Health Care Price Transparency Act of 2023

Discuss with Congressional staff and HHS staff support for Medicare GME expansion and changes to GME program: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act; additional GME slots in CAA, 2021 and CAA, 2023; Rural Residency Planning and Development Act; concerns on Rural Physician Workforce Preservation Act; Senate Finance Committee proposals to increase GME slots. Discuss with Congressional staff opposition to Medicaid proposals in H.R.1: work requirements as a condition of coverage, changes to state-directed payments, reductions to Federal matching funds, reductions to the safe harbor threshold for provider taxes, sunsetting uniform tax waivers, rescission of Medicaid Eligibility rule and Medicaid/CHIP Access rule, reductions to retroactive coverage, reduction of reasonable opportunity window. Discuss technical amendment to CAA, 2021, Sec. 131 pertaining to Medicare GME with Congressional staff. Discuss with Congressional staff distribution methodology for Medicare GME slots created in the CAA, 2021. Discuss expiring COVID-19 Public Health Emergency (PHE) Medicare flexibilities with Congressional staff and HHS staff and support legislative proposals to extend PHE telehealth flexibilities and Acute Hospital Care at Home Waiver. Support extension of Medicare Dependent Hospital and Low-Volume Adjustment programs. Discuss opposition to Medicare site-neutral payment policies with Congressional staff. Oppose changes to NPIs for hospital outpatient departments (118th Congress: H.R. 7623, H.R. 4509, H.R. 7623 as amended, H.R. 4822). Discuss FY 2024 IPPS comments with Congressional, HHS staff: to increase payment update to hospitals, Transforming Episodic Accountability Model, AHEAD Model, and CAA, 2023 Sec 4122 GME slot distribution methodology. Discuss proposals that stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support), make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Support certain changes to Medicaid DSH payments: support two-year elimination of Medicaid DSH cut scheduled for January 1, 2025; support Save Our Safety Net Hospitals Act to restore pre-CAA, 2021 DSH cap calculation methodology and include dual-eligible patients in state DSH cap calculation. Discuss Medicaid waiver with Congressional staff and HHS. Discuss CMMI initiatives on global budgets and primary care in NYS Medicaid waiver. Discuss Medicaid IMD exclusion policies with Congressional staff. Support legislation to increase Medicaid payment rates for labor and delivery services for certain hospitals (118th Congress: S.5236). Oppose CMS final rule to establish minimum nurse staffing in Medicare- and Medicaid-certified long-term care facilities (89 FR 40876) and support legislative efforts to repeal rule. Support Medicare Advantage prior authorization reforms - Improving Seniors Timely Access to Care Act (H.R. 3514/S. 1816). Discuss wage index issues with Congressional staff: H.R. 8561 to address MA local area growth under projection, FY 2025 IPPS/LTCH interim final rule, indirect medical education (IME) payments to hospitals. Meet with CMS leadership to discuss Medicare and Medicaid issues: prior authorization and MA insurance denials, concerns on mandatory participation for AHEAD and TEAM models, Medicare support for health care workforce; support for telehealth flexibilities and Acute Hospital Care at Home waiver extension. Discuss Medicare wage index issues with CMS. Discuss Medicaid Section 1332 waiver with Congressional staff. Urge delayed enforcement of CMS final rule prohibiting nurses from performing glucose tests using high-complexity devices in point-of-care situations.

Client expense: $570,000 · Firm income: Not reported

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

Discussions involving H.Con.Res.14 - Establishing the congressional budget for the United States Government for fiscal year 2025 and setting forth the appropriate budgetary levels for fiscal years 2026 through 2034. Monitored Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 Monitored HR 4822 Health Care Price Transparency Act of 2023 Monitored S 2840 Bipartisan Primary Care and Health Workforce Act

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

Discuss with Congressional staff and HHS staff support for Medicare GME expansion and changes to GME program: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act (H.R. 7050); additional GME slots in CAA, 2021 and CAA, 2023; Rural Residency Planning and Development Act (H.R. 7855); concerns on Rural Physician Workforce Preservation Act; Senate Finance Committee proposals to increase GME slots. Discuss technical amendment to CAA, 2021, Sec. 131 pertaining to Medicare GME with Congressional staff. Discuss with Congressional staff distribution methodology for Medicare GME slots created in the CAA, 2021. Discuss expiring COVID-19 Public Health Emergency (PHE) Medicare flexibilities with Congressional staff and HHS staff and support legislative proposals to extend PHE telehealth flexibilities and Acute Hospital Care at Home Waiver. Support extension of Medicare Dependent Hospital and Low-Volume Adjustment programs. Support proposals to reduce payment cut in CY 2025 Physician Fee Schedule final rule. Discuss opposition to Medicare site-neutral payment policies with Congressional staff. Oppose changes to NPIs for hospital outpatient departments (H.R. 7623, H.R. 4509, H.R. 7623 as amended, H.R. 4822). Comment on FY 2024 IPPS rule to increase payment update to hospitals, Transforming Episodic Accountability Model, AHEAD Model, and CAA, 2023 Sec 4122 GME slot distribution methodology, and discuss comments with Congressional staff and CMS staff. Discuss proposals that stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support), make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Discuss with Congressional staff opposition to proposals to reduce the Medicaid program: work requirements as a condition of coverage, changes to state-directed payments, block grants, per capita caps, reductions to federal matching funds, reductions to the safe harbor threshold for provider taxes, rescission of Medicaid Eligibility rule and Medicaid/CHIP Access rule. Support certain changes to Medicaid DSH payments: support two-year elimination of Medicaid DSH cut scheduled for January 1, 2025; support Save Our Safety Net Hospitals Act (H.R. 9351) to restore pre-CAA, 2021 DSH cap calculation methodology and include dual-eligible patients in state DSH cap calculation. Discuss Medicaid waiver proposal with Congressional staff and HHS. Discuss CMMI initiatives on global budgets and primary care in NYS Medicaid waiver. Discuss Medicaid IMD exclusion policies with Congressional staff. Support legislation to increase Medicaid payment rates for labor and delivery services for certain hospitals (118th Congress: S.5236). Discuss with Congressional staff support for CMS approval of Medicaid managed care organization tax proposed in New York State budget. Oppose CMS final rule to establish minimum nurse staffing in Medicare- and Medicaid-certified long-term care facilities (89 FR 40876) and support legislative efforts to repeal rule. Support Medicare Advantage prior authorization reforms - Improving Seniors Timely Access to Care Act (118th Congress: S. 4532/H.R. 8702). Discuss wage index issues with Congressional staff: H.R. 8561 to address MA local area growth under projection, FY 2025 IPPS/LTCH interim final rule, indirect medical education (IME) payments to hospitals. Meet with CMS leadership to discuss Medicare and Medicaid issues: prior authorization and MA insurance denials, concerns on mandatory participation for AHEAD and TEAM models, Medicare support for health care workforce; support for telehealth flexibilities and Acute Hospital Care at Home waiver extension. Discuss Medicare wage index issues with CMS. Discuss Medicare Part B payment for unlicensed physicians with CMS. Support New York State Essential Plan (Medicaid Section 1332 Waiver) and oppose proposals to reduce coverage. Urge delayed enforcement of CMS final rule prohibiting nurses from performing glucose tests using high-complexity devices in point-of-care situations.

