Protecting American Seniors’ Access to Care Act

S. 3702/H.R. 7165, the Credit for Caring Act. S. 3109/H.R. 8018, the Alleviating Barriers for Caregivers Act. S. 3766/H.R. 7274, the Connecting Caregivers to Medicare Act. S. 3254/H.R 7222, the Lowering Costs for Caregivers Act. No bill number. Discussed enhanced ACA tax credits. No bill number. Discussed high-deductible health plans and health savings accounts. No bill number. Discussed falls prevention. No bill number. Discussed respiratory virus season. No bill number. Discussed consumer protections and artificial intelligence in health care. No bill number. Commented on Notice of Benefit and Payment Parameters for 2026. No bill number. Discussed social isolation and loneliness. H.R. 9803, the Hospice Care Act. S. 5023, the Stand Strong Falls Prevention Act. S. 4556/H.R. 9179, the SAFE STEPS for Veterans Act. H.R. 7618, the Stopping Addiction and Falls for the Elderly (SAFE) Act No bill number. Discussed Assisted in Assisted Living Act. H.R. 3227/H.R. 8244, the Ensuring Seniors Access to Quality Care Act. H.R. 7513/S.3410, the Protecting Americas Seniors Access to Care Act. H.R. 468/H.R. 9067, the Building Americas Health Care Workforce Act. No bill number. Discussed Nursing Home Staffing Standard.

Client expense: $5,580,000 · Firm income: Not reported

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

The Elder Justice Reauthorization and Modernization Act of 2023 AHCA/NCAL proposal of Care For Our Seniors Act Staff Agency Practices - Outreach to the Hill Immigration Delays - outreach to U.S. Departments of State, Homeland Security, & USCIS Advocating for providing temporary nurse aides a reasonable grace period as the public health emergency ends Administration nursing home reform plan Appropriations related outreach Support of the 21st Century Long-Term Care Caucus Outreach to DOL in support of LTC apprenticeship programs Outreach to LTC workforce related and appropriations matters Outreach to CMS and the Hill on the TNA waiver issue Outreach to CMS and the Hill on minimum staffing standards Outreach to DOE on SNF Loan Repayment Issues impacting the LTC workforce, including advocacy on the Care for Seniors Act H.R. 9067 Building Americas Health Care Workforce Act Senate HELP Comm Workforce RFI Comments S.1749/H.R. 3227 -- Ensuring Seniors Access to Quality Care Act Joined coalition in support for the bipartisan resolution S.J.Res.49/H.J.Res.98 Protecting American's Seniors' Access to Care Act (S. 3410/H.R. 7513) Outreach to DOL and NLRB on regulatory related workforce matters impacting LTC providers Advocacy around observation stays bill in the Senate Advocacy around the mark-up of the Protecting Americans Seniors Access to Care Act in the House Ways and Means Committee Advocacy around LTC workforce and AL with the Senate Aging Committee on policies they are considering Support for the SENIOR Act (H.R. 7605), which increases access and affordability of assisted living and address our workforce needs. Outreach to Dept of Labor, Employment and Training Admin on RIN 1205-AC13 - National Apprenticeship System Enhancements Train More Nurses Act (S. 2853/H.R. 6122) Safeguarding Elderly Needs for Innovation and Occupational Resources (SENIOR) Act (H.R. 7605) Protecting America's Seniors' Access to Care Act (S. 3410/H.R. 7513) Support for the Health Care Workforce Investment Act (H.R. 9812)

Client expense: $1,170,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, State, Dept of (DOS)

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

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

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

S 4724, HR 9101- 9/11 Responder and Survivor Health Funding Correction Act of 2024 HR 5378- Lower Costs, More Transparency Act HR 4895- Lowering Drug Costs for American Families Act HR 5796- Protecting Rural Seniors Access to Care Act HR 7513- Protecting America's Seniors Access to Care Act HR 485- Protecting Care for All Patients Care Act S 3679- Lorna Breen Health Care Provider Protection Reauthorization Act HJ Res 139, SJ Res 91- CRA to rescind nursing home staff rule HR 468, HR 9067- Building America's Health Care Workforce Act HR 3227- Ensuring Seniors' Access to Quality Care Act HJ Res 181- CRA to rescind the Association Health Plan Rule S 4671- Capping Prescription Costs Act S 4804, HR 9156- Health Over Wealth Act HR 9581- STAR Act

Client expense: $670,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Extension of COVID-19 public health emergency waivers Nurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act (S.5236) Keeping Obstetrics Local Act S.4338 - Pay PCPs Act of 2024 Issues surrounding Medicare reimbursement (H.R. 8702/S. 4532) Improving Seniors Timely Access to Care Act of 2024 (H.R.10445) Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 (H.R.10545) American Relief Act, 2025 (H.R.10515) American Relief Act, 2025 Issues surrounding surgical smoke

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Nurse staffing shortages Removing barriers to care Strengthening the nurse workforce and increasing the pipeline Nurse burn out and well-being Extension of COVID-19 public health emergency waivers Nurse overtime and patient safety (H.R.2713/S.2418) I CAN Act (S. 1150/H.R. 2411) National Nursing Workforce Center Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act Primary Care and Health Workforce Expansion Act (S.2840) Bipartisan Primary Care and Health Workforce Act (S.2815/H.R.7002) Nurse Faculty Shortage Reduction Act of 2023 (H.R. 3305/S. 1606) Black Maternal Health Momnibus Act (H.R. 7153 / S. 3679) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (S.3770/H.R.7266) Future Advancement of Academic Nursing Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Rural access to care, including issues surrounding home visiting programs, nurse residency programs, and prior authorization (H.Res.1208/S.Res.676) Supporting the goals and ideals of National Nurses Week, to be observed from May 6 through May 12, 2024. (H.R.8330) Stop Nurse Shortages Act Issues surrounding HRSA advisory councils (H.R.10445) Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 (H.R.10545) American Relief Act, 2025 (H.R.10515) American Relief Act, 2025 Issues surrounding surgical smoke

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

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

Meetings, Letters, and Briefings in House and Senate on CMS Nursing Home Staffing Rule, and sharing SEIU strong Opposition to HR 5796, H.R. 7513, S. 3410, H.J. Res. 139 and S.J. Res. 91 that would prohibit the rule. Sent letter and held meetings with several House and Senate individual officers and Committee Staff of House Energy and Commerce, House Ways and Means and Senate Finance in Opposition to HR 6860/S.5018, the Restore Protections for Dialysis Patients Act (RPDPA).

