Improving Access to Medicare Coverage Act of 2023

MMM [House, Senate, HHS, CMS, FDA, Administration on Aging, EOP, DOC] Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act (Public Law No: 117-169). Medicare and Medicaid Prescription Drugs. (No bill): Joined comments with 19 other organizations urging HHS to use its existing authority to license competition in order to lower consumer and taxpayer costs for semaglutide drugs treating diabetes and weight management (e.g., Ozempic and Wegovy). Medicare Prescription Drugs. The PACE Part D Choice Act (H.R. 3549 and S. 1703): Proposal to increase the affordability of the Program of All-Inclusive Care for the Elderly (PACE) for Medicare beneficiaries by lowering the cost of Part D premiums substantially for Medicare-only enrollees, thus opening up the PACE program to this population. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Trustees Report (No bill). Review of the findings on economic, legislative and other developments affecting the actuarial soundness of the Medicare Part A (Hospital Insurance) Trust Fund and the Trust Funds for Parts B and D coverage. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Help Extend Auditory Relief Act of 2024 (H.R. 8064): Proposal to expand Medicare coverage to include hearing examinations and diagnoses, fittings and hearing aids. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home and Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes. The Building Americas Health Care Workforce Act (H.R. 9067): Proposal to allow time spent working in a nursing home (prior to any formal training, and permitted during the COVID-19 pandemic) to count toward a 75-hour minimum federal training standard that is required for certified nursing assistants. Medicare, Medicaid Nursing Homes. The Ensuring Seniors Access to Quality Care Act (H.R. 3227): Proposal to repeal regulations that prohibit certified nursing assistant training and competency evaluation programs in skilled nursing facilities that have a record of health and safety deficiencies and have incurred penalties (e.g., civil monetary penalties for substandard quality of care). Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposals to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposals to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities. Oversight of Health Care Industry Owned by Private Equity Firms. (No bill): Joined with other organizations in submitting comments (April 2024) to HHS, the Federal Trade Commission and the Department of Justice urging sustained, stepped up and rigorous oversight be extended to health care industry transactions that are financed by private equity company companies and other types of private investors. Medicaid Eligibility and Beneficiary Assets. Medicaid Estate Recovery Act (H.R. 7573): Proposals to provide financial protection to the families of Medicaid beneficiaries, including ending Medicaid estate claims and Medicaid liens, except in cases when benefits had been incorrectly paid, as determined by a court.

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

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

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

Observation Stays and 3 Day Stay Issue Outreach to HHS/CMS/Administration Survey Relief/Civil Monetary Penalties CMS on Public Health Waiver and other waivers SNF Payment Rule OSHA Emergency Temporary Standards Care For Our Seniors Act Medicare Advantage H.R. 177 - To amend title XI of the Social Security Act to ensure nursing facilities report information on medical directors of such facilities. CDC/COVID Safety Guidance Outreach to hill, HHS and ONC on LTPAC health information technology needs (zoom meetings and letters) Outreach to hill on needed Physician Fee Schedule reforms (sign on letters only) Improve Access to Mental Access Act S838/HR1638 (sign on letters) Improving Access to Medicare Coverage Act of 2023 s.4137/H.R.5138 HR 5796, S. 3410 - Protecting Rural Seniors Access to Care Act Outreach to hill on needed telehealth reforms (sign on letters only) Improving Seniors Timely Access to Care Act

