises Act (P.L.116-260). Issue: Educate Congress and the administration on the role of academic medicine in the provision of mental and behavioral health care, including initiatives to respond to the opioid epidemic. Support policies to strengthen the behavioral health workforce, promote the uptake of integrated behavioral health models, advance mental health research, and ensure access to coverage and care. Issue: Educate Congress about the financial challenges facing academic medical centers, including reimbursement challenges, workforce challenges, inflation, and others. Issue: Educate Congress and the administration about the impact of the unwinding of the COVID-19 public health emergency on the academic medicine community and the patients they serve. H.R.3887 - Childrens Hospital GME Support Reauthorization Act of 2023 H.R.3841 - To amend title III of the Public Health Service Act to reauthorize the program of payments to children's hospitals that operate graduate medical education programs. Issue: Support clean reauthorization of the Childrens Hospital GME program. Issue: Support reauthorization of the National Health Service Corps and Teaching Health Center Graduate Medical Education. Issue: Express concern regarding actions to inappropriately undermine FDA regulatory authority. Issue: Educate Congress and the administration about medical education on nutrition, hunger, and health; reproductive health; substance use disorders; medication assisted treatment for opioid use disorders; trans health; preventing fraud and abuse; diversity, equity, and inclusion; menopause management; health care for people with disabilities; and maternal health. Issue: Educate Congress and the administration about resident physician practice decision making post US SCOTUS decision in Dobbs. Issue: Educate Congress on resident expectations related to clinical practice and oppose so-called physician service mandates. H.R.7855 - Rural Residency Planning and Development Act of 2024 Issue: Support codification of HRSAs rural residency planning and development program. Issue: Support providing discretionary funds for rural teaching hospitals to expand their residency programs. Issue: Educate Congress on vaccine safety. Issue: Encourage changes to HRSA financial aid programs as a result of FAFSA updates. Issue: Educate Congress on the use of artificial intelligence (AI) in academic medicine. S.4031 - Providing Resources and Opportunities for Health Education and Learning (PRO-HEAL) Act Issue: Support HRSA grants to expand provider pipeline programs to create pathways to health care careers. H.R.7258/S.3968 - Community Training, Education, and Access for Medical Education, and Access for Medical Students (TEAMS) Act Issue: Support enhanced community-based training opportunities for medical students, particularly in rural and medically underserved areas, and fostering long-term sustainable physician practices in high-need communities. H.R.7153/S.3673 - Dr. Lorna Breen Health Care Provider Protection Reauthorization Act Issue: Support ability of HRSA to implement evidenced-based practices for preventing suicide and improving mental health and resiliency among health care professionals, and for training health care professionals in appropriate strategies to address substance use disorders. Issue: Provide input on Next Generation Cures initiative. Issue: Promote overdose prevention. H.R. 10047 The Closing the Substance Use Care Gap Act Issue: Support extension of SAMHSA harm reduction programs.

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Council on Disability, Natl Institutes of Health (NIH), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Vice President of the U.S., White House Office

340B Drug Pricing Program - Continued to urge action to ensure covered entities have access to 340B discounted prices through contract pharmacies. Highlighted critical importance of the 340B program for hospitals. Buffer inventory - Engagements with CMS on reimbursement for hospitals that stockpile buffer supplies of essential medicines. Children's Hospital Graduate Medical Education (CHGME) - Continued to urge Congress to reauthorize CHGME program through the Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887). Offered support for providing $738 million in funding the CHGME program. Drug shortages -Supported elements to increase transparency in prescription drug supply chain and increase reimbursement for generic prescription drugs; issues related to compounding; issues related to buffer inventory. Continued supporting passage of The Drug Shortage Prevention Act (H.R. 3008) and The Drug Origin Transparency Act (H.R. 3810). Provided feedback on the Senate Finance Committee discussion draft on the Drug Shortage Prevention and Mitigation Act (No Bill Number) legislation. Healthcare Workforce - Monitored development of the Bipartisan Primary Care and Health Workforce Act (S.2840) and the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S. 2768). Hospital Group Purchasing - Advocated to highlight the value that hospital group purchasing organizations provide to hospitals and suppliers. Provided education on how GPOs work in the healthcare supply chain and the role they play in delivering value to healthcare providers, as well as key differences between traditional GPOs and PBMs. Interchangeability Status - Responded to the Food and Drug Administration (FDA) draft guidance on Considerations for Demonstrating Interchangeability with a Reference Product: Update. Urged FDA to promptly finalize the Draft Guidance. Medical Device Sterilization - Conducted education and outreach on the potential negative impact on the healthcare supply chain of pending regulations limiting the use of Ethylene Oxide as a medical device sterilant. Mental and Behavioral Health - Highlighted the need for legislation to address significant challenges to mental and behavioral health treatment, including increased demand for services, limited access to treatment, and clinician shortages. Payer-mandated White Bagging - Urged support for policy updates related to payer-mandated white bagging for medications. Social Determinants of Health - Encouraged Congress and agencies to ensure tools like the Vizient Vulnerability Index are being utilized to understand and identify social drivers of health at the neighborhood level. Telehealth - Continued supporting passage of the CONNECT for Health Act (S. 2016/H.R. 4189). Continued to advocate for the adoption of permanent telehealth policies to extend flexibilities beyond the current 2024 expiration date. Telemedicine prescribing - Encouraged Congress to pass a two-year extension of Drug Enforcement Administration (DEA) prescribing flexibilities without requiring an in-person medical evaluation. Workforce - Encouraged passage of The Health Workforce Innovation Act (S.4957).