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

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

Nurse staffing shortages Removing barriers to care Strengthening the nurse workforce and increasing the pipeline Nurse burn out and well-being Extension of COVID-19 public health emergency waivers Nurse overtime and patient safety (H.R.2713/S.2418) I CAN Act (S. 1150/H.R. 2411) National Nursing Workforce Center Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act Primary Care and Health Workforce Expansion Act (S.2840) Bipartisan Primary Care and Health Workforce Act (S.2815/H.R.7002) Nurse Faculty Shortage Reduction Act of 2023 (H.R. 3305/S. 1606) Black Maternal Health Momnibus Act (H.R. 7153 / S. 3679) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (S.3770/H.R.7266) Future Advancement of Academic Nursing Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Rural access to care, including issues surrounding home visiting programs, nurse residency programs, and prior authorization (H.Res.1208/S.Res.676) Supporting the goals and ideals of National Nurses Week, to be observed from May 6 through May 12, 2024. (H.R.8330) Stop Nurse Shortages Act Issues surrounding HRSA advisory councils Issues surrounding surgical smoke (H.R.10445) Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 (H.R.10545) American Relief Act, 2025 (H.R.10515) American Relief Act, 2025

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

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

Extension of COVID-19 public health emergency waivers Nurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act (S.5236) Keeping Obstetrics Local Act S.4338 - Pay PCPs Act of 2024 Issues surrounding Medicare reimbursement Issues surrounding surgical smoke (H.R. 8702/S. 4532) Improving Seniors Timely Access to Care Act of 2024 (H.R.10445) Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 (H.R.10545) American Relief Act, 2025 (H.R.10515) American Relief Act, 2025

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding 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 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. 1638, Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill 15. Proposals regarding the Medicare Low Income Subsidy program 16. H.R. 7513, Protecting Americas Seniors Access to Care Act, entire 17. S. 3410, Protecting Rural Seniors Access to Care Act, entire bill 18. H.R. 8106, To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver, entire bill 19. H.R. 8107, Ensuring Access to Medicaid Buy-in Programs Act of 2024, entire bill 20. H.R. 8109, Money Follows the Person Permanency Act of 2024, entire bill 21. H.R. 8110, Protecting Married Seniors from Impoverishment Act of 2024, entire bill 22. H.R. 8018, Alleviating Barriers for Caregivers Act, entire bill 23. S. 3109, Alleviating Barriers for Caregivers Act, entire bill 24. H.R. 7573, Stop Unfair Medicaid Recoveries Act, entire bill 25. Proposals for $2 per month generic drug prescription co-pays under Medicare

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

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

HR 5796/S 3410 Protecting Rural Seniors Access to Care Act S.1749/HR 3227 Ensuring Seniors' Access to Quality Care Act S100/HR4131 Better Care Better Jobs Act HR 2713/S2418 Improving Care and Access to Nurses Act S 2137/HR5159 Preserving Access to Home Health Care Act S 3118 HCBS Relief Act H.R.7513 s 3307: encounter data enhancement act hr 9803 hospice care, accountability, reform, and enforcement act hr 8107 Ensuring Access to Medicaid Buy-in Programs Act of 2024 H.R. 8261, the Preserving Telehealth, Hospital, and Ambulance Access Act Home Health Payment Adult Day Reimbursement Congressional Review Act -- Nursing home staffing mandate

Client expense: $11,995 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding 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 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill 15. Proposals regarding the Medicare Low Income Subsidy program 16. H.R. 7513, Protecting Americas Seniors Access to Care Act, entire 17. S. 3410, Protecting Rural Seniors Access to Care Act, entire bill 18. H.J.Res. 139, providing for Congressional disapproval of the CMS rule Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting," entire resolution 19. H.R. 8106, To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver, entire bill 20. H.R. 8107, Ensuring Access to Medicaid Buy-in Programs Act of 2024, entire bill 21. H.R. 8109, Money Follows the Person Permanency Act of 2024, entire bill 22. H.R. 8110, Protecting Married Seniors from Impoverishment Act of 2024, entire bill 23. H.R. 8018, Alleviating Barriers for Caregivers Act, entire bill 24. S. 3109, Alleviating Barriers for Caregivers Act, entire bill