Client expense: $530,000 · Firm income: Not reported

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

Physician payment issues (MEI, E/M Budget Neutrality, APMs, MIPS) including SFC white paper: Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B; Prior authorization in Medicare Advantage; HR 1770/S. 2477 Equitable Community Access to Pharmacist Services Act HR 766/S 144 Preventive Health Savings Act HR 618/ S 131 Improving Access to Workers' Compensation for Injured Federal Workers Act of 2023. S.1512 - CONNECT for Health Act of 2021 Monitoring PBM legislation - S. 1967 and S. 1038 H.R. 4822, Health Care Price Transparency Act of 2023; H.R. 2474, Strengthening Medicare for Patients and Providers Act; H.R. 3284, Providers and Payers COMPETE Act; S. 3503, Value in Healthcare Act; H.R. 10545, American Relief Act, 2025

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration (RCD) Project IRF Three-Hour Rule - H.R. 6110, the Access to Inpatient Rehabilitation Therapy Act of 2023 Prior Authorization Reform - H.R. H.R.8702/S. 4532, the Improving Seniors' Timely Access to Care Act of 2024 - H.R. 4822, the Health Care Price Transparency Act of 2023 - H.R. 4968, the Getting Over Lengthy Delays in Care As Required by Doctors Act of 2023 - H.R. 5213, the Reducing Medically Unnecessary Delays in Care Act of 2023 Medicare Reimbursement / Physician Payment Schedule Cuts - H.R. 2474, the Strengthening Medicare for Patients and Providers Act of 2023 - H.R. 10073, the Medicare Patient Access and Practice Stabilization Act of 2024 Scope of Practice - H.R. 2713, the Improving Care and Access to Nurses Act of 2023 - H.R. 618 / S. 131, the Improving Access to Workers' Compensation for Injured Federal Workers Act - National Standards of Practice at the Department of Veterans Affairs Telehealth - Extension of federal telehealth waivers first implemented during COVID-19 public health emergency

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

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

COVID-19 / Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) / Long COVID - S. 801 / H.R. 1616, the CARE for Long COVID Act of 2023 - H.R. 1114, the Long COVID Recovery Now Act of 2023 - H.R. 3258, the TREAT Long COVID Act of 2023 - S. 2560, the Long COVID Support Act of 2023 - H.R. 9907 / S. 4964, the Long COVID Research Moonshot Act of 2024 Funding for Rehabilitation Research Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration (RCD) Project Streamlining access to rehabilitation for Medicare beneficiaries (SNF three day rule, IRF three hour rule) - H.R. 6110, the Access to Inpatient Rehabilitation Therapy Act of 2023 Prior Authorization Reform - H.R. H.R.8702 /S. 4532, the Improving Seniors' Timely Access to Care Act of 2024 - H.R. 4822, the Health Care Price Transparency Act of 2023 - H.R. 4968, the Getting Over Lengthy Delays in Care As Required by Doctors Act of 2023 - H.R. 5213, the Reducing Medically Unnecessary Delays in Care Act of 2023 Medicare Reimbursement / Physician Payment Schedule Cuts - H.R. 2474, the Strengthening Medicare for Patients and Providers Act of 2023 - H.R. 10073, the Medicare Patient Access and Practice Stabilization Act of 2024 Scope of Practice - H.R. 2713, the Improving Care and Access to Nurses Act of 2023 - H.R. 618 / S. 131, the Improving Access to Workers' Compensation for Injured Federal Workers Act - National Standards of Practice at the Department of Veterans Affairs Telehealth - Extension of federal telehealth waivers first implemented during COVID-19 public health emergency

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

Issues related to drug pricing reform Changes to Public law 117-1769 Inflation Reduction Act Awareness of implications to patients and research and development of Public law 117-1769 Inflation Reduction Act S. 113 Prescription Pricing for the People Act of 2023 S.127 Pharmacy Benefit Manager Transparency Act HR 830/ S 1375 HELP Copays Act HR 485 Protecting Health Care for All Patients Act HR 5378 Lower Costs, More Transparency Act R 2534 PROTECT 340B Act of 2023 HR 3561 the PATIENT Act S. 1542 DRUG Act S. 1967 PBM Act HR 3503 The NIH Clinical Trials Diversity Act Issues related to cardiovascular disease awareness and treatment Issues related to Federal Trade Commission FDA issues Issues related to patient affordability issues, including copay cards, copay accumulators, copay maximizers, National Benefit Payment Parameters Biosimilars reimbursement issues, no specific bill Supply Chain Issues, no specific bill Issues related to 340B Issues related to pharmacy benefit managers Proposed rule: Medicaid Program; Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program HR 4818/ S. 2407 Treat and Reduce Obesity Act S. 2305 Biosimilar Red Tape Elimination Act S. 2129 Ensuring Access to Lower-Cost Medicines for Seniors Act Issues related to PAHPA reauthorization Modernizing and Ensuring PBM Accountability Act (Finance Committee) S. 652/ HR2630 SAFE Step Act S 2474/ HR 5376 Share the Savings with Seniors Act S 2456 Protecting Seniors from High Drug Costs Act HR4881 To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program HR 3281 Protecting Patients Against PBM Abuses Act HR 4822 Health Care Price Transparency Act of 2023 S 1339 Pharmacy Benefit Manager Reform Act HR 2679 Pharmacy Benefits Manager Accountability Act HR 4507 Transparency in Coverage Act of 2023 HR 1352 Increasing Access to Biosimilars Act of 2023 HR 2880 Protecting Patients Against PBM Abuses Act Issues pertaining to the implementation of PL 97-414 "Orphan Drug Act," all provisions. HR 5539 Orphan Cures Act HR 5547 Maintaining Investments in New Innovation Act S 3558 BIOSECURE Act HR 7174 Ensuring Pathways to Innovative Cures (EPIC Act) S Res 566 Cholesterol Education Month 2024 HR 7635 340B PATIENTS Act of 2024 H.R. 5391 / S. 2764 The Protecting Patient Access to Cancer and Complex Therapies Act H.R.8574 - 340B Affording Care for Communities and Ensuring a Strong Safety-net Act. HR 5376 Share the Savings With Seniors Act S 3430 Mental Health, Lower Cost Drugs and Extenders Package. BIOCOMPETE (no bill number)- Issues related to prohibiting the export of biotechnology to certain foreign entities HR 8412 Clinical Trial Modernization Act S 5573 Skinny Labels, Big Savings Act HR 10515 American Relief Act