Client expense: $280,000 · Firm income: Not reported

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

H.R.3046/S.1403 - Medical Student Education Authorization Act of 2023 Issue: Support grants for primary care training in medically under-resourced communities. Draft Social Determinants Accelerator Act Issue: Support grants to address social determinants of health. H.R.9161/S.4773 - Health Equity and Accountability Act of 2024 Issue: Support programs to improve health equity and address social determinants of health. S.2333 - Pandemic and All-Hazards Preparedness and Response Act H.R.4420 - Preparedness and Response Reauthorization Act H.R.4421 - Preparing for All Hazards and Pathogens Reauthorization Act H.R.4697 - Protecting PAHPA Act of 2023 Issues: Support the reauthorization of the Pandemic and All-Hazards Preparedness Act with increased funding authorization levels. Issue: Support authorities to strengthen CDCs and ASPRs ability to prevent and respond to existing and emerging threats. S.1995 - Public Health Infrastructure Saves Lives Act Issue: Support investments in core public health infrastructure. Issue: Educate Congress on how the 340B Drug Pricing Program helps safety-net providers to fulfill their missions and care for patients and communities. Support measures to preserve and strengthen the 340B Drug Pricing Program. Oppose efforts to reduce the scope of the program, restrict the use of contract pharmacies, define patient in the context of the program, and impose additional reporting requirements on 340B hospitals. Oppose pharmaceutical industry efforts to transition 340B into a rebate model. H.R.2534 - Preserving Rules Ordered for the Entities Covered Through 340B Act of 2023 (PROTECT 340B Act) Issue: Support measures to prevent pharmacy benefit managers and commercial insurers from imposing discriminatory reimbursement policies on 340B covered entities. H.R.7635 - 340B Pharmaceutical Access to Invest in Essential, Needed Treatments and Support (340B PATIENTS) Act Issue: Support amending the 340B statute to codify covered entities ability to use contract pharmacies. H.R.3290 - To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. Issue: Oppose efforts to impose additional reporting requirements on 340B hospitals. Draft Supporting Underserved and Strengthening Transparency, Accountability, and Integrity Now and for the Future of 340B (SUSTAIN 340B) Act Issue: Support efforts to prohibit pharmaceutical and pharmacy benefit manager (PBM) discrimination against covered entities. Oppose efforts to define patient in the context of the program. Oppose efforts to impose additional administrative and reporting requirements on 340B hospitals. H.R.8574 - 340B ACCESS Act Issue: Oppose efforts to restrict hospital eligibility for the 340B program. Issue: Oppose insurance plans that do not meet Affordable Care Act requirements. Issue: Support policies to improve maternal health outcomes through expanded Medicaid coverage, enhanced data collection, and improved access to behavioral health care during the perinatal period. H.R.2369 - Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2023 Issue: Educate Congress on development of laboratory developed tests (LDTs) at academic medical centers and oppose policies that would increase burdensome regulations and negatively impact patients access to care by allowing FDA regulation of the development of LDTs at academic medical centers. Issue: Educate Congress on the medical education and training continuum, the annual residency Match, and the role of the National Resident Matching Program (NRMP) in medical education and residency. Issue: Provide guidance on the implementation of the No Surprises Act (P.L.116-260). Issue: Educate Congress and the administration on the role of academic medicine in the provision of mental and behavioral health care, including initiatives to respond to the opioid epidemic. Support policies to strengthen the behavioral health workforce, promote the uptake of integrated behavioral health models, advance mental health research, and ensure access to coverage and care. Issue: Educate Congress about the financial challenges facing academic medical centers, including reimbursement challenges, workforce challenges, inflation, and others. Issue: Educate Congress and the administration about the impact of the unwinding of the COVID-19 public health emergency on the academic medicine community and the patients they serve. H.R.3887 - Childrens Hospital GME Support Reauthorization Act of 2023 H.R.3841 - To amend title III of the Public Health Service Act to reauthorize the program of payments to children's hospitals that operate graduate medical education programs Issue: Support clean reauthorization of the Childrens Hospital GME program. Issue: Express concern regarding actions to inappropriately undermine FDA regulatory authority. Issue: Educate Congress and the administration about medical education on nutrition, hunger, and health; reproductive health; substance use disorders; medication assisted treatment for opioid use disorders; trans health; preventing fraud and abuse; diversity, equity, and inclusion; menopause management; health care for people with disabilities; and maternal health. Issue: Educate Congress and the administration about resident physician practice decision making post Dobbs. Issue: Educate Congress on resident expectations related to clinical practice and oppose so-called physician service mandates. H.R.7855 - Rural Residency Planning and Development Act of 2024 Issue: Support codification of HRSAs rural residency planning and development program. Issue: Educate Congress on vaccine safety. Issue: Encourage changes to HRSA financial aid programs as a result of FAFSA updates. Issue: Educate Congress on the use of artificial intelligence (AI) in academic medicine. S.4031 - Providing Resources and Opportunities for Health Education and Learning (PRO-HEAL) Act Issue: Support HRSA grants to expand provider pipeline programs to create pathways to health care careers. H.R.7258/S.3968 - Community Training, Education, and Access for Medical Education, and Access for Medical Students (TEAMS) Act Issue: Support enhanced community-based training opportunities for medical students, particularly in rural and medically underserved areas, and fostering long-term sustainable physician practices in high-need communities. H.R.7153/S.3673 - Dr. Lorna Breen Health Care Provider Protection Reauthorization Act Issue: Support ability of HRSA to implement evidenced-based practices for preventing suicide and improving mental health and resiliency among health care professionals, and for training health care professionals in appropriate strategies to address substance use disorders. Issue: Provide input on Next Generation Cures initiative. Issue: Promote overdose prevention.

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Council on Disability, Natl Institutes of Health (NIH), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Vice President of the U.S., White House Office

H.R.3046/S.1403 - Medical Student Education Authorization Act of 2023 Issue: Support grants for primary care training in medically under-resourced communities. Draft Social Determinants Accelerator Act Issue: Support grants to address social determinants of health. H.R.9161/S.4773 - Health Equity and Accountability Act of 2024 Issue: Support programs to improve health equity and address social determinants of health. S.2333 - Pandemic and All-Hazards Preparedness and Response Act H.R.4420 - Preparedness and Response Reauthorization Act H.R.4421 - Preparing for All Hazards and Pathogens Reauthorization Act H.R.4697 - Protecting PAHPA Act of 2023 Issues: Support the reauthorization of the Pandemic and All-Hazards Preparedness Act with increased funding authorization levels. Issue: Support authorities to strengthen CDCs and ASPRs ability to prevent and respond to existing and emerging threats. S.1995 - Public Health Infrastructure Saves Lives Act Issue: Support investments in core public health infrastructure. Issue: Educate Congress on how the 340B Drug Pricing Program helps safety-net providers to fulfill their missions and care for patients and communities. Support measures to preserve and strengthen the 340B Drug Pricing Program. Oppose efforts to reduce the scope of the program, restrict the use of contract pharmacies, define patient in the context of the program, and impose additional reporting requirements on 340B hospitals. Oppose pharmaceutical industry efforts to transition 340B into a rebate model. H.R.2534 - Preserving Rules Ordered for the Entities Covered Through 340B Act of 2023 (PROTECT 340B Act) Issue: Support measures to prevent pharmacy benefit managers and commercial insurers from imposing discriminatory reimbursement policies on 340B covered entities. H.R.7635 - 340B Pharmaceutical Access to Invest in Essential, Needed Treatments and Support (340B PATIENTS) Act Issue: Support amending the 340B statute to codify covered entities ability to use contract pharmacies. H.R.3290 - To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. Issue: Oppose efforts to impose additional reporting requirements on 340B hospitals. Draft Supporting Underserved and Strengthening Transparency, Accountability, and Integrity Now and for the Future of 340B (SUSTAIN 340B) Act Issue: Support efforts to prohibit pharmaceutical and pharmacy benefit manager (PBM) discrimination against covered entities. Oppose efforts to define patient in the context of the program. Oppose efforts to impose additional administrative and reporting requirements on 340B hospitals. H.R.8574 - 340B ACCESS Act Issue: Oppose efforts to restrict hospital eligibility for the 340B program. Issue: Oppose insurance plans that do not meet Affordable Care Act requirements. Issue: Support policies to improve maternal health outcomes through expanded Medicaid coverage, enhanced data collection, and improved access to behavioral health care during the perinatal period. H.R.2369 - Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2023 Issue: Educate Congress on development of laboratory developed tests (LDTs) at academic medical centers and oppose policies that would increase burdensome regulations and negatively impact patients access to care by allowing FDA regulation of the development of LDTs at academic medical centers. Issue: Educate Congress on the medical education and training continuum, the annual residency Match, and the role of the National Resident Matching Program (NRMP) in medical education and residency. Issue: Provide guidance on the implementation of the No Surprises Act (P.L.116-260). Issue: Educate Congress and the administration on the role of academic medicine in the provision of mental and behavioral health care, including initiatives to respond to the opioid epidemic. Support policies to strengthen the behavioral health workforce, promote the uptake of integrated behavioral health models, advance mental health research, and ensure access to coverage and care. Issue: Educate Congress about the financial challenges facing academic medical centers, including reimbursement challenges, workforce challenges, inflation, and others. Issue: Educate Congress and the administration about the impact of the unwinding of the COVID-19 public health emergency on the academic medicine community and the patients they serve. H.R.3887 - Childrens Hospital GME Support Reauthorization Act of 2023 H.R.3841 - To amend title III of the Public Health Service Act to reauthorize the program of payments to children's hospitals that operate graduate medical education programs Issue: Support clean reauthorization of the Childrens Hospital GME program. Issue: Express concern regarding actions to inappropriately undermine FDA regulatory authority. Issue: Educate Congress and the administration about medical education on nutrition, hunger, and health; reproductive health; substance use disorders; medication assisted treatment for opioid use disorders; trans health; preventing fraud and abuse; diversity, equity, and inclusion; menopause management; health care for people with disabilities; and maternal health. Issue: Educate Congress and the administration about resident physician practice decision making post Dobbs. Issue: Educate Congress on resident expectations related to clinical practice and oppose so-called physician service mandates. H.R.7855 - Rural Residency Planning and Development Act of 2024 Issue: Support codification of HRSAs rural residency planning and development program. Issue: Educate Congress on vaccine safety. Issue: Encourage changes to HRSA financial aid programs as a result of FAFSA updates. Issue: Educate Congress on the use of artificial intelligence (AI) in academic medicine. S.4031 - Providing Resources and Opportunities for Health Education and Learning (PRO-HEAL) Act Issue: Support HRSA grants to expand provider pipeline programs to create pathways to health care careers. H.R.7258/S.3968 - Community Training, Education, and Access for Medical Education, and Access for Medical Students (TEAMS) Act Issue: Support enhanced community-based training opportunities for medical students, particularly in rural and medically underserved areas, and fostering long-term sustainable physician practices in high-need communities. H.R.7153/S.3673 - Dr. Lorna Breen Health Care Provider Protection Reauthorization Act Issue: Support ability of HRSA to implement evidenced-based practices for preventing suicide and improving mental health and resiliency among health care professionals, and for training health care professionals in appropriate strategies to address substance use disorders. Issue: Provide input on Next Generation Cures initiative. Issue: Promote overdose prevention.