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

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

H.R. 485 - Protecting Health Care For All Patients Act of 2023 - Rep. McMorris Rodgers, Cathy - federal programs using prices based on quality-adjusted life years H.R. 824 - Telehealth Benefit Expansion for Workers Act of 2023 - Rep. Walberg, Tim - telehealth and ERISA amendments H.R. 830 - HELP Copays Act - Rep. Carter, Earl - health insurers responsibility for payments made by or on behalf of a plan enrollee toward a plans cost-sharing requirements H.R. 1488 - Affordable Insulin Now Act of 2023 - Rep. Craig, Angie - cost-sharing for insulin products H.R. 2666 - MVP Act - Rep. Guthrie, Brett - value-based purchasing arrangements under Medicaid program and reforms to price reporting H.R. 2691 - Transparent Price Act - Rep. McMorris Rodgers, Cathy - health insurer price transparency H.R. 2813 - Self-Insurance Protection Act - Rep. Good, Bob - ERISA amendments H.R. 2868 - Association Health Plans Act - Rep. Walberg, Tim - ERISA amendments H.R. 2872 - Further Additional Continuing Appropriations and Other Extensions Act, 2024 - Rep. Graves, Garret - extends FY24 funding and program authorities through March 8, 2024 H.R. 2882 - Further Consolidated Appropriations Act, 2024 - Rep. Ciscomani, Juan - provides annual funding through September 30, 2024, for the Departments of Labor, Health and Human Services, and Education, and Related Agencies H.R. 3305 - Black Maternal Health Momnibus Act - Rep. Underwood, Lauren - maternal health including in Medicaid and CHIP H.R. 3561 - PATIENT Act - Rep. McMorris Rodgers, Cathy - PBM transparency, PBM contract design, health insurance transparency, hospital transparency H.R. 3799 - Custom Health Option and Individual Care Expense Arrangement Act- Rep. Hern, Kevin - health reimbursement arrangements H.R. 3801 - Employer Reporting Improvement Act - Rep. Smith, Adrian - ACA reporting requirements H.R. 6956 - Opioid Settlement Accountability Act - Rep. Kaptur, Marcy - funding for opioid prevention and treatment services, training, equipment, and social support services H.R. 6960 - Emergency Medical Services for Children Reauthorization Act of 2024 - Rep. Carter, Earl L. Buddy - funding for emergency medical services for children program H.R. 7513 - Protecting Americas Seniors Access to Care Act - Rep. Fischbach, Michelle - regarding minimum staffing for nursing facilities H.R. 7623 - Telehealth Modernization Act of 2024- Rep. Carter, Buddy - including requirements for Part D plan contracts with PBMs including transparency and delinking provisions H.R. 7858 - Telehealth Enhancement for Mental Health Act of 2024 - Rep. James, John - Medicare, behavioral health, telehealth H.R. 7899 - To direct the Attorney General, in consultation with the Secretary of Health and Human Services, to promulgate the final regulations relating to special registration for telemedicine. - Rep. Ezell, Mike - telehealth H.R. 7907 - Welcome Back to the Health Care Workforce Act - Rep. Krishnamoorthi, Raja- grants/funding, health care workforce H.R. 7929 - Nursing Home Workforce Support and Expansion Act of 2024 - Rep. Horsford, Steven - grants/funding, health care workforce H.R. 7994 - Long-Term Care Workforce Support Act - Rep. Dingell, Debbie - health care workforce H.R. 8444 - Mental Health in Schools Act - Rep. Napolitano, Grace - grant to promote mental health S. 1606 - A bill to end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. - Sen. Booker, Cory - maternal mortality S. 3393 - SUPPORT for Patients and Communities Reauthorization Act. - Sen. Sanders, Bernie - SUD treatment S. 3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 - Sen. Wyden, Ron - mental health, telehealth, health workforce S. 3612 - Access to Family Building Act- Sen. Duckworth, Tammy- right to access reproductive technology (ex. IVF) S. 3756 - At HOME Services Act of 2024- Sen. Rubio, Marco- pilot program for outpatient observation, acute care at home S. 3775 - BOLD Infrastructure for Alzheimers Reauthorization Act of 2024- Sen. Collins, Susan - healthcare infrastructure, Alzheimers S. 3805 - A bill to amend title XI of the Social Security Act to prohibit health plans from imposing fees on health care providers for electronic funds transfers and health care payment and remittance advice transactions, and for other purposes. - Sen. Cassidy, Bill - SSA, healthcare, electronic funds, payments, remittance S. 3847 - Improving Social Determinants of Health Act of 2024- Sen. Smith, Tina- CDC authorization S. 4088 - Welcome Back to the Health Care Workforce Act - Sen. Kaine, Tim - grants/funding, health care workforce S. 4120 - Long-Term Care Workforce Support Act - Sen. Casey, Robert P., Jr. - health care workforce S. 4195 - Childhood Diabetes Reduction Act of 2024 - Sen. Sanders, Bernie - nutrition labeling S. 4357 - Comprehensive Dental Reform Act of 2024- Sen. Sanders, Bernie - promotes access to oral health care S. 4358 - Preventing and Treating Substance Use Disorders Among Older Adults Act- Sen. Casey, Robert - SAMHSA grant program for SUDs S. 4554 - Reproductive Freedom for Women Act- Sen. Murray, Patty - protecting abortion and reproductive rights Issues related to broadband and public health infrastructure; mental health and telehealth; behavioral health; rural health; substance use disorder treatments; Health Savings Accounts; provider directories; artificial intelligence and privacy; insurance industry response to and support for providers regarding the Change Healthcare cyberattack and broader cyber security issues; ACA Marketplace; and Mental Health Parity Proposed Rule.

Client expense: $2,560,000 · Firm income: Not reported

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

-HR 5378 - Lower Costs More Transparency Act, Provisions related to pharmacy benefit manager and health plan transparency -HR 7513 - Protecting America's Seniors' Access to Care Act -HR 485 - Protecting Health Care for All Patients Act -HR 468 - Building America's Health Care Workforce Act -HR 3227 - Ensuring Seniors' Access to Quality Care Act -S 4381 - The Right to Contraception Act -HR 4367/S 2625 - FAMILY Act -HJ Res. 139/SJ Res. 91 - Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting" -HR 8114 - o prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services -HR 4818 - Treat and Reduce Obesity Act (Provisions related to Medicare coverage of anti-obesity medications and intensive behavioral therapy)