Client expense: $890,000 · Firm income: Not reported

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

Minimum Staffing Standards for Long-Term Care Facilities Protecting Rural Seniors Access to Care Act (H.R. 5796/ S. 3490) Physician Fee Schedule Long-term Reform Strengthening Medicare for Patients and Providers Act (H.R. 2474) Ensuring Seniors' Access to Quality Care Act (H.R. 3227/S. 1749) Fee schedule conversion factor tied to inflation Eliminate the budget neutrality requirement Obtain an impact study of the 15% therapy assistant cut on rural and medically underserved areas; mitigate the 15% differential implemented in 2022 Follow and support efforts with respect to the CMS-identified potentially misvalued therapy CPT codes Elimination of Multiple Procedure Payment Reduction (MPPR) Reduced administrative burden through streamlined plan-of-care certifications Changes to the MIPS Quality Payment Program to allow all therapy providers to be eligible for the Quality Payments Program Skilled Nursing Facility Prospective Payment System Clinical Laboratory Fee Schedule Saving Access to Laboratory Services (SALSA) Act ( H.R. 2377 / S. 1000) Home Health Prospective Payment System Medicare Home Health Accessibility Act (H.R. 7148) Expanding Care in the Home Act (H.R. 2853) Medicare Advantage and Merit-based Incentive Payment System (MIPS) Reform Observation Stay Requirements Improving Access to Medicare Coverage Act of 2024 (H.R. 5138) Rehabilitation Therapy Outpatient Supervision Requirements Enabling More of the Physical and Occupational Workforce to Engage in Rehabilitation (EMPOWER) Act (H.R. 4878/S. 2459) Teletherapy/Telerehab Patient Access Expanded Telehealth Access Act (H.R. 3875/ S. 2880) Telehealth Modernization Act of 2024 (H.R. 7623/ S. 3967) Rehabilitation Therapy CPT Codes on Permanent Telehealth List Portable X-ray Transportation Payment Issues

Minimum Staffing Standards for Long-Term Care Facilities Protecting Rural Seniors Access to Care Act (H.R. 5796/ S. 3490) Physician Fee Schedule Long-term Reform Strengthening Medicare for Patients and Providers Act (H.R. 2474) Ensuring Seniors' Access to Quality Care Act (H.R. 3227/S. 1749) Fee schedule conversion factor tied to inflation Eliminate the budget neutrality requirement Obtain an impact study of the 15% therapy assistant cut on rural and medically underserved areas; mitigate the 15% differential implemented in 2022 Follow and support efforts with respect to the CMS-identified potentially misvalued therapy CPT codes Elimination of Multiple Procedure Payment Reduction (MPPR) Reduced administrative burden through streamlined plan-of-care certifications Changes to the MIPS Quality Payment Program to allow all therapy providers to be eligible for the Quality Payments Program Skilled Nursing Facility Prospective Payment System Clinical Laboratory Fee Schedule Saving Access to Laboratory Services (SALSA) Act ( H.R. 2377 / S. 1000) Home Health Prospective Payment System Medicare Home Health Accessibility Act (H.R. 7148) Expanding Care in the Home Act (H.R. 2853) Medicare Advantage and Merit-based Incentive Payment System (MIPS) Reform Observation Stay Requirements Improving Access to Medicare Coverage Act of 2024 (H.R. 5138) Rehabilitation Therapy Outpatient Supervision Requirements Enabling More of the Physical and Occupational Workforce to Engage in Rehabilitation (EMPOWER) Act (H.R. 4878/S. 2459) Teletherapy/Telerehab Patient Access Expanded Telehealth Access Act (H.R. 3875/ S. 2880) Telehealth Modernization Act of 2024 (H.R. 7623/ S. 3967) Rehabilitation Therapy CPT Codes on Permanent Telehealth List Portable X-ray Transportation Payment Issues

Issues pertaining to physician payment and quality measurement, including HR 2474, Strengthening Medicare for Patients and Providers Act; observation care, including S 4137/HR 5138, Improving Access to Medicare Coverage Act of 2023; S 4532/HR 8702, Improving Seniors Timely Access to Care Act of 2024