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Council on Disability, Natl Institutes of Health (NIH), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Vice President of the U.S., White House Office

Medicaid program reforms, including telemedicine and prior authorization issues Section 340B Drug Pricing program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Drug pricing reforms generally Juvenile mental and behavioral health legislation generally "Food as medicine" nutrition programs generally Advanced Research Projects Agency-Health program generally H.R. 3884 and S. 1852 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023), all provisions H.R. 3391 (Gabriella Miller Kids First Research Act 2.0), all provisions H.R. 3887 (Childrens Hospital GME Support Reauthorization Act of 2023), all provisions Medicare "site neutral" payment policy generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 Pediatric cancer research generally Pediatric access to cell and gene therapies generally H.R. 4758 (Accelerating Kids Access to Care Act), all provisions H.R. 7213 (Autism Collaboration, Accountability, Research, Education, and Support Act of 2024), all provisions H.R. 8260 and S. 4350 (Hospital Inpatient Services Modernization Act), all provisions

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid program reforms, including telemedicine Section 340B Drug Pricing Program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Sickle cell disease research funding generally Drug pricing reforms generally Mental and behavioral health legislation generally Advanced Research Projects Agency-Health program generally H.R. 3887 (Childrens Hospital GME Support Reauthorization Act of 2023), all provisions H.R. 3884 and S. 1852 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023), all provisions Site neutral payments to providers generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 H.R. 6960 and S. 3765 (Emergency Medical Services for Children (EMSC) Reauthorization Act of 2024), all provisions H.R. 4758 (Accelerating Kids Access to Care Act), all provisions H.R. 7213 (Autism Collaboration, Accountability, Research, Education, and Support Act of 2024), all provisions Federal policies regarding Lab-Developed Tests, generally

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

Government targets: 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)

Medicaid program reforms, including telemedicine and prior authorization issues Section 340B Drug Pricing program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Drug pricing reforms generally Juvenile mental and behavioral health legislation generally "Food as medicine" nutrition programs generally Advanced Research Projects Agency-Health program generally H.R. 3884 and S. 1852 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of2023), all provisions H.R. 3391 (Gabriella Miller Kids First Research Act 2.0), all provisions H.R. 3887 (Children's Hospital GME Support Reauthorization Act of2023), all provisions Medicare "site neutral" payment policy generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 Pediatric cancer research generally Pediatric access to cell and gene therapies generally H.R. 4758 (Accelerating Kids' Access to Care Act), all provisions H.R. 7213 (Autism Collaboration, Accountability, Research, Education, and Support Act of2024), all provisions H.R. 8260 and S. 4350 (Hospital Inpatient Services Modernization Act), all provisions Pediatric organ procurement and transplant policies generally Violence prevention programs generally

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

Ending Discrimination Against Gay and Bisexual Blood and Tissue Donors Funding for HIV/AIDS Education, Prevention, and Research Funding for and Education Regarding Comprehensive Sexual Health Education Implementation of Section 1557 Nondiscrimination regulations Implementation and Protection of the Patient Protection and Affordable Care Act Labor, HHS, and Education Appropriations PrEP Insurance Coverage Title X Family Planning Funding Access to Gender Affirming Care FDA Ban on Blood Donation by MSM Employment Benefits Surgical Exclusion to Gender Affirming Care through the Department of Veterans Affairs Conversion Therapy H.R. 12; S. 701: Womens Health Protection Act of 2023 H.R. 1723; S. 929: Abortion is Health Care Everywhere Act of 2023 H.R. 1399; H.R. 5636; S. 2357: Protect Children's Innocence Act H.R. 1276; S. 635: Protect Minors from Medical Malpractice Act of 2023 S. 457: Protecting Our Kids from Child Abuse Act H.R. 3131: To prohibit the use of funds to seek membership in the World Health Organization or to provide assessed or voluntary contributions to the World Health Organization. H.R. 3328; S. 1597: Protecting Children From Experimentation Act of 2023 H.R. 3850: Pride In Mental Health Act of 2023 H.R. 3887: Children's Hospital GME Support Reauthorization Act of 2023 H.R. 3583; S. 1697: Real Education and Access for Healthy Youth Act of 2023 H.R. 4340; S. 2176: Therapeutic Fraud Prevention Act of 2023 H.R. 3409; S. 1664: Healthy Families Act H.R. 4392; S. 2188: PrEP Access and Coverage Act of 2023 S. 2246: Gender-Affirming CARE Act S. 2797: Protecting Conscience in Our Health Care Act H.R. 5894; S. 2624: Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2024 H.R. 8423; S. 4613: Elder Pride Act of 2024 S. 4445: Right to IVF Act S. 4381: Right to Contraception Act H.J.Res. 160; S.J.Res. 90: A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Department of Health and Human Services relating to Nondiscrimination in Health Programs and Activities. H.R. 9029; S. 4942: Departments of Labor, Health and Human Services, Education, and Related Agencies Act, 2025 H.J.Res. 182; S.J.Res. 101: Disapproving the rule submitted by the Department of Health and Human Services relating to "Designated Placement Requirements for LGBTQI plus Children". H.R. 9369: Elder Pride Protection Act of 2024 H.R. 9874: To prohibit the performance of gender-related medical treatment on minors, to amend title XVIII of the Social Security Act to prohibit payment and participation under the Medicare program with respect to such treatment, and for other purposes. H.R. 9586: STOP WEIRD Act of 2024 H.R. 9344: Promotion of Youth Sports Act 2024

Client expense: $199,903 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Natl AIDS Policy, SENATE, Veterans Affairs, Dept of (VA), White House Office