Client expense: $560,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

The Elder Justice Reauthorization and Modernization Act of 2023 AHCA/NCAL proposal of Care For Our Seniors Act Staff Agency Practices - Outreach to the Hill Immigration Delays - outreach to U.S. Departments of State, Homeland Security, & USCIS Advocating for providing temporary nurse aides a reasonable grace period as the public health emergency ends Administration nursing home reform plan Appropriations related outreach Support of the 21st Century Long-Term Care Caucus Outreach to DOL in support of LTC apprenticeship programs Outreach to LTC workforce related and appropriations matters Outreach to CMS and the Hill on the TNA waiver issue Outreach to CMS and the Hill on minimum staffing standards Outreach to DOE on SNF Loan Repayment Issues impacting the LTC workforce, including advocacy on the Care for Seniors Act H.R. 9067 Building Americas Health Care Workforce Act Senate HELP Comm Workforce RFI Comments S.1749/H.R. 3227 -- Ensuring Seniors Access to Quality Care Act Joined coalition in support for the bipartisan resolution S.J.Res.49/H.J.Res.98 Protecting American's Seniors' Access to Care Act (S. 3410/H.R. 7513) Outreach to DOL and NLRB on regulatory related workforce matters impacting LTC providers Advocacy around observation stays bill in the Senate Advocacy around the mark-up of the Protecting Americans Seniors Access to Care Act in the House Ways and Means Committee Advocacy around LTC workforce and AL with the Senate Aging Committee on policies they are considering Support for the SENIOR Act (H.R. 7605), which increases access and affordability of assisted living and address our workforce needs. Outreach to Dept of Labor, Employment and Training Admin on RIN 1205-AC13 - National Apprenticeship System Enhancements Train More Nurses Act (S. 2853/H.R. 6122) Safeguarding Elderly Needs for Innovation and Occupational Resources (SENIOR) Act (H.R. 7605) Protecting America's Seniors' Access to Care Act (S. 3410/H.R. 7513) Support for the Health Care Workforce Investment Act (H.R. 9812)

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, State, Dept of (DOS)

S. 3109/H.R. 8018, the Alleviating Barriers for Caregivers Act. S. 3766/H.R. 7274, the Connecting Caregivers to Medicare Act. No bill number. Discussed funding for SHIP low-income outreach and enrollment programs. No bill number. Discussed Medicare Advantage and health savings accounts. H.R.7623/S.3697, the Telehealth Modernization Act. S. 5070/H.R. 8107, the Ensuring Access to Medicaid Buy-In Programs Act. No bill number. Discussed Medicare Physician Fee Schedule for calendar year 2025. No bill number. Discussed Medicare Hospital Outpatient Prospective Payment System for calendar year 2025. No bill number. Discussed Fiscal Year 2025 Home Health Prospective Payment System Rate Update. No bill number. Discussed Medicare open enrollment. H.R. 8702/S.4532, the Improving Seniors Timely Access to Care Act of 2024. H.R. 8331/S. 4280, the Essential Caregivers Act. H.J.Res.139, Providing for Congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. S.J.Res.91, A joint resolution providing for Congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting" H.R. 8244, the Ensuring Seniors Access to Quality Care Act. S.1749/H.R. 3227, the Ensuring Seniors Access to Quality Care Act. S.3410/H.R. 7513, the Protecting Americas Seniors Access to Care Act. H.R. 468, the Building Americas Health Care Workforce Act. H.R. 9067, the Building Americas Health Care Workforce Act. S. 5023, the Stand Strong Falls Prevention Act. S.1190, the Direct Support Worker Training Reimbursement Act of 2023. S.1196, the Mollie Baldwin Upskilling of Personal and Home Care Aides Act of 2023. S.1192, the CADSAW Act of 2023. No bill number. Discussed Medicaid home and community-based services and presumptive eligibility and self-directed services. No bill number. Discussed Caregiver Training Services. No bill number. Discussed GUIDE Model. No bill number. Discussed Medicare, Medicaid, and family caregivers. No bill number. Discussed Medicaid access final rule. H.R. 8108, the Care for Military Kids Act. H. R. 8106, to increase transparency and expand coverage options for home and community-based services under a Medicaid waiver. No bill number. Discussed long-term care. H.R. 9803, the Hospice Care Act.

Client expense: $4,820,000 · Firm income: Not reported

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

Health Issues Nurse staffing shortages Removing barriers to care Strengthening the nurse workforce and increasing the pipeline Nurse burn out and well-being Extension of COVID-19 public health emergency waivers Nurse overtime and patient safety (H.R.2713/S.2418) I CAN Act (S. 1150/H.R. 2411) National Nursing Workforce Center Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act Primary Care and Health Workforce Expansion Act (S.2840) Bipartisan Primary Care and Health Workforce Act (S.2815/H.R.7002) Nurse Faculty Shortage Reduction Act of 2023 (H.R. 3305/S. 1606) Black Maternal Health Momnibus Act (H.R. 7153 / S. 3679) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (S.3770/H.R.7266) Future Advancement of Academic Nursing Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Rural access to care, including issues surrounding home visiting programs, nurse residency programs, and prior authorization (H.Res.1208/S.Res.676) Supporting the goals and ideals of National Nurses Week, to be observed from May 6 through May 12, 2024. (H.R.8330) Stop Nurse Shortages Act Issues surrounding HRSA advisory councils

Client expense: $270,000 · Firm income: Not reported

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

Extension of COVID-19 public health emergency waivers Nurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act (S.5236) Keeping Obstetrics Local Act S.4338 - Pay PCPs Act of 2024