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Minimum Staffing Standards for Long-Term Care Facilities Protecting Rural Seniors Access to Care Act (H.R. 5796/ S. 3490) Physician Fee Schedule Long-term Reform Strengthening Medicare for Patients and Providers Act (H.R. 2474) Ensuring Seniors' Access to Quality Care Act (H.R. 3227/S. 1749) Fee schedule conversion factor tied to inflation Eliminate the budget neutrality requirement Obtain an impact study of the 15% therapy assistant cut on rural and medically underserved areas; mitigate the 15% differential implemented in 2022 Follow and support efforts with respect to the CMS-identified potentially misvalued therapy CPT codes Elimination of Multiple Procedure Payment Reduction (MPPR) Reduced administrative burden through streamlined plan-of-care certifications Changes to the MIPS Quality Payment Program to allow all therapy providers to be eligible for the Quality Payments Program Skilled Nursing Facility Prospective Payment System Clinical Laboratory Fee Schedule Saving Access to Laboratory Services (SALSA) Act ( H.R. 2377 / S. 1000) Home Health Prospective Payment System Medicare Home Health Accessibility Act (H.R. 7148) Expanding Care in the Home Act (H.R. 2853) Medicare Advantage and Merit-based Incentive Payment System (MIPS) Reform Observation Stay Requirements Improving Access to Medicare Coverage Act of 2024 (H.R. 5138) Rehabilitation Therapy Outpatient Supervision Requirements Enabling More of the Physical and Occupational Workforce to Engage in Rehabilitation (EMPOWER) Act (H.R. 4878/S. 2459) Teletherapy/Telerehab Patient Access Expanded Telehealth Access Act (H.R. 3875/ S. 2880) Telehealth Modernization Act of 2024 (H.R. 7623/ S. 3967) Rehabilitation Therapy CPT Codes on Permanent Telehealth List Portable X-ray Transportation Payment Issues

Observation Stays and 3 Day Stay Issue Outreach to HHS/CMS/Administration Survey Relief/Civil Monetary Penalties CMS on Public Health Waiver and other waivers SNF Payment Rule OSHA Emergency Temporary Standards Care For Our Seniors Act Medicare Advantage H.R. 177 - To amend title XI of the Social Security Act to ensure nursing facilities report information on medical directors of such facilities. CDC/COVID Safety Guidance Outreach to hill, HHS and ONC on LTPAC health information technology needs (zoom meetings and letters) Outreach to hill on needed Physician Fee Schedule reforms (sign on letters only) Improve Access to Mental Access Act S838/HR1638 (sign on letters) Improving Access to Medicare Coverage Act of 2023 HR 5138 HR 5796, S. 3410 - Protecting Rural Seniors Access to Care Act Outreach to hill on needed telehealth reforms (sign on letters only) Improving Seniors Timely Access to Care Act

Client expense: $1,020,000 · Firm income: Not reported

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

Urged CMS to finalize the DACA eligibility rule which would expand eligibility for recipients of the Deferred Action for Childhood Arrivals program to enroll in qualified health plans through the Affordable Care Act Health Insurance Marketplace and qualify for subsidies and cost-sharing reductions based on income. (H.R. 7858) Telehealth Enhancement for Mental Health Act - Expressed support for the Telehealth Enhancement for Mental Health Act. This legislation would revolutionize access to mental health care by changing Medicare reimbursement policies for mental health services provided via telehealth. (H.R. 8261) Preserving Telehealth, Hospital and Ambulance Access Act: Expressed support for the Preserving Telehealth, Hospital and Ambulance Access Act. This legislation would expand Medicare telehealth for two years, hospital-at-home flexibilities for five years, and Medicare supplemental payments for rural hospitals and ambulatory services. (H.R. 5378) Lower Costs, More Transparency Act - Urged Congress to reject policies that reduce reimbursements under the Medicare program, especially site-neutral proposals. Urged the Centers for Medicare and Medicaid Services (CMS) to revise its proposed rule for Medicaid managed care programs. The proposed rule includes significant provisions related to state directed payments (SDPs), supplemental payments states can utilize for managed care. Urged the Centers for Medicare and Medicaid Services (CMS) CMS to continue providing vital information about Medicaid redeterminations, including making information and data pertaining to Medicaid renewals publicly available and to work with states to provide information about Medicaid beneficiaries whose coverage has been reinstated after being previously terminated, as well as breaking the information down by race and ethnicity. (S. 4137/H.R. 5138) - Improving Access Medicare Coverage Act - Expressed support for the Improving Access Medicare Coverage Act. This legislation will make days spent in observation count towards Medicare's three-day inpatient stay requirement for Skilled Nursing Facility (SNF) coverage. Urged the Centers for Medicare and Medicaid Services (CMS) to take action to prevent millions of Medicaid beneficiaries from losing coverage as states begin unwinding the temporary Medicaid provisions in place during the pandemic. (H.R. 2665) - Supporting Safety Net Hospitals Act - Expressed support for the Supporting Safety Net Hospitals Act. The legislation would address spending cuts to Medicaid DSH payments. Urged Congress to address the Medicaid disproportionate share hospital (DSH) cuts scheduled to begin in fiscal year (FY) 2024.