Ending Discrimination Against Gay and Bisexual Blood and Tissue Donors Funding for HIV/AIDS Education, Prevention, and Research Funding for and Education Regarding Comprehensive Sexual Health Education Implementation of Section 1557 Nondiscrimination regulations Implementation and Protection of the Patient Protection and Affordable Care Act Labor, HHS, and Education Appropriations PrEP Insurance Coverage Title X Family Planning Funding Access to Gender Affirming Care FDA Ban on Blood Donation by MSM Employment Benefits Surgical Exclusion to Gender Affirming Care through the Department of Veterans Affairs Conversion Therapy H.R. 12; S. 701: Womens Health Protection Act of 2023 H.R. 1723; S. 929: Abortion is Health Care Everywhere Act of 2023 H.R. 1399; H.R. 5636; S. 2357: Protect Children's Innocence Act H.R. 1276; S. 635: Protect Minors from Medical Malpractice Act of 2023 S. 457: Protecting Our Kids from Child Abuse Act H.R. 3131: To prohibit the use of funds to seek membership in the World Health Organization or to provide assessed or voluntary contributions to the World Health Organization. H.R. 3328; S. 1597: Protecting Children From Experimentation Act of 2023 H.R. 3850: Pride In Mental Health Act of 2023 H.R. 3887: Children's Hospital GME Support Reauthorization Act of 2023 H.R. 3583; S. 1697: Real Education and Access for Healthy Youth Act of 2023 H.R. 4340; S. 2176: Therapeutic Fraud Prevention Act of 2023 H.R. 3409; S. 1664: Healthy Families Act H.R. 4392; S. 2188: PrEP Access and Coverage Act of 2023 S. 2246: Gender-Affirming CARE Act S. 2797: Protecting Conscience in Our Health Care Act H.R. 5894; S. 2624: Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2024 H.R. 8423; S. 4613: Elder Pride Act of 2024 S. 4445: Right to IVF Act S. 4381: Right to Contraception Act H.J.Res. 160; S.J.Res. 90: A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Department of Health and Human Services relating to Nondiscrimination in Health Programs and Activities. H.R. 9029; S. 4942: Departments of Labor, Health and Human Services, Education, and Related Agencies Act, 2025 H.J.Res. 182; S.J.Res. 101: Disapproving the rule submitted by the Department of Health and Human Services relating to "Designated Placement Requirements for LGBTQI plus Children". H.R. 9369: Elder Pride Protection Act of 2024 H.R. 9874: To prohibit the performance of gender-related medical treatment on minors, to amend title XVIII of the Social Security Act to prohibit payment and participation under the Medicare program with respect to such treatment, and for other purposes. H.R. 9586: STOP WEIRD Act of 2024 H.R. 9344: Promotion of Youth Sports Act 2024

Client expense: $199,903 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Natl AIDS Policy, SENATE, Veterans Affairs, Dept of (VA), White House Office

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: $460,000 · Firm income: Not reported

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

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 CDC Injury Control Research Centers Funding NIH Pediatric Medical Research Prioritization FDA Proposed Rule Titles "Medical Device Laboratory Developed Tests"

Client expense: $45,000 · 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 CDC Injury Control Research Centers Funding NIH Pediatric Medical Research Prioritization FDA Proposed Rule Titles "Medical Device Laboratory Developed Tests"

Client expense: $45,000 · 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

340B Drug Pricing Program - Continued to urge action to ensure covered entities have access to 340B discounted prices through contract pharmacies. Highlighted critical importance of the 340B program for hospitals. Responded to the discussion draft of the Supporting Underserved and Strengthening Transparency, Accountability, and Integrity Now and for the Future of 340B Act (SUSTAIN 340B Act) and supplemental request for information (RFI). Buffer inventory - Engagements with CMS on reimbursement for hospitals that stockpile buffer supplies of essential medicines Children's Hospital Graduate Medical Education (CHGME) - Continued to urge Congress to reauthorize CHGME program through the Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887). Offered support for providing $738 million in funding the CHGME program. Drug shortages -Supported elements to increase transparency in prescription drug supply chain and increase reimbursement for generic prescription drugs; issues related to compounding; issues related to buffer inventory. Continued supporting passage of The Drug Shortage Prevention Act (H.R. 3008) and The Drug Origin Transparency Act (H.R. 3810) and engaged on the Stop Drug Shortages Act (McMorris Rodgers, No Bill Number) discussion draft. Healthcare Workforce - Monitored development of the Bipartisan Primary Care and Health Workforce Act (S.2840) and the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S. 2768). Hospital Group Purchasing - Advocated to highlight the value that hospital group purchasing organizations provide to hospitals and suppliers. Provided education on how GPOs work in the healthcare supply chain and the role they play in delivering value to healthcare providers, as well as key differences between traditional GPOs and PBMs. Medical Device Sterilization - Conducted education and outreach on the potential negative impact on the healthcare supply chain of pending regulations limiting the use of Ethylene Oxide as a medical device sterilant. Mental and Behavioral Health - Highlighted the need for legislation to address significant challenges to mental and behavioral health treatment, including increased demand for services, limited access to treatment, and clinician shortages. Office of the National Coordinator (ONC) Standards Bulletin 2024-1 (SB24-1) - Offered recommendations to constructively improve Draft USCDI v5 to support efforts related to health equity. Payer-mandated White Bagging - Urged support for policy updates related to payer-mandated white bagging for medications. Social Determinants of Health - Encouraged Congress and agencies to ensure tools like the Vizient Vulnerability Index are being utilized to understand and identify social drivers of health at the neighborhood level. Telehealth - Continued supporting passage of the CONNECT for Health Act (S. 2016/H.R. 4189). Continued to advocate for the adoption of permanent telehealth policies to extend flexibilities beyond the current 2024 expiration date.

Client expense: $290,000 · 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), SENATE

H.R.3046/S.1403 - Medical Student Education Authorization Act of 2023 Issue: Support grants for primary care training in medically under-resourced communities. Draft Social Determinants Accelerator Act Issue: Support grants to address social determinants of health. Draft Health Equity and Accountability Act Issue: Support programs to improve health equity and address social determinants of health. S.2333 - Pandemic and All-Hazards Preparedness and Response Act H.R.4420 - Preparedness and Response Reauthorization Act H.R.4421 - Preparing for All Hazards and Pathogens Reauthorization Act H.R.4697 - Protecting PAHPA Act of 2023 Issues: Support the reauthorization of the Pandemic and All-Hazards Preparedness Act with increased funding authorization levels. Issue: Support authorities to strengthen CDCs and ASPRs ability to prevent and respond to existing and emerging threats. S.1995 - Public Health Infrastructure Saves Lives Act Issue: Support investments in core public health infrastructure. Issue: Educate Congress on how the 340B Drug Pricing Program helps safety-net providers to fulfill their missions and care for patients and communities. Support measures to preserve and strengthen the 340B Drug Pricing Program and oppose efforts to reduce the scope of the program, restrict the use of contract pharmacies, define patient in the context of the program, and impose additional reporting requirements on 340B hospitals. H.R.2534 - Preserving Rules Ordered for the Entities Covered Through 340B Act of 2023 (PROTECT 340B Act) Issue: Support measures to prevent pharmacy benefit managers and commercial insurers from imposing discriminatory reimbursement policies on 340B covered entities. H.R.3290 - To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. Issue: Oppose efforts to impose additional reporting requirements on 340B hospitals. Draft Supporting Underserved and Strengthening Transparency, Accountability, and Integrity Now and for the Future of 340B (SUSTAIN 340B) Act Issue: Support efforts to prohibit pharmaceutical and pharmacy benefit manager (PBM) discrimination against covered entities. Oppose efforts to define patient in the context of the program. Oppose efforts to impose additional administrative and reporting requirements on 340B hospitals. H.R.8574 - 340B ACCESS Act Issue: Oppose efforts to restrict hospital eligibility for the 340B program. Issue: Educate Congress about the impacts of drug shortages on academic medical centers and the patients they serve. Support measures to address drug shortages and strengthen the pharmaceutical supply chain. Draft End Drug Shortages Act Issue: Support policies to increase visibility into the pharmaceutical supply chain. Issue: Oppose insurance plans that do not meet Affordable Care Act requirements. Issue: Support policies to improve maternal health outcomes through expanded Medicaid coverage, enhanced data collection, and improved access to behavioral health care during the perinatal period. H.R.2369 - Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2023 Issue: Educate Congress on development of laboratory developed tests (LDTs) at academic medical centers and oppose policies that would increase burdensome regulations and negatively impact patients access to care by allowing FDA regulation of the development of LDTs at academic medical centers. Issue: Educate Congress on the medical education and training continuum, the annual residency Match, and the role of the National Resident Matching Program (NRMP) in medical education and residency. Issue: Provide guidance on the implementation of the No Surprises Act (P.L.116-260). Issue: Educate Congress and the administration on the role of academic medicine in the provision of mental and behavioral health care, including initiatives to respond to the opioid epidemic. Support policies to strengthen the behavioral health workforce, promote the uptake of integrated behavioral health models, advance mental health research, and ensure access to coverage and care. Issue: Educate Congress about the financial challenges facing academic medical centers, including reimbursement challenges, workforce challenges, inflation, and others. Issue: Educate Congress and the administration about the impact of the unwinding of the COVID-19 public health emergency on the academic medicine community and the patients they serve. H.R.3887 - Childrens Hospital GME Support Reauthorization Act of 2023 H.R.3841 - To amend title III of the Public Health Service Act to reauthorize the program of payments to children's hospitals that operate graduate medical education programs Issue: Support clean reauthorization of the Childrens Hospital GME program. Issue: Express concern regarding actions to inappropriately undermine FDA regulatory authority. Issue: Educate Congress and the administration about medical education on nutrition, hunger, and health; reproductive health; substance use disorders; medication assisted treatment for opioid use disorders; trans health; preventing fraud and abuse; diversity, equity, and inclusion; menopause management; health care for people with disabilities; and maternal health. Issue: Educate Congress and the administration about resident physician practice decision making post Dobbs. Issue: Educate Congress on resident expectations related to clinical practice and oppose so-called physician service mandates. H.R.7855 - Rural Residency Planning and Development Act of 2024 Issue: Support codification of HRSAs rural residency planning and development program. Issue: Educate Congress on vaccine safety. Issue: Encourage changes to HRSA financial aid programs as a result of FAFSA updates. Issue: Educate Congress on the use of artificial intelligence (AI) in academic medicine. S.4031 - Providing Resources and Opportunities for Health Education and Learning (PRO-HEAL) Act Issue: Support HRSA grants to expand provider pipeline programs to create pathways to health care careers. H.R.7258/S.3968 - Community Training, Education, and Access for Medical Education, and Access for Medical Students (TEAMS) Act Issue: Support enhanced community-based training opportunities for medical students, particularly in rural and medically underserved areas, and fostering long-term sustainable physician practices in high-need communities. H.R.7153 - Dr. Lorna Breen Health Care Provider Protection Reauthorization Act Issue: Support ability of HRSA to implement evidenced-based practices for preventing suicide and improving mental health and resiliency among health care professionals, and for training health care professionals in appropriate strategies to address substance use disorders.

