To amend title XVIII of the Social Security Act to establish a definition of essential health system in statute.

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

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

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

Support for the Reinforcing Essential Health Systems for Communities Act (H.R. 7397). The Preventing Illegal Laboratories and Protecting Public Health Act of 2024 (H.R. 8065).

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

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

Client expense: $460,000 · Firm income: Not reported

Support for legislation establishing an essential hospital designation in federal law (H.R. 7397) for purposes of reimbursement of services provided under Medicare. Provided clinical expertise and faculty perspective on existing legal barriers to access to reproductive health services, contraception and abortion drugs.

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

Government targets: HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

Support for the Reinforcing Essential Health Systems for Communities Act (H.R. 7397). The Preventing Illegal Laboratories and Protecting Public Health Act of 2024 (H.R. 8065).

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

Government targets: HOUSE OF REPRESENTATIVES

Q2 Lobbying Report (April 1-June 30) HCR Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program Resident Physician Shortage Act of 2023 (H.R. 2389) No Surprises Act regulations Food and Drug Amendments No Surprise Bills for New Moms Act (H.R. 3387) Securing the U.S. Organ Procurement and Transplantation Network Act (H.R. 2544) Promoting Access to Treatments and Increasing Extremely Needed Transparency Act (H.R. 3561) Medicaid VBPs for Patients (MVP) Act (H.R. 2666) Providers and Payers COMPETE Act (H.R. 3284) To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program (H.R. 3290) Transparent PRICE Act (H.R. 3281/H.R. 2691)) Resident Physician Shortage Reduction (S. 1302) Medical Student Education Authorization Act (H.R. 3046) Save Americas Rural Hospitals Act (H.R. 833) Chronic Care Management Improvement Act (H.R. 2829) Safety From Violence for Healthcare Employees Act (H.R. 2584) Supporting Safety Net Hospitals Act (H.R. 2665) Patient Access to Higher Quality Health Care Act (H.R. 977/S.470) FEMA re: COVID-19 related reimbursement Public Health Guidance Transparency and Accountability Act of 2023 (H.R. 4529) Public Health Emergency Congressional Review Act (H.R. 4381) CDC Leadership Accountability Act of 2023 (H.R. 3813) Preparing for All Hazards and Pathogens Reauthorization Act (H.R. 4421) Preparedness and Response Reauthorization Act (H.R. 4420) Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887) Health Care Price Transparency Act of 2023 (H.R. 4822) Providers and Payers COMPETE Act (H.R. 3284) Lower Costs, More Transparency Act (H.R. 5378 Transparency in Coverage Act (H.R. 4507) GOLD Card Act of 2023 (H.R. 4968) No Fees for EFTs Act (H.R.6487) Rural Health Care Facilities Revitalization Act (H.R. 5989) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (H.R. 7153) To amend title XVIII of the Social Security Act to establish a definition of essential health system in statute (H.R. 7397) Substance Use Disorder Workforce Act (H.R. 7050) 340B PATIENTS Act (H.R. 7635) The 340B Affording Care for Communities and Ensuring a Strong Safety-net (ACCESS) Act (H.R. 8574) Improving Seniors Access to Timely Care Act (H.R. 8702/S.4532) The Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931) Rural Health Care Facilities Revitalization Act (H.R. 5989) MMM Accelerated and Advance Payment Program repayment flexibility Graduate Medical Education (GME) funding Telehealth flexibilities and payment Annual Prospective Payment System Rules Organ acquisition payment policies Californias Medicaid Hospital Quality Assurance Fee Program BUD FY 2024 Appropriations bills Nursing and allied health workforce funding FY 2024 budget request Further Continuing Appropriations and Other Extensions Act (H.R. 6363) Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (H.R. 5894) Tax Relief for American Families and Workers Act of 2024 (H.R. 7024) Extension of Continuing Appropriations and Other Matters Act, 2024 (H.R. 7463) Submitted Comments Regulatory Comment Letters SUBJECT: CMS-1808-P, Medicare and Medicaid Programs and the Childrens Health Insurance Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates; Quality Programs Requirements; and Other Policy Changes; Proposed Rule, Federal Register (Vol. 89, No. 86), May 2, 2024 SUBJECT: CMS-4207-NC, Medicare Program; Request for Information on Medicare Advantage Data, Federal Register (Vol. 89, No. 20), January 30, 2024 SUBJECT: CMS-1806-P, Medicare Program; FFY 2025 Inpatient Psychiatric Facilities Prospective Payment System - Rate Update, Proposed Rule, Federal Register (Vol. 89, No. 65), April 3, 2024 SUBJECT: CMS-1804-P, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FFY 2025 and Updates to the IRF Quality Reporting Program; Proposed Rule, Federal Register (Vol. 89, No. 62), March 29, 2024 SUBJECT: Docket No. ATR 102 - Request for Information on Consolidation in Health Care Markets SUBJECT: CMS-3367-P, Medicare Program; Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflict of Interest, and Related Provisions, Proposed Rule, Federal Register (Vol 89, No 32), February 15, 2024 Legislative Comment Letters Rep. Ami Bera Request for Information Regarding the Current State of Artificial Intelligence (AI) in the Health Care Industry, April 30, 2024 Senate Request for Information Regarding Draft SUSTAIN 340B Act, April 1, 2024