Issues pertaining to physician payment and quality measurement, including HR 2474, Strengthening Medicare for Patients and Providers Act; observation care, including HR 5138, Improving Access to Medicare Coverage Act of 2023; prior authorization and access to care through Medicare Advantage

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3548 (Health Care Prices Revealed and Information to Consumers Explained Transparency Act) This bill aims to provide greater transparency in hospital pricing to consumers and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3548 (Health Care Prices Revealed and Information to Consumers Explained Transparency Act) This bill aims to provide greater transparency in hospital pricing to consumers and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3548 (Health Care Prices Revealed and Information to Consumers Explained Transparency Act) This bill aims to provide greater transparency in hospital pricing to consumers and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3548 (Health Care Prices Revealed and Information to Consumers Explained Transparency Act) This bill aims to provide greater transparency in hospital pricing to consumers and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3548 (Health Care Prices Revealed and Information to Consumers Explained Transparency Act) This bill aims to provide greater transparency in hospital pricing to consumers and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

Observation Stays and 3 Day Stay Issue Outreach to HHS/CMS/Administration Survey Relief/Civil Monetary Penalties CMS on Public Health Waiver and other waivers SNF Payment Rule OSHA Emergency Temporary Standards Care For Our Seniors Act Medicare Advantage H.R. 177 - To amend title XI of the Social Security Act to ensure nursing facilities report information on medical directors of such facilities. CDC/COVID Safety Guidance Outreach to hill, HHS and ONC on LTPAC health information technology needs (zoom meetings and letters) Outreach to hill on needed Physician Fee Schedule reforms (sign on letters only) Improve Access to Mental Access Act S838/HR1638 (sign on letters) Improving Access to Medicare Coverage Act of 2023 HR 5138 HR 5796, S. 3410 - Protecting Rural Seniors Access to Care Act Outreach to hill on needed telehealth reforms (sign on letters only)

Client expense: $990,000 · Firm income: Not reported

Minimum Staffing Standards for Long-Term Care Facilities Protecting Rural Seniors Access to Care Act (H.R. 5796/ S. 3490) Physician Fee Schedule Long-term Reform Strengthening Medicare for Patients and Providers Act (H.R. 2474) Ensuring Seniors' Access to Quality Care Act (H.R. 3227/S. 1749) Fee schedule conversion factor tied to inflation Eliminate the budget neutrality requirement Obtain an impact study of the 15% therapy assistant cut on rural and medically underserved areas; mitigate the 15% differential implemented in 2022 Follow and support efforts with respect to the CMS-identified potentially misvalued therapy CPT codes Elimination of Multiple Procedure Payment Reduction (MPPR) Reduced administrative burden through streamlined plan-of-care certifications Changes to the MIPS Quality Payment Program to allow all therapy providers to be eligible for the Quality Payments Program Skilled Nursing Facility Prospective Payment System Clinical Laboratory Fee Schedule Saving Access to Laboratory Services (SALSA) Act ( H.R. 2377 / S. 1000) Home Health Prospective Payment System Medicare Home Health Accessibility Act (H.R. 7148) Expanding Care in the Home Act (H.R. 2853) Medicare Advantage and Merit-based Incentive Payment System (MIPS) Reform Observation Stay Requirements Improving Access to Medicare Coverage Act of 2024 (H.R. 5138) Rehabilitation Therapy Outpatient Supervision Requirements Enabling More of the Physical and Occupational Workforce to Engage in Rehabilitation (EMPOWER) Act (H.R. 4878/S. 2459) Teletherapy/Telerehab Patient Access Expanded Telehealth Access Act (H.R. 3875/ S. 2880) Telehealth Modernization Act of 2024 (H.R. 7623/ S. 3967) Rehabilitation Therapy CPT Codes on Permanent Telehealth List Portable X-ray Transportation Payment Issues