Client expense: $270,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S 4724, HR 9101- 9/11 Responder and Survivor Health Funding Correction Act of 2024 HR 5378- Lower Costs, More Transparency Act HR 4895- Lowering Drug Costs for American Families HR 5796- Protecting Rural Seniors Access to Care Act HR 7513- Protecting America's Seniors Access to Care Act HR 485- Protecting Health Care for All Patients Act S 3679- Lorna Breen Health Care Provider Protection Reauthorization Act HJ Res 139, SJ Res 91- CRA to rescind nursing home staffing rule HR 468, HR 9067- Building America's Health Care Workforce Act HR 3227- Ensuring Seniors' Access to Quality Care Act HJ Res 181- CRA to rescind the Association Health Plan Rule S 4671- Capping Prescription Costs Act S 4804, HR 9156- Health Over Wealth Act

Client expense: $720,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medication safety; pharmacy regulation and licensure, drug supply chain security and combatting the opioid epidemic including ensuring MOUD access; Prescription drug monitoring programs; HR 501 Block, Report, and Suspend Suspicious Shipments Act; Ryan Haight Act/DEA rule on telehealth; HR 4531/S 2433 SUPPORT for Patients and Communities Reauthorization Act; H.R. 7513/S. 3679 Dr. Loma Breen Health Care Provider Protection Reauthorization Act; H.R. 7513/S. 3679 Dr. Loma Breen Health Care Provider Protection Reauthorization Act.

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

Government targets: Drug Enforcement Administration (DEA), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), SENATE

Medication safety; pharmacy regulation and licensure, drug supply chain security and combatting the opioid epidemic including ensuring MOUD access; Prescription drug monitoring programs; HR 501 Block, Report, and Suspend Suspicious Shipments Act; Ryan Haight Act/DEA rule on telehealth; HR 4531/S 2433 SUPPORT for Patients and Communities Reauthorization Act; H.R. 7513/S. 3679 Dr. Loma Breen Health Care Provider Protection Reauthorization Act.

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

Government targets: Drug Enforcement Administration (DEA), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), SENATE

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.

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

Meetings, Letters, Press Conference and Briefings in House and Senate on CMS Nursing Home Staffing Rule, and sharing SEIU strong Opposition to HR 5796, H.R. 7513, S. 3410, H.J. Res. 139 and S.J. Res. 91 that would prohibit the rule. Sent letter and held meetings with several House and Senate individual officers and Committee Staff of House Energy and Commerce, House Ways and Means and Senate Finance in Opposition to HR 6860/S.5018, the Restore Protections for Dialysis Patients Act (RPDPA). Meetings with House Offices in Opposition to H.R. 3227, Ensuring Seniors' Access to Quality Care Act.

Client expense: $240,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Nurse staffing shortages Removing barriers to care Strengthening the nurse workforce and increasing the pipeline Nurse burn out and well-being Extension of COVID-19 public health emergency waivers Nurse overtime and patient safety (H.R.2713/S.2418) I CAN Act (S. 1150/H.R. 2411) National Nursing Workforce Center Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act Primary Care and Health Workforce Expansion Act (S.2840) Bipartisan Primary Care and Health Workforce Act (S.2815/H.R.7002) Nurse Faculty Shortage Reduction Act of 2023 (H.R. 3305/S. 1606) Black Maternal Health Momnibus Act (H.R. 7153 / S. 3679) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (S.3770/H.R.7266) Future Advancement of Academic Nursing Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Rural access to care, including issues surrounding home visiting programs, nurse residency programs, and prior authorization (H.Res.1208/S.Res.676) Supporting the goals and ideals of National Nurses Week, to be observed from May 6 through May 12, 2024. (H.R.8330) Stop Nurse Shortages Act Issues surrounding HRSA advisory councils

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

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

Extension of COVID-19 public health emergency waivers Nurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act (S.5236) Keeping Obstetrics Local Act S.4338 - Pay PCPs Act of 2024

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 5796/S 3410 Protecting Rural Seniors Access to Care Act S.1749/HR 3227 Ensuring Seniors' Access to Quality Care Act S100/HR4131 Better Care Better Jobs Act HR 2713/S2418 Improving Care and Access to Nurses Act S 2137/HR5159 Preserving Access to Home Health Care Act S 3118 HCBS Relief Act H.R.7513 s 3307: encounter data enhancement act Hospice Program Integrity and Reform (Hospice CARE Act discussion) Home Health Payment Adult Day Reimbursement Congressional Review Act -- Nursing home staffing mandate