Client expense: $742,323 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Council on Disability, Natl Institutes of Health (NIH), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Vice President of the U.S., White House Office

Medicaid program reforms, including telemedicine Section 340B Drug Pricing Program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Sickle cell disease research funding generally Drug pricing reforms generally Mental and behavioral health legislation generally Advanced Research Projects Agency-Health program generally H.R. 3887 (Childrens Hospital GME Support Reauthorization Act of 2023), all provisions H.R. 3884 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023), all provisions Site neutral payments to providers generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 H.R. 6960 and S. 3765 (Emergency Medical Services for Children (EMSC) Reauthorization Act of 2024), all provisions H.R. 4758 (Accelerating Kids Access to Care Act), all provisions H.R. 7213 (Autism Collaboration, Accountability, Research, Education, and Support Act of 2024), all provisions

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid program reforms, including telemedicine and prior authorization issues Section 340B Drug Pricing program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Drug pricing reforms generally Juvenile mental and behavioral health legislation generally "Food as medicine" nutrition programs generally Advanced Research Projects Agency-Health program generally H.R. 3884 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023), all provisions H.R. 3391 (Gabriella Miller Kids First Research Act 2.0), all provisions H.R. 3887 (Childrens Hospital GME Support Reauthorization Act of 2023), all provisions Medicare "site neutral" payment policy generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 Pediatric cancer research generally Pediatric access to cell and gene therapies generally H.R. 4822 (Health Care Price Transparency Act of 2023), all provisions H.R. 7808 (EARLY Minds Act), regarding pediatric mental health H.R. 4758 (Accelerating Kids Access to Care Act), all provisions H.R. 7213 (Autism Collaboration, Accountability, Research, Education, and Support Act of 2024), all provisions

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Q2 Lobbying Report (April 1-June 30) 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 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-1808-P, Medicare and Medicaid Programs and the Childrens Health Insurance Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates; Quality Programs Requirements; and Other Policy Changes; Proposed Rule, Federal Register (Vol. 89, No. 86), May 2, 2024 SUBJECT: CMS-4207-NC, Medicare Program; Request for Information on Medicare Advantage Data, Federal Register (Vol. 89, No. 20), January 30, 2024 SUBJECT: CMS-1806-P, Medicare Program; FFY 2025 Inpatient Psychiatric Facilities Prospective Payment System - Rate Update, Proposed Rule, Federal Register (Vol. 89, No. 65), April 3, 2024 SUBJECT: CMS-1804-P, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FFY 2025 and Updates to the IRF Quality Reporting Program; Proposed Rule, Federal Register (Vol. 89, No. 62), March 29, 2024 SUBJECT: Docket No. ATR 102 - Request for Information on Consolidation in Health Care Markets SUBJECT: CMS-3367-P, Medicare Program; Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflict of Interest, and Related Provisions, Proposed Rule, Federal Register (Vol 89, No 32), February 15, 2024 Legislative Comment Letters Rep. Ami Bera Request for Information Regarding the Current State of Artificial Intelligence (AI) in the Health Care Industry, April 30, 2024 Senate Request for Information Regarding Draft SUSTAIN 340B Act, April 1, 2024

Client expense: $420,000 · 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)

Medicaid program reforms, including telemedicine and prior authorization issues Section 340B Drug Pricing program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Drug pricing reforms generally Juvenile mental and behavioral health legislation generally Gun violence prevention programs generally "Food as medicine" nutrition programs generally Advanced Research Projects Agency-Health program generally H.R. 3884 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023), all provisions H.R. 3391 (Gabriella Miller Kids First Research Act 2.0), all provisions H.R. 3887 (Children's Hospital GME Support Reauthorization Act of 2023), all provisions Medicare "site neutral" payment policy generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 Pediatric cancer research generally Pediatric access to cell and gene therapies generally H.R. 4822 (Health Care Price Transparency Act of 2023), all provisions H.R. 7808 (EARLY Minds Act), regarding pediatric mental health H.R. 4758 (Accelerating Kids Access to Care Act), all provisions Laboratory developed tests generally, including H.R. 2369 (Verifying Accurate Leading-edge IVCT Development Act of 2023), all provisions H.R. 7213 (Autism Collaboration, Accountability, Research, Education, and Support Act of 2024), all provisions

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), 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: $450,000 · Firm income: Not reported

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

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 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 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 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 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

H.R. 3887, the Childrens Hospital GME Support Reauthorization Act of 2023; No Bill Number - Childrens Hospital Graduate Medical Education (CHGME) and Congressionally Directed Spending Request within the Labor, HHS, Appropriations bill; No Bill Number - Health Care Workforce priorities; No Bill Number - delay of cuts to Disproportionate Share Hospital payments.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3887, the Childrens Hospital GME Support Reauthorization Act of 2023; No Bill Number - Childrens Hospital Graduate Medical Education (CHGME) and Congressionally Directed Spending Request within the Labor, HHS, Appropriations bill; No Bill Number - Health Care Workforce priorities; No Bill Number - delay of cuts to Disproportionate Share Hospital payments.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Ending Discrimination Against Gay and Bisexual Blood and Tissue Donors Funding for HIV/AIDS Education, Prevention, and Research Funding for and Education Regarding Comprehensive Sexual Health Education Implementation of Section 1557 Nondiscrimination regulations Implementation and Protection of the Patient Protection and Affordable Care Act Labor, HHS, and Education Appropriations PrEP Insurance Coverage Title X Family Planning Funding Access to Gender Affirming Care FDA Ban on Blood Donation by MSM Employment Benefits Surgical Exclusion to Gender Affirming Care through the Department of Veterans Affairs Conversion Therapy H.R. 12; S. 701: Womens Health Protection Act of 2023 H.R. 1723; S. 929: Abortion is Health Care Everywhere Act of 2023 H.R. 1399; H.R. 5636; S. 2357: Protect Children's Innocence Act H.R. 1276; S. 635: Protect Minors from Medical Malpractice Act of 2023 S. 457: Protecting Our Kids from Child Abuse Act H.R. 3131: To prohibit the use of funds to seek membership in the World Health Organization or to provide assessed or voluntary contributions to the World Health Organization. H.R. 3328; S. 1597: Protecting Children From Experimentation Act of 2023 H.R. 3850: Pride In Mental Health Act of 2023 H.R. 3887: Children's Hospital GME Support Reauthorization Act of 2023 H.R. 3583; S. 1697: Real Education and Access for Healthy Youth Act of 2023 H.R. 4340; S. 2176: Therapeutic Fraud Prevention Act of 2023 H.R. 3409; S. 1664: Healthy Families Act H.R. 4392; S. 2188: PrEP Access and Coverage Act of 2023 S. 2246: Gender-Affirming CARE Act S. 2797: Protecting Conscience in Our Health Care Act H.R. 5894; S. 2624: Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2024 H.R. 8423 Elder Pride Act of 2024 S. 4445: Right to IVF Act S. 4381: Right to Contraception Act H.J.Res. 160; S.J.Res. 90: A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Department of Health and Human Services relating to Nondiscrimination in Health Programs and Activities.