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

(H.R. 5378) Lower Costs, More Transparency Act - Urged Congress to reject policies that reduce reimbursements under the Medicare program, especially site-neutral proposals. Urged the Centers for Medicare and Medicaid Services (CMS) to revise its proposed rule for Medicaid managed care programs. The proposed rule includes significant provisions related to state directed payments (SDPs), supplemental payments states can utilize for managed care. Urged the Centers for Medicare and Medicaid Services (CMS) CMS to continue providing vital information about Medicaid redeterminations, including making information and data pertaining to Medicaid renewals publicly available and to work with states to provide information about Medicaid beneficiaries whose coverage has been reinstated after being previously terminated, as well as breaking the information down by race and ethnicity. (H.R. 5138) - Improving Access Medicare Coverage Act - Expressed support for the Improving Access Medicare Coverage Act. This legislation will make days spent in observation count towards Medicare's three-day inpatient stay requirement for Skilled Nursing Facility (SNF) coverage. Urged the Centers for Medicare and Medicaid Services (CMS) to take action to prevent millions of Medicaid beneficiaries from losing coverage as states begin unwinding the temporary Medicaid provisions in place during the pandemic. (H.R. 2665) - Supporting Safety Net Hospitals Act - Expressed support for the Supporting Safety Net Hospitals Act. The legislation would address spending cuts to Medicaid DSH payments. Urged Congress to address the Medicaid disproportionate share hospital (DSH) cuts scheduled to begin in fiscal year (FY) 2024.

Client expense: $136,413 · Firm income: Not reported

S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3548 (Health Care Prices Revealed and Information to Consumers Explained Transparency Act) This bill aims to provide greater transparency in hospital pricing to consumers and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3548 (Health Care Prices Revealed and Information to Consumers Explained Transparency Act) This bill aims to provide greater transparency in hospital pricing to consumers and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3548 (Health Care Prices Revealed and Information to Consumers Explained Transparency Act) This bill aims to provide greater transparency in hospital pricing to consumers and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3548 (Health Care Prices Revealed and Information to Consumers Explained Transparency Act) This bill aims to provide greater transparency in hospital pricing to consumers and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3548 (Health Care Prices Revealed and Information to Consumers Explained Transparency Act) This bill aims to provide greater transparency in hospital pricing to consumers and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

Issues pertaining to physician payment and quality measurement, including HR 2474, Strengthening Medicare for Patients and Providers Act; observation care, including HR 5138, Improving Access to Medicare Coverage Act of 2023; prior authorization and access to care through Medicare Advantage

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Observation Stays and 3 Day Stay Issue Outreach to HHS/CMS/Administration Survey Relief/Civil Monetary Penalties CMS on Public Health Waiver and other waivers SNF Payment Rule OSHA Emergency Temporary Standards Care For Our Seniors Act Medicare Advantage H.R. 177 - To amend title XI of the Social Security Act to ensure nursing facilities report information on medical directors of such facilities. CDC/COVID Safety Guidance Outreach to hill, HHS and ONC on LTPAC health information technology needs (zoom meetings and letters) Outreach to hill on needed Physician Fee Schedule reforms (sign on letters only) Improve Access to Mental Access Act S838/HR1638 (sign on letters) Improving Access to Medicare Coverage Act of 2023 HR 5138 HR 5796, S. 3410 - Protecting Rural Seniors Access to Care Act