Client expense: $11,563 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 7513, Protecting America's Seniors Access to Care Act, all provisions; H.R. 468, Building Americas Health Care Workforce Act, all provisions; H.R. 8113, Transparency into State Directed Payments Act of 2024, all provisions; H.R. 8115, To amend title XIX of the Social Security Act to allow for the deferral or disallowance of portions of payments for certain managed care violations under Medicaid, all provisions; H.R. 1110, KEEP Telehealth Option Act, all provisions; H.R. 7711, Advancing Access to Telehealth Act, all provisions; H.R. 3432, Telemental Health Care Access Act, all provisions; H.R. 3875, the Expanded Telehealth Access Act, all provisions; H.R. 5611, Helping Ensure Access to Local Telehealth (HEALTH) Act of 2023, all provisions; H.R. 6033, Patient Education and Knowledge (SPEAK) Act of 2023, all provisions; H.R. 5541, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, all provisions; H.R. 7863, To require the Secretary of Health and Human Services to issue guidance on furnishing behavioral health services via telehealth to individuals with limited English proficiency under Medicare program, all provisions; H.R. 134, To amend title XVIII of the Social Security Act to remove geographic requirements and expand originating sites for telehealth services, all provisions; H.R. 8261, The Preserving Telehealth, Hospital, and Ambulance Access Act, Issues pertaining to Telehealth, Hospital at Home, and MDH-LVA; S.4350 / H.R. 8260, Hospital Inpatient Services, Modernization Act of 2024, all provisions; H.R. 8235, Rural Physician Workforce Preservation Act, all provisions; S. 2016/ H.R. 4189, The CONNECT for Health Act of 2023, Specifically telehealth waivers, geographic restrictions, originating site requirements, in person requirement behavioral health, RHCs and FQHCs access; S. 1110, the Rural Hospital Support Act, all provisions; S. 1673 / H.R. 1666, Protecting Access to Ground Ambulance Medical Services Act of 2023, all provisions; H.R. 6430, Assistance for Rural Community Hospitals (ARCH)Act, all provisions; S. 803, Save Rural Hospitals Act, all provisions; H.R. 4968, GOLD Card Act of 2023, all provisions; H.R. 3173 / S. 4532, Improving Seniors' Timely Access to Care, all provisions; H.R. 5013/S. 3503, Value in Health Care Act, all provisions; HR 2389/ S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions; Draft Bill, Graduate Medical Education Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; H.J.Res. 139 / S.J. Res 91, A joint resolution for congressional disapproval of a rule relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting", all provisions; HR 1565, Critical Access Hospital Relief Act of 2023, all provisions; H.R. 7623, Telehealth Modernization Act, Issues pertaining to Telehealth, Hospital at Home, Unique Health Identifier; H.R.1128, Rural Health Care Access Act of 2023, all provisions; S.1571, Rural Hospital Closure Relief Act of 2023, all provisions; S. 470 / H.R. 977, The Patient Access to Higher Quality Health Care Act, all provisions; Draft Bill, Keeping Obstetrics Local Act, all provisions;H.R.5378, Lower Costs, More Transparency Act, Issues related to site neutral payment cuts, hospital price transparency, unique health identifier, 340B Program; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for the inpatient psychiatric facility (IPF) prospective payment system (PPS), Issues pertaining to payment policy proposals for inpatient psychiatric facilities (IPFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for skilled nursing facility prospective payment system , Issues pertaining to payment policy proposals for skilled nursing facilities (SNFs); Centers for Medicare & Medicaid Services (CMS)FY25 proposed rule for inpatient rehabilitation facility prospective payment system, Issues pertaining to payment policy proposals for inpatient rehabilitation facilities (IRFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Hospital Inpatient Prospective Payment Systems , Issues pertaining to payment policy proposals for acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Long-Term Care Hospital Prospective Payment System, Issues pertaining to payment policy proposals for long term acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), Transforming Episode Accountability Model (TEAM), Deadline expansion and proposed mandatory alternative payment model; Centers for Medicare & Medicaid Services (CMS), Medicare Advantage Data RFI, Issues pertaining to enforcement and accountability of MA plans, prompt payment, gold carding, Standarization, penalties, and plan oversight; Centers for Medicare & Medicaid Services (CMS); Anomalous DME Spending in MSSP, accountable care models; Centers for Medicare & Medicaid Services (CMS), Accrediting Organizations (AO's), Feedback to strengthen accrediting organizations oversight; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees; Site Neutral Payments, for Q2 2024, Issues related to site neutral payment cuts for drug administration; Valued Based Care, for Q2 2024, Specifically on alternative payment models, MACRA reform, feedback on proposed TEAM model; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, and REHs; Physician Payments, Issues pertaining to proposed solutions to improve MACRA, alternative payment models, mental health of workforce; LTCH High Cost Outlier Threshold, Issues concerning High Cost Outlier in LTCH payment policy; Organ Transplant Model, Issues pertaining to Value Based Care; Rural Health Clinic Payments, Issues related to increasing payments for rural health clinics; Chronic Care Management, Issues pertaining to chronic care management for Medicare beneficiaries.

Client expense: $6,080,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Natl Drug Control Policy (NDCP), SENATE, White House Office