Client expense: $256,453 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Natl AIDS Policy, SENATE, Veterans Affairs, Dept of (VA), White House Office

340B Drug Pricing Program - Continued to urge action to ensure covered entities have access to 340B discounted prices through contract pharmacies. Highlighted critical importance of the 340B program for hospitals. Responded to the discussion draft of the Supporting Underserved and Strengthening Transparency, Accountability, and Integrity Now and for the Future of 340B Act (SUSTAIN 340B Act) and supplemental request for information (RFI). Buffer inventory - Engagements with CMS on reimbursement for hospitals that stockpile buffer supplies of essential medicines. Children's Hospital Graduate Medical Education (CHGME) - Continued to urge Congress to reauthorize CHGME program through the Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887). Offered support for providing $738 million in funding the CHGME program. Drug shortages -Supported elements to increase transparency in prescription drug supply chain and increase reimbursement for generic prescription drugs; issues related to compounding; issues related to buffer inventory. Engaged on recent FTC/HHS joint Request for Information related to generic drug shortages, as well as the January Senate Finance Committee White Paper Preventing and Mitigating Generic Drug Shortages: Policy Options Under Federal Health Programs. Continued supporting passage of The Drug Shortage Prevention Act (H.R. 3008) and The Drug Origin Transparency Act (H.R. 3810) and engaged on the Stop Drug Shortages Act (McMorris Rodgers, No Bill Number) discussion draft. Endorsed passage of legislation to address patent thickets (H.R. 6986/S.3583). Endorsed passage of the Affordable Prescriptions for Patients Act (S.150). Endorsed passage of the Mapping Americas Pharmaceutical Supply (MAPS) Act (H.R. 6992). Healthcare Workforce - Endorsed passage of the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S. 2768). Monitored development of the Bipartisan Primary Care and Health Workforce Act (S.2840). Hospital Group Purchasing - Advocated to highlight the value that hospital group purchasing organizations provide to hospitals and suppliers. Provided education on how GPOs work in the healthcare supply chain and the role they play in delivering value to healthcare providers, as well as key differences between traditional GPOs and PBMs. Medical Device Sterilization - Conducted education and outreach on the potential negative impact on the healthcare supply chain of pending regulations limiting the use of Ethylene Oxide as a medical device sterilant. Mental and Behavioral Health - Highlighted the need for legislation to address significant challenges to mental and behavioral health treatment, including increased demand for services, limited access to treatment, and clinician shortages. Payer-mandated White Bagging - Urged support for policy updates related to payer-mandated white bagging for medications. Preparing for All Hazards and Pathogens Reauthorization Act (H.R. 4421) and Preparedness and Response Reauthorization Act (H.R. 4420) - Supported timely passage of legislation to reauthorize the Pandemic and All Hazards Preparedness Act. Advocated for including provisions to increase transparency in the healthcare supply chain and improve hospital and health system emergency preparedness. Social Determinants of Health - Encouraged Congress and agencies to ensure tools like the Vizient Vulnerability Index are being utilized to understand and identify social drivers of health at the neighborhood level. Supported an increase in the Physician Fee Schedule conversion factor in Consolidated Appropriations Act, 2024 (H.R. 4366) to offset recent administrative payment cuts. Telehealth - Continued supporting passage of the CONNECT for Health Act (S. 2016/H.R. 4189). Continued to advocate for the adoption of permanent telehealth policies to extend flexibilities beyond the current 2024 expiration date.

Client expense: $270,000 · 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), 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 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 CDC Injury Control Research Centers Funding NIH Pediatric Medical Research Prioritization FDA Proposed Rule Titles "Medical Device Laboratory Developed Tests"

Client expense: $110,000 · 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 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 CDC Injury Control Research Centers Funding NIH Pediatric Medical Research Prioritization FDA Proposed Rule Titles "Medical Device Laboratory Developed Tests"

Client expense: $110,000 · 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

Medicaid program reforms, including telemedicine and prior authorization issues Section 340B Drug Pricing program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Drug pricing reforms generally Juvenile mental and behavioral health legislation generally "Food as medicine" nutrition programs generally Medicaid Disproportionate Share Hospital payments Advanced Research Projects Agency-Health program generally H.R. 3884 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023), all provisions H.R. 3391 (Gabriella Miller Kids First Research Act 2.0), all provisions H.R. 3887 (Children's Hospital GME Support Reauthorization Act of 2023), all provisions Medicare "site neutral" payment policy generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 Pediatric cancer research generally Pediatric access to cell and gene therapies generally H.R. 4822 (Health Care Price Transparency Act of 2023), all provisions H.R. 7808 (EARLY Minds Act), regarding pediatric mental health Laboratory developed tests generally, including H.R. 2369 (Verifying Accurate Leading-edge IVCT Development Act of 2023), all provisions