Client expense: $2,780,000 · Firm income: Not reported

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

Issues related to drug pricing reform Changes to Public law 117-1769 Inflation Reduction Act Awareness of implications to patients and research and development of Public law 117-1769 Inflation Reduction Act S. 113 Prescription Pricing for the People Act of 2023 S.127 Pharmacy Benefit Manager Transparency Act HR 485 Protecting Health Care for All Patients Act HR 5378 Lower Costs, More Transparency Act HR 2534 PROTECT 340B act of 2023 HR 3561 the PATIENT act Issues related to cardiovascular disease awareness and treatment Issues related to ESRD Issues related to asthma and self-administered drug list Issues related to reimbursement for biologics/biosimilars Proposed rule: Medicaid Program; Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program HR 4818/ S2407 Treat and Reduce Obesity Act S. 2129 Ensuring Access to Lower-Cost Medicines for Seniors Act Issues related to PAHPA reauthorization Modernizing and Ensuring PBM Accountability Act (Finance Committee) S. 1542/HR 6283 DRUG Act S652 SAFE Step Act HR 3281 Protecting Patients Against PBM Abuses Act HR 4822 Health Care Price Transparency Act of 2023 S 1339 Pharmacy Benefit Manager Reform Act HR 2679 Pharmacy Benefits Manager Accountability Act HR 4507 Transparency in Coverage Act of 2023 S 2474/HR 5376 Share the Savings with Seniors Act S 2456 Protecting Seniors from High Drug Costs Act HR4881 To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program HR 1352 Increasing Access to Biosimilars Act of 2023 HR 2880 Protecting Patients Against PBM Abuses Act HR 5547 Maintaining Investments in New Innovation Act HR 7174 Ensuring Pathways to Innovative Cures (EPIC Act) HR 7635 340B PATIENTS Act of 2024 H.R. 5391 / S. 2764 The Protecting Patient Access to Cancer and Complex Therapies Act H.R.8574 - 340B Affording Care for Communities and Ensuring a Strong Safety-net Act. HR 5376 Share the Savings With Seniors Act. S 3430 Mental Health, Lower Cost Drugs and Extenders Package HR 5539 Orphan Cures Act HR 10515 American Relief Act

Client expense: $2,780,000 · Firm income: Not reported

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

H.R. 5391/S. 2764, Protecting Patient Access to Cancer and Complex Therapies Act; Access and reimbursement of Part B Drugs in Medicare; Continued expansion of Telehealth services including in H.R. 3875/S. 3967, Expanded Telehealth Access Act and Telehealth Modernization Act; H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency Act (PATIENT Act) of 2023; H.R. 4822, Health Care Price Transparency Act of 2023; Support for site neutrality policies in H.R. 5378, Lower Costs, More Transparency Act; Implementation of provisions included in Subtitle B of PL. 117-169 - Inflation Reduction Act of 2022; Issues related to MACRA Reform including H.R. 2474, Strengthening Medicare for Patients and Providers Act; Support the passage of H.R. 5526/S. 3458, the Seniors' Access to Critical Medications Act; H.R. 6683, Preserving Seniors Access to Physicians Act of 2023; Issues related to prior authorization in H.R. 8702/S. 4518, Improving Seniors Timely Access to Care Act of 2024; S. 2973, The Modernizing and Ensuring PBM Accountability (MEPA) Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to Medical Economic Index (MEI) in the 2023 Physician Fee Schedule Rule; H.R. 2474, Strengthening Medicare for Patients and Providers Act; H.R. 3561, PATIENT Act of 2023; H.R. 3284, Providers and Payers COMPETE Act; H.R. 4822, Health Care Price Transparency Act of 2023; S. 3503, Value in Healthcare Act; SFC white paper entitled, Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B; Issues related to physician payment cuts; H.R. 1770/S. 2477, Equitable Community Access to Pharmacist Services Act; H.R. 10545, American Relief Act, 2025

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to S. 113, the Prescription Pricing for the People Act; S. 127, the Pharmacy Benefit Manager Transparency Act; S. 1339, Pharmacy Benefit Manager Reform Act; S.1542/H.R. 6283, the Delinking Revenue from Unfair Gouging (DRUG) Act; H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023; H.R. 2666, the Medicaid VBPs for Patients (MVP) Act; H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023 (previously H.R. 2691, Transparent PRICE Act); H.R. 3281, To promote hospital and insurer price transparency; H.R. 2880, Protecting Patients Against PBM Abuses Act; H.R. 2679, The PBM Accountability Act; H.R.3285, the Fairness for Patient Medications Act, to establish patient protections with respect to highly rebated drugs; H.R. 3262, To amend title XI of the Social Security Act to increase transparency of certain health-related ownership information; H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program; H.R. 2666, the Medicaid VBPs for Patients (MVP) Act; H.R. 3284, the Providers and Payers COMPETE Act; S. 1967 the Patients Before Middlemen (PBM) Act; Protect Patients Access to Pharmacies Act; S. 2406, PBM Oversight Act of 2023; S. 2973, Modernizing and Ensuring PBM Accountability Act; S. 2436, the Neighborhood Options for Patients Buying Medicines (NO PBMs) Act; S. 2405, the Strengthening Pharmacy Access for Seniors Act; S. 2254, the Medicare PBM Accountability Act; S. 2052, the Protect Patient Access to Pharmacies Act; H.R. 4822, the Health Care Price Transparency Act of 2023; H.R. 3284, the Providers and Payers COMPETE Act; H.R. 4508, the Hidden Fee Disclosure Act; H.R. 4507, the Transparency in Coverage Act of 2023; H.R. 4895, the Lowering Drug Costs for American Families Act; H.R. 5378 Lower Costs, More Transparency Act; H.R. 4527, Health Data Access, Transparency, and Affordability Act (DATA) Act; H.R. 3285, Fairness for Patient Medications Act; S. 2973 Modernizing and Ensuring PBM Accountability Act; S. 3548, Health Care Prices Revealed and Information to Consumers Explained Transparency Act (Health Care PRICE Transparency Act 2.0); H.R.3285 - Fairness for Patient Medications Act; H.R. 3008, the Drug Shortage Prevention Act of 2023; H.R. 3810, the Drug Origin Transparency Act of 2023; H.R. 3793, the Ensuring Access to Lifesaving Drugs Act of 2023; H.R. 167, the Patient Access to Urgent-Use Pharmacy Compounding Act of 2023; H.R. 7535, Prescription Drug Supply Chain Pricing Transparency Act; S. 2305, Biosimilar Red Tape Elimination Act; H.R. 6986/S.3583, to address patent thickets; H.R. 8261, the Preserving Telehealth, Hospital, and Ambulance Access Act; Supporting Underserved and Strengthening Transparency, Accountability, and Integrity Now and for the Future of 340B Act (SUSTAIN 340B Act); S.150, the Affordable Prescription Drug for Patients Act; S. 142, the Preserve Access to Affordable Generics and Biosimilars Act; S. 5503, H.R. 10362, the Patients Before Monopolies (PBM) Act; P.L. No: 118-158 and draft FY2025 Continuing Resolution, issues related to PBMs.

Client expense: $1,420,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S 2840 Bipartisan Primary Care and Health Workforce Act (all sections of full text) S 468 Hospital Transparency Compliance Enforcement Act (all sections of full text) HR 8113 Transparency into State Directed Payments Act of 2024 HR 4822 Health Care Price Transparency Act of 2023 (all sections of full text) Discussions involving CMS price transparency rule for hospitals Discussions involving enhanced premium tax credit Discussions involving 340B Drug Pricing Program Discussions pertinent to health care group purchasing organizations (GPOs) Monitored Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 Monitored S 3430 Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 Monitored S 1636 Protecting Rural Telehealth Access Act Monitored HR 3440 Protecting Rural Telehealth Access Act Monitored S 2016 Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 Monitored HR 4189 Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 Monitored discussions related to cyber-security threats on healthcare industry providers Monitored discussions pertaining to CMS rulemaking on surprise billing ban Monitored nominations to executive branch agencies and federally authorized commissions

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

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

Issues related to health care access and reimbursement through the Medicare and Medicaid programs including site neutrality and prior authorization policies in the Medicare program, specifically, The PATIENT Act of 2023 (H.R. 3561),the Healthcare Price Transparency Act (H.R. 4822), Accelerating Kids Access to Care Act(HR 3089, S 1544) and The Medicare Patient Access to Cancer Treatment (MPACT) Act (H.R. 4473).