H.R. 485 - Protecting Health Care For All Patients Act of 2023 - Rep. McMorris Rodgers, Cathy - federal programs using prices based on quality-adjusted life years H.R. 824 - Telehealth Benefit Expansion for Workers Act of 2023 - Rep. Walberg, Tim - telehealth and ERISA amendments H.R. 830 - HELP Copays Act - Rep. Carter, Earl - health insurers responsibility for payments made by or on behalf of a plan enrollee toward a plans cost-sharing requirements H.R. 1488 - Affordable Insulin Now Act of 2023 - Rep. Craig, Angie - cost-sharing for insulin products H.R. 2666 - MVP Act - Rep. Guthrie, Brett - value-based purchasing arrangements under Medicaid program and reforms to price reporting H.R. 2691 - Transparent Price Act - Rep. McMorris Rodgers, Cathy - health insurer price transparency H.R. 2813 - Self-Insurance Protection Act - Rep. Good, Bob - ERISA amendments H.R. 2868 - Association Health Plans Act - Rep. Walberg, Tim - ERISA amendments H.R. 2872 - Further Additional Continuing Appropriations and Other Extensions Act, 2024 - Rep. Graves, Garret - extends FY24 funding and program authorities through March 8, 2024 H.R. 2882 - Further Consolidated Appropriations Act, 2024 - Rep. Ciscomani, Juan - provides annual funding through September 30, 2024, for the Departments of Labor, Health and Human Services, and Education, and Related Agencies H.R. 3305 - Black Maternal Health Momnibus Act - Rep. Underwood, Lauren - maternal health including in Medicaid and CHIP H.R. 3561 - PATIENT Act - Rep. McMorris Rodgers, Cathy - PBM transparency, PBM contract design, health insurance transparency, hospital transparency H.R. 3799 - Custom Health Option and Individual Care Expense Arrangement Act- Rep. Hern, Kevin - health reimbursement arrangements H.R. 3801 - Employer Reporting Improvement Act - Rep. Smith, Adrian - ACA reporting requirements H.R. 6956 - Opioid Settlement Accountability Act - Rep. Kaptur, Marcy - funding for opioid prevention and treatment services, training, equipment, and social support services H.R. 6960 - Emergency Medical Services for Children Reauthorization Act of 2024 - Rep. Carter, Earl L. Buddy - funding for emergency medical services for children program H.R. 7513 - Protecting Americas Seniors Access to Care Act - Rep. Fischbach, Michelle - regarding minimum staffing for nursing facilities H.R. 7858 - Telehealth Enhancement for Mental Health Act of 2024 - Rep. James, John - Medicare, behavioral health, telehealth H.R. 7899 - To direct the Attorney General, in consultation with the Secretary of Health and Human Services, to promulgate the final regulations relating to special registration for telemedicine. - Rep. Ezell, Mike - telehealth H.R. 7907 - Welcome Back to the Health Care Workforce Act - Rep. Krishnamoorthi, Raja- grants/funding, health care workforce H.R. 7929 - Nursing Home Workforce Support and Expansion Act of 2024 - Rep. Horsford, Steven - grants/funding, health care workforce H.R. 7994 - Long-Term Care Workforce Support Act - Rep. Dingell, Debbie - health care workforce H.R. 8444 - Mental Health in Schools Act - Rep. Napolitano, Grace - grant to promote mental health S. 1606 - A bill to end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. - Sen. Booker, Cory - maternal mortality S. 3393 - SUPPORT for Patients and Communities Reauthorization Act. - Sen. Sanders, Bernie - SUD treatment S. 3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 - Sen. Wyden, Ron - mental health, telehealth, health workforce S. 3612 - Access to Family Building Act- Sen. Duckworth, Tammy- right to access reproductive technology (ex. IVF) S. 3756 - At HOME Services Act of 2024- Sen. Rubio, Marco- pilot program for outpatient observation, acute care at home S. 3775 - BOLD Infrastructure for Alzheimers Reauthorization Act of 2024- Sen. Collins, Susan - healthcare infrastructure, Alzheimers S. 3805 - A bill to amend title XI of the Social Security Act to prohibit health plans from imposing fees on health care providers for electronic funds transfers and health care payment and remittance advice transactions, and for other purposes. - Sen. Cassidy, Bill - SSA, healthcare, electronic funds, payments, remittance S. 3847 - Improving Social Determinants of Health Act of 2024- Sen. Smith, Tina- CDC authorization S. 4088 - Welcome Back to the Health Care Workforce Act - Sen. Kaine, Tim - grants/funding, health care workforce S. 4120 - Long-Term Care Workforce Support Act - Sen. Casey, Robert P., Jr. - health care workforce S. 4195 - Childhood Diabetes Reduction Act of 2024 - Sen. Sanders, Bernie - nutrition labeling S. 4357 - Comprehensive Dental Reform Act of 2024- Sen. Sanders, Bernie - promotes access to oral health care S. 4358 - Preventing and Treating Substance Use Disorders Among Older Adults Act- Sen. Casey, Robert - SAMHSA grant program for SUDs S. 4554 - Reproductive Freedom for Women Act- Sen. Murray, Patty - protecting abortion and reproductive rights Issues related to broadband and public health infrastructure; mental health and telehealth; behavioral health; rural health; substance use disorder treatments; Health Savings Accounts; provider directories; artificial intelligence and privacy; insurance industry response to and support for providers regarding the Change Healthcare cyberattack; ACA Marketplace; and Mental Health Parity Proposed Rule.

Client expense: $2,390,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE, White House Office

The Elder Justice Reauthorization and Modernization Act of 2023 AHCA/NCAL proposal of Care For Our Seniors Act Staff Agency Practices - Outreach to the Hill Immigration Delays - outreach to U.S. Departments of State, Homeland Security, & USCIS Advocating for providing temporary nurse aides a reasonable grace period as the public health emergency ends Administration nursing home reform plan Appropriations related outreach Support of the 21st Century Long-Term Care Caucus Outreach to DOL in support of LTC apprenticeship programs Outreach to LTC workforce related and appropriations matters Outreach to CMS and the Hill on the TNA waiver issue Outreach to CMS and the Hill on minimum staffing standards Outreach to DOE on SNF Loan Repayment Issues impacting the LTC workforce, including advocacy on the Care for Seniors Act H.R.468 - Building America's Health Care Workforce Act Senate HELP Comm Workforce RFI Comments S.1749/H.R. 3227 -- Ensuring Seniors Access to Quality Care Act Joined coalition in support for the bipartisan resolution S.J.Res.49/H.J.Res.98 Protecting American's Seniors' Access to Care Act (S. 3410/H.R. 7513) Outreach to DOL and NLRB on regulatory related workforce matters impacting LTC providers Advocacy for re-intro of the observation stays bill in the Senate Advocacy around the mark-up of the Protecting Americans Seniors Access to Care Act in the House Ways and Means Committee Advocacy around LTC workforce and AL with the Senate Aging Committee on policies they are considering Support for the SENIOR Act (H.R. 7605), which increases access and affordability of assisted living and address our workforce needs. Outreach to Dept of Labor, Employment and Training Admin on RIN 1205-AC13 - National Apprenticeship System Enhancements Train More Nurses Act (S. 2853/H.R. 6122) Safeguarding Elderly Needs for Innovation and Occupational Resources (SENIOR) Act (H.R. 7605) Protecting America's Seniors' Access to Care Act (S. 3410/H.R. 7513)

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, State, Dept of (DOS)