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

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

H.R.3046/S.1403 - Medical Student Education Authorization Act of 2023 Issue: Support grants for primary care training in medically under-resourced communities. Draft Social Determinants Accelerator Act Issue: Support grants to address social determinants of health. Draft Health Equity and Accountability Act Issue: Support programs to improve health equity and address social determinants of health. S.2333 - Pandemic and All-Hazards Preparedness and Response Act H.R.4420 - Preparedness and Response Reauthorization Act H.R.4421 - Preparing for All Hazards and Pathogens Reauthorization Act H.R.4697 - Protecting PAHPA Act of 2023 Issues: Support the reauthorization of the Pandemic and All-Hazards Preparedness Act with increased funding authorization levels. Issue: Support authorities to strengthen CDCs and ASPRs ability to prevent and respond to existing and emerging threats. S.1995 - Public Health Infrastructure Saves Lives Act Issue: Support investments in core public health infrastructure. Issue: Educate Congress on how the 340B Drug Pricing Program helps safety-net providers to fulfill their missions and care for patients and communities. Support measures to preserve and strengthen the 340B Drug Pricing Program and oppose efforts to reduce the scope of the program, restrict the use of contract pharmacies, define patient in the context of the program, and impose additional reporting requirements on 340B hospitals. H.R.2534 - Preserving Rules Ordered for the Entities Covered Through 340B Act of 2023 (PROTECT 340B Act) Issue: Support measures to prevent pharmacy benefit managers and commercial insurers from imposing discriminatory reimbursement policies on 340B covered entities. H.R.3290 - To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. Issue: Oppose efforts to impose additional reporting requirements on 340B hospitals. Draft Supporting Underserved and Strengthening Transparency, Accountability, and Integrity Now and for the Future of 340B (SUSTAIN 340B) Act Issue: Support efforts to prohibit pharmaceutical and pharmacy benefit manager (PBM) discrimination against covered entities. Oppose efforts to define patient in the context of the program. Oppose efforts to impose additional administrative and reporting requirements on 340B hospitals. Issue: Educate Congress about the impacts of drug shortages on academic medical centers and the patients they serve. Support measures to address drug shortages and strengthen the pharmaceutical supply chain. Issue: Oppose insurance plans that do not meet Affordable Care Act requirements. Issue: Support policies to improve maternal health outcomes through expanded Medicaid coverage, enhanced data collection, and improved access to behavioral health care during the perinatal period. H.R.3838/S.2415 - Preventing Maternal Deaths Reauthorization Act Issue: Support continued federal funding for state-based maternal mortality review committees. H.R.2369 - Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2023 Issue: Educate Congress on development of laboratory developed tests (LDTs) at academic medical centers and oppose policies that would increase burdensome regulations and negatively impact patients access to care by allowing FDA regulation of the development of LDTs at academic medical centers. Issue: Educate Congress on the medical education and training continuum, the annual residency Match, and the role of the National Resident Matching Program (NRMP) in medical education and residency. Issue: Provide guidance on the implementation of the No Surprises Act (P.L.116-260). Issue: Educate Congress and the administration on the role of academic medicine in the provision of mental and behavioral health care, including initiatives to respond to the opioid epidemic. Support policies to strengthen the behavioral health workforce, promote the uptake of integrated behavioral health models, advance mental health research, and ensure access to coverage and care. Issue: Educate Congress about the financial challenges facing academic medical centers, including reimbursement challenges, workforce challenges, inflation, and others. Issue: Educate Congress and the administration about the impact of the unwinding of the COVID-19 public health emergency on the academic medicine community and the patients they serve. H.R.3887 - Childrens Hospital GME Support Reauthorization Act of 2023 H.R.3841 - To amend title III of the Public Health Service Act to reauthorize the program of payments to children's hospitals that operate graduate medical education programs Issue: Support clean reauthorization of the Childrens Hospital GME program. Issue: Express concern regarding actions to inappropriately undermine FDA regulatory authority. Issue: Educate Congress and the administration about medical education on nutrition, hunger, and health; reproductive health; substance use disorders; medication assisted treatment for opioid use disorders; trans health; preventing fraud and abuse; diversity, equity, and inclusion; menopause management; health care for people with disabilities; and maternal health. Issue: Educate Congress on resident expectations related to clinical practice and oppose so-called physician service mandates. H.R.7855 - Rural Residency Planning and Development Act of 2024 Issue: Support codification of HRSAs rural residency planning and development program. Issue: Educate Congress on vaccine safety.

Client expense: $660,005 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Vice President of the U.S., White House Office

Ending Discrimination Against Gay and Bisexual Blood and Tissue Donors Funding for HIV/AIDS Education, Prevention, and Research Funding for and Education Regarding Comprehensive Sexual Health Education Implementation of Section 1557 Nondiscrimination regulations Implementation and Protection of the Patient Protection and Affordable Care Act Labor, HHS, and Education Appropriations PrEP Insurance Coverage Title X Family Planning Funding Access to Gender Affirming Care FDA Ban on Blood Donation by MSM Employment Benefits Surgical Exclusion to Gender Affirming Care through the Department of Veterans Affairs Conversion Therapy H.R. 12; S. 701: Womens Health Protection Act of 2023 H.R. 1723; S. 929: Abortion is Health Care Everywhere Act of 2023 H.R. 1399; H.R. 5636; S. 2357: Protect Children's Innocence Act H.R. 1276; S. 635: Protect Minors from Medical Malpractice Act of 2023 S. 457: Protecting Our Kids from Child Abuse Act H.R. 3131: To prohibit the use of funds to seek membership in the World Health Organization or to provide assessed or voluntary contributions to the World Health Organization. H.R. 3328; S. 1597: Protecting Children From Experimentation Act of 2023 H.R. 3850: Pride in Mental Health Act of 2023 H.R. 3887: Children's Hospital GME Support Reauthorization Act of 2023 H.R. 3583: Real Education and Access for Healthy Youth Act of 2023 H.R. 4340; S. 2176: Therapeutic Fraud Prevention Act of 2023 H.R. 3409; S. 1664: Healthy Families Act H.R. 4392; S. 2188: PrEP Access and Coverage Act of 2023 S. 2246: Gender-Affirming CARE Act S. 2797: Protecting Conscience in Our Health Care Act H.R. 5894; S. 2624: Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2024

Client expense: $222,963 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Natl AIDS Policy, SENATE, Veterans Affairs, Dept of (VA), White House Office

Q1 Lobbying Report (Jan. 1-March 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 Public Health Emergency designation 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 (HR7635) 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 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 SUBJECT: CMS-4205-P, Medicare Program; Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications (Vol 88, No. 219), Wednesday, November 15th SUBJECT: RIN 0955-AA05, 21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking, Proposed Rule, Federal Register (Vol 88, No 210), November 1, 2023 Subject: CMS-9897-P Federal Independent Dispute Resolution Operations, Proposed Rule, Federal Register (Vol. 88, No. 212), November 3, 2023

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

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

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 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: $420,000 · Firm income: Not reported

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

Medicaid program reforms, including telemedicine and prior authorization issues Section 340B Drug Pricing program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Drug pricing reforms generally Juvenile mental and behavioral health legislation generally "Food as medicine" nutrition programs generally Medicaid Disproportionate Share Hospital payments Advanced Research Projects Agency-Health program generally H.R. 3884 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023), all provisions H.R. 3391 (Gabriella Miller Kids First Research Act 2.0), all provisions H.R. 3887 (Childrens Hospital GME Support Reauthorization Act of 2023), all provisions Medicare "site neutral" payment policy generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 Pediatric cancer research generally Pediatric access to cell and gene therapies generally H.R. 4822 (Health Care Price Transparency Act of 2023), all provisions H.R. 7808 (EARLY Minds Act), regarding pediatric mental health

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid program reforms, including telemedicine Section 340B Drug Pricing Program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Sickle cell disease research funding generally Drug pricing reforms generally Mental and behavioral health legislation generally Advanced Research Projects Agency-Health program generally H.R. 3887 (Childrens Hospital GME Support Reauthorization Act of 2023), all provisions H.R. 3884 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023), all provisions Site neutral payments to providers generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 Autism CARES Act reauthorization - draft bill H.R. 6960 and S. 3765 (Emergency Medical Services for Children (EMSC) Reauthorization Act of 2024), all provisions