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

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

Monitored Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 Monitored HR 4822 Health Care Price Transparency Act of 2023 Monitored S 2840 Bipartisan Primary Care and Health Workforce Act

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

S 1976 Preserving Patient Access to Home Infusion Act (all sections of full text)(support) HR 4104 Preserving Patient Access to Home Infusion Act (all sections of full text)(support) Discussions involving Medicaid access rule Discussions involving funding for state Medicaid programs to improve home- and community-based services Discussions involving federal definition of Long-Term Care pharmacies Discussions involving CMS finalized physician fee schedule Discussions involving home health Discussions pertaining to proposed legislation regarding Pharmacy Benefit Managers Discussions involving Medicare prescription drug proposals Discussions involving hospice proposals Discussions related to implementation of P.L. 117-169 Inflation Reduction Act of 2022 and affects on the long-term care pharmacy industry Monitored Further Continuing Approprations and Disaster Relief Supplemental Appropriations Act, 2025 Monitored nominations to executive branch agencies and federally authorized commissions Monitored HR 4822 Health Care Price Transparency Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage (star ratings, risk adjustment, Health Equity Index, supplemental benefits), Medicare Prior Authorization and electronic Prior Authorization (S. 4532, H.R. 8702), Provider Directories (S. 3430), Transparency & PBMs (H.R. 3561, H.R. 5378, H.R. 4822, H.R. 2880), Site Neutrality & Provider Billing (S. 1869, H.R. 3417, H.R. 5378), Medicare Coverage & Obesity (H.R. 4818 & S. 2407)

Client expense: $640,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Affordable Care Act--extending enhanced APTCs (H.R. 9774, S. 5194) and unauthorized enrollments in Marketplace plans (S. 4767), Affordability (H.R. 3589), Behavioral Health, Employer-Provided Health Coverage, Health Equity, Maternal Health, Surprise Billing, Health IT, Cybersecurity, Interoperability, Health Care Innovation, Telehealth-extending flexibilities, Transparency & PBMs (S. 127, S. 1339, S. 3430, H.R. 3651, H.R. 4507, H.R. 4508, H.R. 4509, H.R. 4527, H.R. 4822, H.R. 5378), Provider Directories (S. 3430), Prescription Drugs (S. 150, S. 1067, S. 1114, S. 2305), Preventative Services

Client expense: $640,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

-HR 830 / S 1357, HELP Copays Act -HR 2630 / S 652, Safe Step Act -S 1339, Pharmacy Benefit Manager Reform Act -H.R. 1770, the Equitable Community Access to Pharmacist Services Act -HR 824, the Telehealth Benefit Expansion for Workers Act -Accelerating Kids Access to Care Act - S. 127 Pharmacy Benefit Manager Transparency Act of 2023 - S. 1339 Pharmacy Benefit Manager Reform Act - H.R. 4507 Transparency in Coverage Act of 2023 - H.R. 4822 Health Care Price Transparency Act of 2023 - H.R. 3561 PATIENT Act of 2023 -H.R. 5378 - The Lower Costs, More Transparency Act - H.R. 2761 SPARC Act, Specialty Physicians Advancing Rural Care (SPARC) Act - S.1701/H.R.3503 NIH Clinical Trial Diversity Act of 2023 - H.R. 1114 Long COVID RECOVERY NOW Act - S.2840 the Bipartisan Primary Care and Health Workforce Act - Reducing Drug Prices for Seniors Act - Improving Seniors Timely Access to Care Act - Health Care Affordability Act

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE

HR 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 (PATIENT Act), advocating concerns over additional reporting requirements regarding PBMs. HR 4822, Healthcare Transparency Act of 2023, advocating concerns over certain reporting requirements regarding PBMs. HR 4846, Better Deals and Lower Prices Act of 2023, advocating concerns over certain reporting requirements that would be imposed on PBMs. Advocacy on behalf of PBMs on various House oversight hearings. Advocate against any and all proposed PBM legislation for inclusion in December 21, 2024 Continuing Resolution.