Client expense: $1,340,000 · Firm income: Not reported

Issues pertaining to physician payment and quality measurement, including HR 2474, Strengthening Medicare for Patients and Providers Act; observation care, including HR 5138, Improving Access to Medicare Coverage Act of 2023; prior authorization and access to care through Medicare Advantage

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3797 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. .R. 1843 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. S. 1001 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. H.R. 4509 (Transparency in Billing Act): To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. H.R. 1264 (Commonsense Reporting Act): This bill addresses the eligibility verification process for the premium assistance tax credit and cost-sharing subsidy under the Patient Protection and Affordable Care Act.

H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3797 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R.5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 1843 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. S. 1001 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. H.R. 4509 (Transparency in Billing Act): To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. H.R. 1264 (Commonsense Reporting Act): This bill addresses the eligibility verification process for the premium assistance tax credit and cost-sharing subsidy under the Patient Protection and Affordable Care Act.

H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3797 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R.5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 1843 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. S. 1001 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. H.R. 4509 (Transparency in Billing Act): To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. H.R. 1264 (Commonsense Reporting Act): This bill addresses the eligibility verification process for the premium assistance tax credit and cost-sharing subsidy under the Patient Protection and Affordable Care Act.

H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. .R. 1843 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. S. 1001 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. H.R. 4509 (Transparency in Billing Act): To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes.

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

(H.R. 5378) Lower Costs, More Transparency Act - Urged Congress to reject policies that reduce reimbursements under the Medicare program, especially site-neutral proposals. Urged the Centers for Medicare and Medicaid Services (CMS) to revise its proposed rule for Medicaid managed care programs. The proposed rule includes significant provisions related to state directed payments (SDPs), supplemental payments states can utilize for managed care. Urged the Centers for Medicare and Medicaid Services (CMS) CMS to continue providing vital information about Medicaid redeterminations, including making information and data pertaining to Medicaid renewals publicly available and to work with states to provide information about Medicaid beneficiaries whose coverage has been reinstated after being previously terminated, as well as breaking the information down by race and ethnicity. (H.R. 5138) - Improving Access Medicare Coverage Act - Expressed support for the Improving Access Medicare Coverage Act. This legislation will make days spent in observation count towards Medicare's three-day inpatient stay requirement for Skilled Nursing Facility (SNF) coverage. Urged the Centers for Medicare and Medicaid Services (CMS) to take action to prevent millions of Medicaid beneficiaries from losing coverage as states begin unwinding the temporary Medicaid provisions in place during the pandemic. (H.R. 2665) - Supporting Safety Net Hospitals Act - Expressed support for the Supporting Safety Net Hospitals Act. The legislation would address spending cuts to Medicaid DSH payments. Urged Congress to address the Medicaid disproportionate share hospital (DSH) cuts scheduled to begin in fiscal year (FY) 2024.

Client expense: $221,406 · Firm income: Not reported

H.R. 824, the Telehealth Benefit Expansion for Workers Act of 2023. H.R. 2713/S. 2418, the Improving Care and Access to Nurses Act. S. 1687, the Beneficiary Enrollment Notification and Eligibility Simplification 2.0 Act. No bill number. Discussed Medicare financial stability and solvency. No bill number. Discussed family caregivers and 1-800-MEDICARE. No bill number. Discussed reducing red tape for family caregivers in Medicare, Medicaid, Social Security and CHIP. No bill number. Discussed access to Medicaid services, including home and community-based services. No bill number. Discussed Medicare home health payment proposed rule. H.R. 5138, the Improving Access to Medicare Coverage Act. No bill number. Discussed Civil Money Penalty Reinvestment Program. No bill number. Discussed 2024 Medicare physician fee schedule proposed rule and family caregivers. No bill number. Discussed 2024 Medicare hospital outpatient prospective payment system proposed rule and family caregivers. No bill number. Discussed minimum nursing home staffing standards and proposed rule. No bill number. Discussed 21st Century Long-Term Care Caucus. No bill number. Discussed GUIDE Model. No bill number. Discussed shortage of nursing home state surveyors and related funding. No bill number. Discussed Medicare home health. H.R. 5518, the Right to Medicare Act. H.R. 5378, the Lower Costs, More Transparency Act. No bill number. Discussed Medicaid Managed Care programs.