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3887, the Childrens Hospital GME Support Reauthorization Act of 2023; No Bill Number - Childrens Hospital Graduate Medical Education (CHGME) and Congressionally Directed Spending Request within the Labor, HHS, Appropriations bill; No Bill Number - Health Care Workforce priorities; No Bill Number - delay of cuts to Disproportionate Share Hospital payments.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3887, the Childrens Hospital GME Support Reauthorization Act of 2023; No Bill Number - Childrens Hospital Graduate Medical Education (CHGME) and Congressionally Directed Spending Request within the Labor, HHS, Appropriations bill; No Bill Number - Health Care Workforce priorities; No Bill Number - delay of cuts to Disproportionate Share Hospital payments.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3046/S.1403 - Medical Student Education Authorization Act of 2023 Issue: Support grants for primary care training in medically under-resourced communities. Draft Social Determinants Accelerator Act Issue: Support grants to address social determinants of health. Draft Health Equity and Accountability Act Issue: Support programs to improve health equity and address social determinants of health. S.2333 - Pandemic and All-Hazards Preparedness and Response Act H.R.4420 - Preparedness and Response Reauthorization Act H.R.4421 - Preparing for All Hazards and Pathogens Reauthorization Act H.R.4697 - Protecting PAHPA Act of 2023 Issues: Support the reauthorization of the Pandemic and All-Hazards Preparedness Act with increased funding authorization levels. Issue: Support authorities to strengthen CDCs and ASPRs ability to prevent and respond to existing and emerging threats. S.1995 - Public Health Infrastructure Saves Lives Act Issue: Support investments in core public health infrastructure. Issue: Educate Congress on how the 340B Drug Pricing Program helps safety-net providers to fulfill their missions and care for patients and communities. Support measures to preserve and strengthen the 340B Drug Pricing Program and oppose efforts to reduce the scope of the program, restrict use of contract pharmacies, and impose additional reporting requirements for 340B hospitals. H.R.2534 - Preserving Rules Ordered for the Entities Covered Through 340B Act of 2023 (PROTECT 340B Act) Issue: Support measures to prevent pharmacy benefit managers and commercial insurers from imposing discriminatory reimbursement policies on 340B covered entities. H.R.3561 - Promoting Access to Treatments and Extremely Needed Transparency Act of 2023 (PATIENT Act) Issue: Oppose requiring 340B covered entities to report their 340B savings for patients enrolled in Medicaid managed care plans. Oppose implementation of so-called site-neutral payment policies in the Medicare program. Oppose burdensome and duplicative reporting and transparency requirements. H.R.3290 - To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. Issue: Impose efforts to impose additional, onerous reporting requirements on 340B hospitals. Issue: Oppose insurance plans that do not meet Affordable Care Act requirements. Issue: Support policies to improve maternal health outcomes through expanded Medicaid coverage, enhanced data collection, and improved access to behavioral health care during the perinatal period. H.R.3838/S. 2415 Preventing Maternal Deaths Reauthorization Act Issue: Support continued federal funding for state-based maternal mortality review committees. H.R.2369 - Verifying Accurate Leading-edge IVCT Development (VALID) Act of 2023 Issue: Educate Congress on development of Laboratory Developed Tests at academic medical centers and oppose policies that would increase burdensome regulations and negatively impact patients access to care by allowing Food and Drug Administration regulation of the development of Laboratory Developed Tests at academic medical centers. Issue: Educate Congress on the medical education and training continuum, the annual residency Match, and the role of the National Resident Matching Program (NRMP) in medical education and residency. Issue: Provide guidance on the implementation of the No Surprises Act (P.L. 116-260). Issue: Educate Congress and the administration on the role of academic medicine in the provision of mental and behavioral health care, including initiatives to respond to the opioid epidemic. Support policies to strengthen the behavioral health workforce, promote the uptake of integrated behavioral health models, and ensure access to coverage and care. Issue: Educate Congress about the financial challenges facing academic medical centers, including reimbursement challenges, workforce challenges, inflation, and others. Issue: Educate Congress and the administration about the impact of the unwinding of the COVID-19 public health emergency on the academic medicine community and the patients they serve. S.2840 - Bipartisan Primary Care and Health Workforce Act Issue: Oppose cuts to the Prevention and Public Health Fund. Support workforce investments and extension of National Health Service Corps funding. H.R.3887 - Childrens Hospital GME Support Reauthorization Act of 2023 H.R.3841 - To amend title III of the Public Health Service Act to reauthorize the program of payments to children's hospitals that operate graduate medical education programs Issue: Urge clean reauthorization of the Childrens Hospital GME program. Issue: Express concern regarding actions to inappropriately undermine FDA regulatory authority. Issue: Educate Congress and the administration about medical education on nutrition, hunger, and health; reproductive health; substance use disorders; trans health; preventing fraud and abuse; diversity, equity, and inclusion; menopause management; and health care for people with disabilities. H.R.2670/S.2226 - National Defense Authorization Act for Fiscal Year 2024 Issue: Support military health workforce.

Client expense: $641,145 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Vice President of the U.S., White House Office

Medicaid program reforms, including telemedicine and prior authorization issues Section 340B Drug Pricing program, including H.R. 5378 (Lower Costs, More Transparency Act), Section 202 Drug pricing reforms generally Juvenile mental and behavioral health legislation generally "Food as medicine" nutrition programs generally Medicaid Disproportionate Share Hospital payments Advanced Research Projects Agency-Health program generally H.R. 3884 (Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023), all provisions H.R. 3391 (Gabriella Miller Kids First Research Act 2.0), all provisions H.R. 3887 (Children's Hospital GME Support Reauthorization Act of 2023), all provisions Implementation of Pediatric Specialty Loan Repayment Program Medicare "site neutral" payment policy generally, including H.R. 5378 (Lower Costs, More Transparency Act), Section 203 Pediatric cancer research generally Pediatric access to cell and gene therapies generally H.R. 4822 (Health Care Price Transparency Act of 2023), all provisions H.R. 4714 / S. 2345 (Pediatricians Accelerate Childhood Therapies (PACT) Act), all provisions H.R. 2412 (Helping Kids Cope Act), all provisions H.R. 5976 / S. 3060 (Youth Mental Health Research Act), all provisions S. 2556 (Improving Coordination and Access to Resources Equitably (CARE) for Youth Act), all provisions

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

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

Hospital Group Purchasing - Advocated to highlight the value that hospital group purchasing organizations provide to hospitals and suppliers. Provided education on how GPOs work in the healthcare supply chain and the role they play in delivering value to healthcare providers. Endorsed passage of Connecting Our Medical Providers with Links to Expand Tailored and Effective (COMPLETE) Care Act (H.R. 5819/S.1378). Preparing for All Hazards and Pathogens Reauthorization Act (H.R. 4421) and Preparedness and Response Reauthorization Act (H.R. 4420) - Supported passage of legislation to reauthorize the Pandemic and All Hazards Preparedness Act. Advocated for including provisions to increase transparency in the healthcare supply chain and improve hospital and health system emergency preparedness. Payer-mandated White Bagging - Urged support for policy updates related to payer-mandated white bagging for medications. Drug shortages -Supported elements to increase transparency in prescription drug supply chain and increase reimbursement for generic prescription drugs; issues related to compounding; issues related to buffer inventory. Endorsed passage of the Drug Origin Transparency Act (H.R. 3810). Endorsed passage of the Biosimilar Red Tape Elimination Act (S. 2305). Supported passage of the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act (S. 1355/H.R. 2940). Supported passage of the Biologics Competition Act (H.R. 1790). Endorsed passage of Biosimilar Red Tape Elimination Act (S.2305) 340B Drug Pricing Program - Continued to urge action to ensure covered entities have access to 340B discounted prices through contract pharmacies. Highlighted critical importance of the 340B program for hospitals. Endorsed passage of the Preserving Rules Ordered for The Entities Covered Through (PROTECT) 340B Act (H.R. 2534). Opposed legislation (H.R. 3290/S. 1133) that would place cumbersome reporting obligations on 340B covered entities. Buffer inventory - Engagements with CMS on reimbursement for hospitals that stockpile buffer supplies of essential medicines Mental and Behavioral Health - Highlighted during congressional briefing how hospitals are providing mental and behavioral health treatment and support for their communities. Highlighted the need for legislation to address significant challenges to mental and behavioral health treatment, including increased demand for services, limited access to treatment, and clinician shortages. Healthcare Workforce - Supported passage of the Resident Physician Shortage Reduction Act (H.R. 2389 / S. 1302), the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S. 2768) and the Healthcare Workforce Resilience Act (H.R 6205/S. 3211); Monitored development and introduction of the Bipartisan Primary Care and Health Workforce Act (S.2840) Children's Hospital Graduate Medical Education (CHGME) - Urged Congress to reauthorize CHGME program through the Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887). Offered support for providing $738 million in funding the CHGME program. Unique Device Identification (UDI) - Continued engagement to improve data standards and validation and support opportunities for the improved use of unique device identification and the Global UDI database (GUDID). Telehealth - Continued supporting passage of the CONNECT for Health Act (S. 2016/H.R. 4189). Continued to advocate for the adoption of permanent telehealth policies to extend flexibilities beyond the current 2024 expiration date. Social Determinants of Health - Encouraged Congress and agencies to ensure tools like the Vizient Vulnerability Index are being utilized to understand and identify social drivers of health at the neighborhood level. Medical Device Sterilization - Conducted education and outreach on the potential negative impact on the healthcare supply chain of pending regulations limiting the use of Ethylene Oxide as a medical device sterilant. Issues related to pharmacy benefit managers

Client expense: $780,000 · 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), SENATE