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

Government targets: HOUSE OF REPRESENTATIVES

Issues related to prescription drug value, including implementation of the Inflation Reduction Act (PL 117-169). Issues related to vaccine development, distribution and injury compensation. Issues related to insulin pricing. Issues related to FDA regulation of pharmaceuticals. Issues related to prescription drug pricing and pharmacy benefit manager business practices, including S. 127, Pharmacy Benefit Manager Transparency Act, S.1339 - Pharmacy Benefit Manager Reform Act, H.R. 2679, the PBM Accountability Act, H.R.4822 - Health Care Price Transparency Act, H.R. 5378 - Lower Costs, More Transparency Act. Issues related to the 340B program, including H.R. 3290, to ensure transparency and oversight of the 340B drug discount program. Pandemic All-Hazards Preparedness Act (PAHPA) reauthorization, including S.2333 - Pandemic and All-Hazards Preparedness and Response Act. Issues related to Type 1 diabetes screening. H.R.10545, FY25 Continuing Appropriations.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to prescription drug value, including implementation of the Inflation Reduction Act (PL 117-169). Issues related to vaccine development and distribution. Issues related to insulin pricing. Issues related to FDA regulation of pharmaceuticals. Issues related to prescription drug pricing and pharmacy benefit manager business practices, including S. 127, Pharmacy Benefit Manager Transparency Act, S.1339 - Pharmacy Benefit Manager Reform Act, H.R. 2679, the PBM Accountability Act, H.R.4822 - Health Care Price Transparency Act, H.R. 5378 - Lower Costs, More Transparency Act. Issues related to the 340B program, including H.R. 3290, to ensure transparency and oversight of the 340B drug discount program. Pandemic All-Hazards Preparedness Act (PAHPA) reauthorization, including S.2333 - Pandemic and All-Hazards Preparedness and Response Act. S.3558 - Biosecure. H.R.10545, FY25 Continuing Appropriations.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to prescription drug value, including implementation of the Inflation Reduction Act (PL 117-169). Issues related to vaccine development, distribution and injury compensation. Issues related to FDA regulation of pharmaceuticals. Issues related to prescription drug pricing and pharmacy benefit manager business practices, including S. 127, Pharmacy Benefit Manager Transparency Act, S.1339 - Pharmacy Benefit Manager Reform Act, H.R. 2679, the PBM Accountability Act, H.R.4822 - Health Care Price Transparency Act, H.R. 5378 - Lower Costs, More Transparency Act. Issues related to the 340B program, including H.R. 3290, to ensure transparency and oversight of the 340B drug discount program. Pandemic All-Hazards Preparedness Act (PAHPA) reauthorization, including S.2333 - Pandemic and All-Hazards Preparedness and Response Act. H.R.10545, FY25 Continuing Appropriations.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to prescription drug value, including implementation of the Inflation Reduction Act (PL 117-169). Issues related to FDA regulation of pharmaceuticals. Issues related to prescription drug pricing and pharmacy benefit manager business practices, including S. 127, Pharmacy Benefit Manager Transparency Act, S.1339 - Pharmacy Benefit Manager Reform Act, H.R. 2679, the PBM Accountability Act, H.R.4822 - Health Care Price Transparency Act, H.R. 5378 - Lower Costs, More Transparency Act. Issues related to the 340B program, including H.R. 3290, to ensure transparency and oversight of the 340B drug discount program. Pandemic All-Hazards Preparedness Act (PAHPA) reauthorization, including S.2333 - Pandemic and All-Hazards Preparedness and Response Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to prescription drug value, including implementation of the Inflation Reduction Act (PL 117-169). Issues related to FDA regulation of pharmaceuticals. Issues related to prescription drug pricing and pharmacy benefit manager business practices, including S. 127, Pharmacy Benefit Manager Transparency Act, S.1339 - Pharmacy Benefit Manager Reform Act, H.R. 2679, the PBM Accountability Act, H.R.4822 - Health Care Price Transparency Act, H.R. 5378 - Lower Costs, More Transparency Act. Issues related to the 340B program, including H.R. 3290, to ensure transparency and oversight of the 340B drug discount program. Pandemic All-Hazards Preparedness Act (PAHPA) reauthorization, including S.2333 - Pandemic and All-Hazards Preparedness and Response Act. H.R. 10545, FY25 Continuing Appropriations.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Recovery audit contractor reform. Medicare regulatory reform, including Medicare physician fee schedule and sequestration relief and payment reforms, including Medicare physician payment provisions in: (1) S. 3430, the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, Sec. 403 to extend work geographic index floor under Medicare; Sec. 404 to extend incentive payments for participation in eligible alternative payment models; and Sec. 407 to increase support for physicians and other professionals in adjusting to Medicare payment changes; (2) H.R. 6545, the Physician Fee Schedule Update and Improvements Act, including provisions to increase the work geographic index, increase the Medicare physician fee schedule conversion factor and extend and modify incentive payments for participation in eligible alternative payment models; (3) H.R. 4366, the Consolidated Appropriations Act, 2024, P.L. 118-42: Sec. 304, Extending Incentive Payments for Participation in Eligible Alternative Payment Models; and Sec. 305, Temporary Payment Increase under the Medicare Physician Fee Schedule to Account for Exceptional Circumstances and Atypical Timing of Enactment; and (4) HR ____ Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025-related to physician payment adjustment of 2.5%. Network adequacy oversight, including Medicare Advantage plan provider directory accuracy issues, including provisions in S. 3430, the Better Mental Health Care, Lower Cost Drugs, and Extenders Act of 2023, in Sec. 109, to require MA plans to maintain accurate provider directories on a public website. Medicare accountable care organizations. Electronic health record interoperability and vendor accountability. Medicare Parts C and D prior authorization reforms, including related provisions in: H.R. 4968, the GOLD Card Act; H.R. 4822, the Health Care Price Transparency Act; H.R. 5378, the Lower Costs, More Transparency Act; and S. 4518/S. 4532/H.R. 8702, to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Physician-led hospital barriers, including related provisions in H.R. 977/S. 470, the Patient Access to Higher Quality Care Act, and H.R. 9001, the Physician Led and Rural Access to Quality Care Act, to revise certain physician self-referral exemptions relating to physician-owned hospitals in rural areas. Enhance Center for Medicare & Medicaid Innovation quality initiatives and patient access to Medicare Part B covered drugs, including monitor: (1) implementation of provisions in the Inflation Reduction Act of 2022 (P.L. 117-169), Subtitle B, Part 1, sec. (b), to modify Medicare Part B reimbursement by application of Maximum Fair Prices and Conforming Amendments, to selected Medicare Part B covered drugs; and (2) CMMI Medicare Part B drug demonstrations, including the Most Favored Nation demonstration.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Repeal Section 6001 of the Affordable Care Act - section 6001 prohibits expansion of physician-led hospitals - including related provisions in H.R. 977/S. 470, the Patient Access to Higher Quality Care Act; and in H.R. 9001, the Physician Led and Rural Access to Quality Care Act, to revise certain physician self-referral exemptions relating to physician-owned hospitals in rural areas; and related issues regarding hospital competition and consolidation. Center for Medicare & Medicaid Innovation demonstration to expand patient access to physician-led hospitals. Reform Medicare Advantage prior authorization, including related provisions in: H.R. 4968, the GOLD Card Act; H.R. 4822, the Health Care Price Transparency Act; H.R. 5378, the Lower Costs, More Transparency Act; and S. 4518/S. 4532/H.R. 8702, to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Advocacy related to H.R. 8246, Second Chances for Rural Hospitals Act, and access to physician-led entities.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

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

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

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

S. 260/H.R. 704 - Promoting Access to Diabetic Shoes Act H.R. 2583/S. 3481 - Increasing Access to Quality Cardiac Rehabilitation Care Act H.R. 2713/S. 2418 - Improving Care and Access to Nurses (ICAN) Act S. 3939/H.R. 7665 - ACO Assignment Improvement Act of 2024 H.R. 7623/S. 3967 - Telehealth Modernization Act H.R. 5163/ S. 3193 - Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act S. 923 - Better Mental Health Care for Americans Act H.R. 3305/S. 1606 - Black Maternal Health Momnibus Act H.R. 2663/S. 1176 - Workplace Violence Prevention for Health Care and Social Service Workers Act S. 2085 - A bill to amend title XVIII of the Social Security Act to provide for Medicare coverage of multi-cancer early detection screening tests H.R. 2407 - the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act H.R. 4189/S. 2016 - CONNECT for Health Act S. 1869 - Site-based Invoicing and Transparency Enhancement Act (SITE) Act H.R. 3623/S. 1586 - Educating Future Nurses Act H.R. 2829 - Chronic Care Management Improvement Act of 2023 H.R. 2400/S. 1165 - Reentry Act of 2023 S.1378 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care) Act H.R. 4822 - Health Care Price Transparency Act of 2023 H.R. 4779 - Breast Cancer Patient Equity Act Primary Care and Health Workforce Expansion Act S. 2840 - Bipartisan Primary Care and Health Workforce Act S. 1976/H.R. 4104 - Preserving Patient Access to Home Infusion Act Support implementation of Medicare code G2211 S. 3297/H.R. 6407 - Medical Nutrition Therapy Act of 2023 S. 3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 S. 4338 - Pay PCPs Act of 2024 H.R. 8261 - Preserving Telehealth, Hospital, and Ambulance Access Act Issues related to Medicare Part B reform Skilled nursing facility admitting examination and assessment requirements Health plan coverage and program requirements, including provider non-discrimination, network adequacy and prior authorization Nursing faculty and workforce shortage Include nurses, APRNs, and nursing students in all national public health plans Rural health care issues, including rural workforce, COVID-19 vaccination, and reimbursement Addressing health equity Medication-Assisted Treatment (MATs) Issues relating to the mental and substance use disorder workforce Opioid epidemic COVID-19 Pandemic, including funding, personal protective equipment, testing and vaccines Extension of CMS waivers beyond the COVID-19 Public Health Emergency Telehealth, remote patient monitoring and other forms of health technology Reducing regulatory burdens, including those relating to Medicare Conditions of Participation Medicare provider reimbursement Documentation of medical records Use of clinician home address on Medicare claims when providing telehealth services