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

Client expense: $450,000 · Firm income: Not reported

Q1 Lobbying Report (Jan. 1-March 31) HCR Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program Resident Physician Shortage Act of 2023 (H.R. 2389) No Surprises Act regulations Public Health Emergency designation Food and Drug Amendments No Surprise Bills for New Moms Act (H.R. 3387) Securing the U.S. Organ Procurement and Transplantation Network Act (H.R. 2544) Promoting Access to Treatments and Increasing Extremely Needed Transparency Act (H.R. 3561) Medicaid VBPs for Patients (MVP) Act (H.R. 2666) Providers and Payers COMPETE Act (H.R. 3284) To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program (H.R. 3290) Transparent PRICE Act (H.R. 3281/H.R. 2691)) Resident Physician Shortage Reduction (S. 1302) Medical Student Education Authorization Act (H.R. 3046) Save Americas Rural Hospitals Act (H.R. 833) Chronic Care Management Improvement Act (H.R. 2829) Safety From Violence for Healthcare Employees Act (H.R. 2584) Supporting Safety Net Hospitals Act (H.R. 2665) Patient Access to Higher Quality Health Care Act (H.R. 977/S.470) FEMA re: COVID-19 related reimbursement Public Health Guidance Transparency and Accountability Act of 2023 (H.R. 4529) Public Health Emergency Congressional Review Act (H.R. 4381) CDC Leadership Accountability Act of 2023 (H.R. 3813) Preparing for All Hazards and Pathogens Reauthorization Act (H.R. 4421) Preparedness and Response Reauthorization Act (H.R. 4420) Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887) Health Care Price Transparency Act of 2023 (H.R. 4822) Providers and Payers COMPETE Act (H.R. 3284) Lower Costs, More Transparency Act (H.R. 5378 Transparency in Coverage Act (H.R. 4507) GOLD Card Act of 2023 (H.R. 4968) No Fees for EFTs Act (H.R.6487) Rural Health Care Facilities Revitalization Act (H.R. 5989) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (H.R. 7153) To amend title XVIII of the Social Security Act to establish a definition of essential health system in statute (H.R. 7397) Substance Use Disorder Workforce Act (H.R. 7050) 340B PATIENTS Act (HR7635) MMM Accelerated and Advance Payment Program repayment flexibility Graduate Medical Education (GME) funding Telehealth flexibilities and payment Annual Prospective Payment System Rules Organ acquisition payment policies Californias Medicaid Hospital Quality Assurance Fee Program BUD FY 2024 Appropriations bills Nursing and allied health workforce funding FY 2024 budget request Further Continuing Appropriations and Other Extensions Act (H.R. 6363) Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (H.R. 5894) Tax Relief for American Families and Workers Act of 2024 (H.R. 7024) Extension of Continuing Appropriations and Other Matters Act, 2024 (H.R. 7463) Submitted Comments SUBJECT: CMS-4205-P, Medicare Program; Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications (Vol 88, No. 219), Wednesday, November 15th SUBJECT: RIN 0955-AA05, 21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking, Proposed Rule, Federal Register (Vol 88, No 210), November 1, 2023 Subject: CMS-9897-P Federal Independent Dispute Resolution Operations, Proposed Rule, Federal Register (Vol. 88, No. 212), November 3, 2023

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

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