Client expense: $3,890,000 · Firm income: Not reported

Observation Stays and 3 Day Stay Issue Outreach to HHS/CMS/Administration Survey Relief/Civil Monetary Penalties CMS on Public Health Waiver and other waivers SNF Payment Rule OSHA Emergency Temporary Standards Care For Our Seniors Act Medicare Advantage H.R. 177 - To amend title XI of the Social Security Act to ensure nursing facilities report information on medical directors of such facilities. CDC/COVID Safety Guidance Outreach to hill, HHS and ONC on LTPAC health information technology needs (zoom meetings and letters) Outreach to hill on needed Physician Fee Schedule reforms (sign on letters only) Improve Access to Mental Access Act S838/HR1638 (sign on letters) Improving Access to Medicare Coverage Act of 2023 HR 5138

Client expense: $990,000 · Firm income: Not reported

Issues pertaining to physician payment and quality measurement, including HR 2474, Strengthening Medicare for Patients and Providers Act; observation care, including HR 5138, Improving Access to Medicare Coverage Act of 2023; prior authorization and access to care through Medicare Advantage

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

(H.R. 5138) - Improving Access Medicare Coverage Act - Expressed support for the Improving Access Medicare Coverage Act. This legislation will make days spent in observation count towards Medicare's three-day inpatient stay requirement for Skilled Nursing Facility (SNF) coverage. Urged the Centers for Medicare and Medicaid Services (CMS) to take action to prevent millions of Medicaid beneficiaries from losing coverage as states begin unwinding the temporary Medicaid provisions in place during the pandemic. (H.R. 2665) - Supporting Safety Net Hospitals Act - Expressed support for the Supporting Safety Net Hospitals Act. The legislation would address pending cuts to Medicaid DSH payments. Urged Congress to address the Medicaid disproportionate share hospital (DSH) cuts scheduled to begin in fiscal year (FY) 2024.

Client expense: $202,711 · Firm income: Not reported

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

H.R. 824, the Telehealth Benefit Expansion for Workers Act of 2023. H.R. 2713/S. 2418, the Improving Care and Access to Nurses Act. S. 1687, the Beneficiary Enrollment Notification and Eligibility Simplification 2.0 Act. No bill number. Discussed Medicare financial stability and solvency. No bill number. Discussed family caregivers and 1-800-MEDICARE. No bill number. Discussed reducing red tape for family caregivers in Medicare, Medicaid, Social Security and CHIP. No bill number. Discussed access to Medicaid services, including home and community-based services. No bill number. Discussed Medicare home health payment proposed rule. H.R. 5138, the Improving Access to Medicare Coverage Act. No bill number. Discussed Civil Money Penalty Reinvestment Program. No bill number. Discussed 2024 Medicare physician fee schedule proposed rule and family caregivers. No bill number. Discussed 2024 Medicare hospital outpatient prospective payment system proposed rule and family caregivers. No bill number. Discussed minimum nursing home staffing standards and proposed rule. No bill number. Discussed 21st Century Long-Term Care Caucus. No bill number. Discussed GUIDE Model. No bill number. Discussed shortage of nursing home state surveyors and related funding. No bill number. Discussed Medicare home health. H.R. 5518, the Right to Medicare Act. H.R. 5378, the Lower Costs, More Transparency Act. No bill number. Discussed Medicaid Managed Care programs.

Client expense: $3,890,000 · Firm income: Not reported

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