Client expense: $470,000 · Firm income: Not reported

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

S. 260/H.R. 704 - Promoting Access to Diabetic Shoes Act H.R. 2583/S. 3481 - Increasing Access to Quality Cardiac Rehabilitation Care Act H.R. 2713/S. 2418 - Improving Care and Access to Nurses (ICAN) Act S. 3939/H.R. 7665 - ACO Assignment Improvement Act of 2024 H.R. 7266/S. 3770 - Future Advancement of Academic Nursing (FAAN) Act H.R. 7153/S. 3679 - Dr. Lorna Breen Health Care Provider Protection Reauthorization Act H.R. 7623/S. 3967 - Telehealth Modernization Act H.R. 7002/S. 2815 - Nurse Faculty Shortage Reduction Act H.R. 5163/ S. 3193 - Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act H.R. 4534/S. 2245 - the Women and Lung Cancer Research and Preventive Services Act H.R. 5829 - Health Care Practitioner Disaster Protection Act S. 923 - Better Mental Health Care for Americans Act H.R. 3768/S. 1851 - Midwives for MOMs Act H.R. 3305/S. 1606 - Black Maternal Health Momnibus Act H.R. 2411/S. 1150 - National Nursing Workforce Center Act of 2023 H.R. 2663/S. 1176 - Workplace Violence Prevention for Health Care and Social Service Workers Act H.R. 3523/S. 1710 - Perinatal Workforce Act S. 2085 - A bill to amend title XVIII of the Social Security Act to provide for Medicare coverage of multi-cancer early detection screening tests H.R 2407 - the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act S. 2016 - CONNECT for Health Act S. 1869 - Site-based Invoicing and Transparency Enhancement Act (SITE) Act H.R. 3355 - Substance Use Disorder Treatment and Recovery Loan Repayment Program Reauthorization Act of 2023 S. 1627 - Providing Real-World Education and Clinical Experience by Precepting Tomorrows Nurses Act (PRECEPT) Nurses Act H.R. 3623/S. 1586 - Educating Future Nurses Act H.R. 3730/S. 198 - Rural Health Clinic Burden Reduction Act H.R. 2829 - Chronic Care Management Improvement Act of 2023 H.R. 2400/S. 1165 - Reentry Act of 2023 S. 1378 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care) Act H.Con.Res.42 - Honoring Mary Eliza Mahoney, America's first professionally trained Black nurse. S.Res.201/H.Res.375 - A resolution supporting the goals and ideals of National Nurses Week, to be observed from May 6 through May 12, 2023. H.R. 4822 - Health Care Price Transparency Act of 2023 H.R. 4779 - Breast Cancer Patient Equity Act Primary Care and Health Workforce Expansion Act S. 2840 - Bipartisan Primary Care and Health Workforce Act S. 3297/H.R. 6407 - Medical Nutrition Therapy Act of 2023 Support funding for the National Health Service Corps S. 862 - Restoring Americas Health Care Workforce and Readiness Act S. 1976/H.R. 4104 - Preserving Patient Access to Home Infusion Act S. 3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 S.Res. 676/H.Res. 1208 - a resolution supporting the goals and ideals of National Nurses Week, to be observed from May 6 through May 12, 2024 S. 4338 - Pay PCPs Act of 2024 H.R. 9133/S. 4835 - Primary and Behavioral Health Care Access Act H.R. 6860/S. 5018 - the Restore Protections for Dialysis Patients Act H.R. 10280 - Strengthening Pathways to Health Professions Act Issues related to Medicare Part B reform Issues related to enhancing access to care at home in rural and underserved communities Support for the creation of the Office of Caregiver Health Support a final rule prohibiting menthol cigarettes and cigars Support implementation of Medicare code G2211 Extending COVID-19 waivers related to nurse practitioners and critical access hospitals Skilled nursing facility admitting examination and assessment requirements Health plan coverage and program requirements, including provider non-discrimination, network adequacy and prior authorization Nursing faculty and workforce shortage Nursing education Include nurses, APRNs, and nursing students in all national public health plans Public health and nursing workforce infrastructure Rural health care issues, including rural workforce, COVID-19 vaccination, and reimbursement Addressing health equity Medication-Assisted Treatment (MATs) Issues relating to the mental and substance use disorder workforce Opioid epidemic COVID-19 Pandemic, including funding, personal protective equipment, testing and vaccines Provide resources to support nurses, APRNs, and nursing students mental health needs, especially for those responding to the pandemic Extension of CMS waivers beyond the COVID-19 Public Health Emergency Use of telehealth to prescribe controlled substances under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 [Public Law No: 110-425] Site specific restrictions on providers under DEA controlled substances policy Implementation of the Medication Access and Training Expansion (MATE) Act Telehealth, remote patient monitoring and other forms of health technology Reducing regulatory burdens, including those relating to Medicare Conditions of Participation Medicare provider reimbursement Primary care payment reform Documentation of medical records Inclusion of NPs in the HPSA bonus program for clinicians practicing in primary care HPSAs Framework reform of the National Institutes of Health and the National Institute of Nursing Research Optimizing the Food and Drug Administration's Use of and Processes for Advisory Committees

Client expense: $470,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

S. 1869 - Site Act To Ensure Fair Billing Practices for items and services furnished by off campus hospital locations H.R. 3417 - FAIR ACt To ensure fair billing practices for items and services furnished by off campus outpatient departments of a provider H.R.3561 - The Patient Act of 2023 To promote hospital and payor price transparency and for other purposes H.R. 4822 Health Care Price Transparency Act of 2023 To improve price transparency with respect to certain health care services H.R. 5378 Lower Costs, More Transparency Act To promote transparency in the health care sector H.R. 7681 Primary and Virtual Care Affordability Act To extend the exemption for telehealth services from certain high deductible health plan rules and to establish a safe harbor for high deductible plans with no deductible for certain primary care services Improving Senior Access to Timely Care Act ACA Subsidies; Tax Credits; Health Equity Index Methodology Reward Factor; Prior Authorization; Telehealth; Hospital Billing; Site Neutral Payment Reform; ACA Fraud

Client expense: $475,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for Prior Authorization Reform, (H.R. 4822) Support for Medicare reform legislation (H.R. 2474) "Strengthening Medicare for Patients and Providers Act" Support for Resident Education Deferred Interest (REDI) Act (H.R. 1202/S.704)

Client expense: $36,000 · Firm income: Not reported

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

Reducing regulatory and legislative barriers for Nurse Practitioners Issues surrounding COVID-19 public health emergency declaration waivers (H.R. 704/S. 260) The Promoting Access to Diabetic Shoes Act Issues surrounding nurse workforce shortages Rural health care access (H.R.2713/S.2418) ICAN Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act (H.R. 4822) Health Care Price Transparency Act of 2023 (H.R. 4104) Preserving Patient Access to Home Infusion Act (S.3939/H.R.7665) ACO Assignment Improvement Act Issues surrounding skilled nursing facilities Issues surrounding Medicare Part B reform Medicare provider reimbursement (H.R.8261) Preserving Telehealth, Hospital, and Ambulance Access Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation and regulation related to health care delivery and health insurance coverage, mental health and substance use disorder care and coverage, the transition out of the COVID-19 pandemic and electronic health information/technology. H.R. 4527 Health DATA Act S. 3679, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act H.R. 5378 the Lower Costs, More Transparency Act S.3548 - Health Care Prices Revealed and Information to Consumers Explained Transparency Act S.3430 - An original bill to amend titles XVIII and XIX of the Social Security Act to expand the mental health care workforce and services, reduce prescription drug costs, and extend certain expiring provisions under Medicare and Medicaid, and for other purposes. HR 3305 & S. 1606 Black Maternal Health Momnibus Act HR 4822 Health Care Price Transparency Act HR 3284 Providers and Payers COMPETE Act HR 2840 Bipartisan Primary Care and Health Workforce Act HR 4818 Treat and Reduce Obesity Act of 2023 S. 2333 Pandemic and All Hazards Preparedness and Response Act H.R. 4421 Preparing for All Hazards and Pathogens Reauthorization Act H.R. 3561, PATIENT Act of 2023 H.R. 3281, the Transparent PRICE Act H.R. 3262, To amend title XI of the Social Security Act to increase transparency of certain health-related ownership information H.R. 2868 Association Health Plans Act H.R. 2813 Self-Insurance Protection Act H.R. 3799 CHOICE Arrangement Act H.R. 3432, Telemental Health Care Access Act H.R.824, Telehealth Benefit Expansion for Workers Act of 2023 H.R. 4189, S. 2016, CONNECT for Health Act S. 923, Better Mental Health Care for Americans Act H.R. 3120, Healthy Competition for Better Care Act H.R. 1843 Telehealth Expansion Act of 2023 S.954 - 118th Congress (2023-2024)A bill to provide for appropriate cost-sharing for insulin products covered under private health plans, and to establish a program to support health care providers and pharmacies in providing discounted insulin products to uninsured individuals. H.R.10445 - Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 H.R.10515 - American Relief Act, 2025 H.R.10545 - American Relief Act, 2025 H.R. 9774 & S. 5194 - Health Care Affordability Act of 2024 H.R. 3120 & S. 1451 - Healthy Competition for Better Care Act

Client expense: $220,000 · Firm income: Not reported

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

Discuss Medicare and Medicaid issues with HHS staff. Discuss with Congressional staff and HHS staff support for Medicare GME expansion and changes to GME program: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act (H.R. 7050); additional GME slots in CAA, 2021 and CAA, 2023; Rural Residency Planning and Development Act (H.R. 7855); concerns on Rural Physician Workforce Preservation Act; Senate Finance Committee proposals to increase GME slots. Discussion with CMS on the interpretation of CAA, 2021, Sec. 131, and resetting of GME caps pertaining to Sec. 131. Discuss technical amendment to CAA, 2021, Sec. 131 pertaining to Medicare GME with Congressional staff. Discuss with Congressional staff distribution methodology for Medicare GME slots created in the CAA, 2021. Discuss expiring COVID-19 Public Health Emergency (PHE) Medicare flexibilities with Congressional staff and HHS staff and support legislative proposals to extend PHE telehealth flexibilities and Acute Hospital Care at Home Waiver (H.R. 7623). Support extension of Medicare Dependent Hospital and Low-Volume Adjustment programs. Support proposals to reduce payment cut in CY 2025 Physician Fee Schedule final rule. Discuss opposition to Medicare site-neutral payment policies with Congressional staff. Oppose changes to NPIs for hospital outpatient departments (H.R. 7623, H.R. 4509, H.R. 7623 as amended, H.R. 4822). Comment on FY 2024 IPPS rule to increase payment update to hospitals, Transforming Episodic Accountability Model, AHEAD Model, and CAA, 2023 Sec 4122 GME slot distribution methodology, and discuss comments with Congressional staff and CMS staff. Discuss proposals that stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support), make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Support certain changes to Medicaid DSH payments: support two-year elimination of Medicaid DSH cut scheduled for January 1, 2025; support Save Our Safety Net Hospitals Act (H.R. 9351) to restore pre-CAA, 2021 DSH cap calculation methodology and include dual-eligible patients in state DSH cap calculation. Discuss Medicaid waiver proposal with Congressional staff and HHS. Discuss CMMI initiatives on global budgets and primary care in NYS Medicaid waiver. Discuss Medicaid IMD exclusion policies with Congressional staff. Support legislation to increase Medicaid payment rates for labor and delivery services for certain hospitals (S.5236). Discuss with Congressional staff support for CMS approval of Medicaid managed care organization tax proposed in New York State budget. Oppose CMS final rule to establish minimum nurse staffing in Medicare- and Medicaid-certified long-term care facilities (89 FR 40876) and support legislative efforts to repeal rule. Support Medicare Advantage prior authorization reforms - Improving Seniors Timely Access to Care Act (S. 4532/H.R. 8702). Meet with CMS staff and CMS Regional Administrator to discuss Medicare Advantage (MA) plans and MA utilization management practices. Discuss wage index issues with Congressional staff: H.R. 8561 to address MA local area growth under projection, FY 2025 IPPS/LTCH interim final rule, indirect medical education (IME) payments to hospitals. Meet with CMS Innovation Center to discuss CMMI models of care. Meet with CMS leadership to discuss Medicare and Medicaid issues: prior authorization and MA insurance denials, concerns on mandatory participation for AHEAD and TEAM models, Medicare support for health care workforce; support for telehealth flexibilities and Acute Hospital Care at Home waiver extension.

Client expense: $350,000 · Firm income: Not reported

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

Advocate for proposals to provide direct financial support to safety net hospitals with Congressional staff. Discuss opposition to Medicare site-neutral payment policies with Congressional staff. Educate Congressional staff on hospital price transparency federal rule (84 FR 65602). Oppose changes to NPIs for hospital outpatient departments (H.R. 7623, H.R. 4509, H.R. 7623 as amended, H.R. 4822). Meet with Congressional staff to discuss H.R. 5378, the Lower Costs, More Transparency Act of 2023, and comment on following proposals in bill: support for delay of Medicaid DSH cut, codification and expansion of Federal price transparency rule, oppose National Provider Identifier (NPI) requirements for hospital outpatient departments, oppose changes to 340B drug pricing program, support reauthorization of Community Health Centers, support reauthorization of National Health Service Corps, support reauthorization of Teaching Health Center Graduate Medical Education funding. Discuss hospital and health provisions in CAA, 2024 (H.R. 4366) with HHS staff and Congressional staff: support public health extenders and elimination of Medicaid DSH cut. Discuss support for the 340B Drug Pricing Program with Congressional staff and discuss certain changes: oppose 340B ACCESS Act (H.R. 7635), comment on SUSTAIN 340B Act discussion draft, support PATIENTS Act (H.R. 7635); oppose back-end rebate proposals. Discuss legislative proposals with Congressional staff to stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support); make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Discuss Medicare Graduate Medical Education (GME) provisions in the Consolidated Appropriations Act (CAA), 2021 and CAA, 2023 with HHS staff. Discuss with Congressional staff support for Medicare GME expansion and changes to GME program: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act (H.R. 7050); additional GME slots in CAA, 2021 and CAA, 2023; Rural Residency Planning and Development Act (H.R. 7855); concerns on Rural Physician Workforce Preservation Act and opposition to modifications to ongoing slot distribution; Senate Finance Committee draft proposals to increase GME slots. Discuss with HHS staff and Congressional staff recommendations to address workforce shortages for nursing and ancillary health care workforce: faculty recruitment and retention, additional financial support for supervision and precepting students, Medicare payment for nursing and allied health, testing new workforce models, establishing incentives and early recruitment strategies, providing funding for clinical training site, and immigration reforms that expedite entry for foreign health care workers. Support passage of the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S.2768). Support revisions to Conrad 30 waiver program to increase the number of foreign physicians that may remain in the US after completing GME: S.665/H.R.4942, S.2719/H.R.6980, H.R. 4875. Discuss expiring COVID-19 Public Health Emergency Medicare flexibilities with Congressional staff and HHS staff and support legislative proposals to extend PHE telehealth flexibilities and Acute Hospital Care at Home Waiver: H.R. 7623. Oppose legislative proposals to impose financial penalties on hospitals relating to minimum cybersecurity standards (S.5218). Discuss legislative proposals to regulate the use of artificial intelligence in health care delivery with Congressional staff. Discuss FEMA COVID-19 Public Assistance payouts with Congressional staff. Support Improving Seniors Timely Access to Care Act (S. 4532/H.R. 8702). Discuss legislative proposals on consumer medical debt with Congressional staff. Outreach to HHS Assistant Secretary for Preparedness and Response urging certain regulatory flexibilities to alleviate IV fluid shortages.

Client expense: $350,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, White House Office

Adequacy of Medicare physician payments for physicians and implementation of the Medicare Access and CHIP Reauthorization Act, including related provisions in: (1) S. 4935 Physician Fee Stabilization Act and H.R. 6545, the Physician Fee Schedule Update and Improvements Act, including provisions to increase the work geographic index, increase the Medicare physician fee schedule conversion factor and extend and modify incentive payments for participation in eligible alternative payment models; (2) H.R. 6683, the Preserving Seniors Access to Physicians Act; (3) H.R. 2474, the Strengthening Medicare for Patients and Providers Act; and (4) HR ____ Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025-related to physician payment adjustment of 2.5%. Issues related to adequate network coverage for ophthalmology care within Medicare Advantage plans and advocate for relief from prior authorization requirements under Medicare Advantage and Medicare Part D plans, including related provisions in: H.R. 4822, the Health Care Price Transparency Act; H.R. 5378, the Lower Costs, More Transparency Act; and S. 4518/S. 4532/H.R. 8702, to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Medicare reimbursement for telemedicine, including related provisions in S. 3430, the Better Mental Health Care, Lower Costs Drugs, and Extenders Act, including Sec. 105 regarding Medicare payment for mental health services furnished through telehealth, and Sec. 107 regarding communications regarding telehealth and interstate licensure requirements; H.R. 7623, The Telehealth Modernization Act of 2024; SEC. 101. Extension of Certain Telehealth Flexibilities; H.R. 8261, the Preserving Telehealth, Hospital, and Ambulance Access Act; Section 2, extending Medicare Telehealth Flexibilities. Use of step therapy in Medicare and health insurance coverage, including related provisions in H.R. 2630/S. 652, the Safe Step Act. Enhance Center for Medicare & Medicaid Innovation quality initiatives and patient access to Medicare Part B covered drugs, including monitor CMMI Medicare Part B drug-related demonstrations.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supports a similar bill, S. 5035, introduced by Sen. Boozman. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, by Rep. Underwood to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. We support similar legislation introduced by Sen. Shaheen in the Senate. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Urged Congress to support year-end Continuing Resolution (CR) that contained PBM reform, averting Medicare physician payment cuts by 2.5%, provided bonus payment to physicians participating in APMs, and extended telehealth flexibilities adopted during the COVID-19 pandemic for 2 years. Also advocated that streamlined prior authorization process for Medicare Advantage plans be included in the CR. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process in the reintroduced the Improving Seniors' Timely Access to Care Act, S.4532. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Client expense: $242,106 · Firm income: Not reported

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

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supports a similar bill, S. 5035, introduced by Sen. Boozman. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, by Rep. Underwood to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. We support similar legislation introduced by Sen. Shaheen in the Senate. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Urged Congress to support year-end Continuing Resolution (CR) that contained PBM reform, averting Medicare physician payment cuts by 2.5%, provided bonus payment to physicians participating in APMs, and extended telehealth flexibilities adopted during the COVID-19 pandemic for 2 years. Also advocated that streamlined prior authorization process for Medicare Advantage plans be included in the CR. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process in the reintroduced the Improving Seniors' Timely Access to Care Act, S.4532. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Client expense: $124,919 · Firm income: Not reported

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

IPC supports "Better Mental Health Care, Lower Cost Drugs and Extenders Act" (S 3430) IPC supports the "Pharmacists Fight Back Act" (HR 9096) IPC supports Drug Transparency in Medicaid Act (H.R. 1613) ICP supports Promoting Access to Treatments and Increasing Extremely Needed Transparent (PATIENT) Act (HR 3561) IPC supports Drug Transparency in Medicaid Act (S. 1038) IPC supports The Modernizing and Ensuring PBM Accountability Act (S 2973) IPC supports Pharmacy and Medically Underserved Areas Enhancement Act (S 1491) IPC supports Protecting Patients Access to Pharmacy Act (S. 2052) IPC supports The Health Care Price Transparency Act (H.R. 4822) IPC supports Lower Cost, More Transparency Act (LCMT) (H.R. 5378) IPC supports Protecting Patients Against PBM Abuses Act (H.R. 2880) IPC Transparency and Fairness for Pharmacies Act (H.R. 5393) IPC supports Senate Bi-Partisan Working Group for 340B Reform - RFI response. IPC Supports FDA - Development of Small Dispensers Assessment Under the Drug Supply Chain Security Act; Request for Comments (FDA-2023-N-3103) IPC supports the Inflation Reduction Act of 2022 and CMS implementation. IPC opposes S. 1339 Pharmacy Benefits Reform Act - because it may preempt state PBM laws relating to ERISA. IPC supports S. 1491 Pharmacy and Medically Underserved Areas Enhancement Act IPC supports S. 127 Pharmacy Benefit Manager Transparency Act IPC supports (H.R. 1770/S. 2477) The Equitable Community Access to Pharmacists Services Act IPC supports FDA delay of DSCSA enhanced data compliance-request for comments CMS Implementation of PY 2024 Medicare Part D drug rule-comments CMS Implementation of drug provisions of the IRA 2022-including the drug negotiation provision

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

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

Physician payment issues (MEI, E/M Budget Neutrality, APMs, MIPS) including SFC white paper: Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B; Prior authorization in Medicare Advantage; HR 1770/S. 2477 Equitable Community Access to Pharmacist Services Act HR 766/S 144 Preventive Health Savings Act HR 618/ S 131 Improving Access to Workers' Compensation for Injured Federal Workers Act of 2023. S.1512 - CONNECT for Health Act of 2021 Monitoring PBM legislation - S. 1967 and S. 1038 H.R. 4822, Health Care Price Transparency Act of 2023; H.R. 2474, Strengthening Medicare for Patients and Providers Act; H.R. 3561, PATIENT Act of 2023; H.R. 3284, Providers and Payers COMPETE Act; S. 3503, Value in Healthcare Act;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to health care access and reimbursement through the Medicare and Medicaid programs including site neutrality and prior authorization policies in the Medicare program, specifically, The PATIENT Act of 2023 (H.R. 3561),the Healthcare Price Transparency Act (H.R. 4822) and The Medicare Patient Access to Cancer Treatment (MPACT) Act (H.R. 4473).

Client expense: $56,000 · Firm income: Not reported

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