H.R. 7513, Protecting America's Seniors Access to Care Act, all provisions; H.R. 468, Building Americas Health Care Workforce Act, all provisions; H.R. 8113, Transparency into State Directed Payments Act of 2024, all provisions; H.R. 8115, To amend title XIX of the Social Security Act to allow for the deferral or disallowance of portions of payments for certain managed care violations under Medicaid, all provisions; H.R. 1110, KEEP Telehealth Option Act, all provisions; H.R. 7711, Advancing Access to Telehealth Act, all provisions; H.R. 3432, Telemental Health Care Access Act, all provisions; H.R. 3875, the Expanded Telehealth Access Act, all provisions; H.R. 5611, Helping Ensure Access to Local Telehealth (HEALTH) Act of 2023, all provisions; H.R. 6033, Patient Education and Knowledge (SPEAK) Act of 2023, all provisions; H.R. 5541, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, all provisions; H.R. 7863, To require the Secretary of Health and Human Services to issue guidance on furnishing behavioral health services via telehealth to individuals with limited English proficiency under Medicare program, all provisions; H.R. 134, To amend title XVIII of the Social Security Act to remove geographic requirements and expand originating sites for telehealth services, all provisions; H.R. 8261, The Preserving Telehealth, Hospital, and Ambulance Access Act, Issues pertaining to Telehealth, Hospital at Home, and MDH-LVA; S.4350 / H.R. 8260, Hospital Inpatient Services, Modernization Act of 2024, all provisions; H.R. 8235, Rural Physician Workforce Preservation Act, all provisions; S. 2016/ H.R. 4189, The CONNECT for Health Act of 2023, Specifically telehealth waivers, geographic restrictions, originating site requirements, in person requirement behavioral health, RHCs and FQHCs access; S. 1110, the Rural Hospital Support Act, all provisions; S. 1673 / H.R. 1666, Protecting Access to Ground Ambulance Medical Services Act of 2023, all provisions; H.R. 6430, Assistance for Rural Community Hospitals (ARCH)Act, all provisions; S. 803, Save Rural Hospitals Act, all provisions; H.R. 4968, GOLD Card Act of 2023, all provisions; H.R. 3173 / S. 4532, Improving Seniors' Timely Access to Care, all provisions; H.R. 5013/S. 3503, Value in Health Care Act, all provisions; HR 2389/ S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions; Draft Bill, Graduate Medical Education Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; H.J.Res. 139 / S.J. Res 91, A joint resolution for congressional disapproval of a rule relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting", all provisions; HR 1565, Critical Access Hospital Relief Act of 2023, all provisions; H.R. 7623, Telehealth Modernization Act, Issues pertaining to Telehealth, Hospital at Home, Unique Health Identifier; H.R.1128, Rural Health Care Access Act of 2023, all provisions; S.1571, Rural Hospital Closure Relief Act of 2023, all provisions; S. 470 / H.R. 977, The Patient Access to Higher Quality Health Care Act, all provisions; Draft Bill, Keeping Obstetrics Local Act, all provisions;H.R.5378, Lower Costs, More Transparency Act, Issues related to site neutral payment cuts, hospital price transparency, unique health identifier, 340B Program; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for the inpatient psychiatric facility (IPF) prospective payment system (PPS), Issues pertaining to payment policy proposals for inpatient psychiatric facilities (IPFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for skilled nursing facility prospective payment system , Issues pertaining to payment policy proposals for skilled nursing facilities (SNFs); Centers for Medicare & Medicaid Services (CMS)FY25 proposed rule for inpatient rehabilitation facility prospective payment system, Issues pertaining to payment policy proposals for inpatient rehabilitation facilities (IRFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Hospital Inpatient Prospective Payment Systems , Issues pertaining to payment policy proposals for acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Long-Term Care Hospital Prospective Payment System, Issues pertaining to payment policy proposals for long term acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), Transforming Episode Accountability Model (TEAM), Deadline expansion and proposed mandatory alternative payment model; Centers for Medicare & Medicaid Services (CMS), Medicare Advantage Data RFI, Issues pertaining to enforcement and accountability of MA plans, prompt payment, gold carding, Standarization, penalties, and plan oversight; Centers for Medicare & Medicaid Services (CMS); Anomalous DME Spending in MSSP, accountable care models; Centers for Medicare & Medicaid Services (CMS), Accrediting Organizations (AO's), Feedback to strengthen accrediting organizations oversight; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees; Site Neutral Payments, for Q2 2024, Issues related to site neutral payment cuts for drug administration; Valued Based Care, for Q2 2024, Specifically on alternative payment models, MACRA reform, feedback on proposed TEAM model; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, and REHs; Physician Payments, Issues pertaining to proposed solutions to improve MACRA, alternative payment models, mental health of workforce; LTCH High Cost Outlier Threshold, Issues concerning High Cost Outlier in LTCH payment policy; Organ Transplant Model, Issues pertaining to Value Based Care; Rural Health Clinic Payments, Issues related to increasing payments for rural health clinics; Chronic Care Management, Issues pertaining to chronic care management for Medicare beneficiaries.

Client expense: $9,080,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Natl Drug Control Policy (NDCP), SENATE, White House Office

S.4503, the Corporate Crimes Against Health Care Securing Continued Healthcare for Our Operations and Logistics Professionals Act S.4278, the Physician and Patient Safety Act H.R.8444 , the Mental Health in Schools Act S.4286, the Comprehensive Addiction Resources Emergency Act H.R.8524, the Elementary and Secondary School Counseling Act H.R. 7153/ S. 3679, the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act H.R. 468, the Building Americas Health Care Workforce Act H.R. 3227, the Ensuring Seniors Access to Quality Care Act H.R.8526, the Trauma-Informed Schools Act S.1999 the Right to Contraception Act H.RES.1180, a resolution recognizing the importance of diversity, equity, and inclusion efforts in medical education H.R.7513/S.3410/H.J Res 139, legislation related to the administrations nursing home staffing regulation Health over Wealth Act IAQ and Healthy Schools Act (draft bill) Cognitive behavioral therapy and schools (draft bill) Abortion bans Long COVID Rural healthcare and hospital workforce challenges and related issues Shortage of minority healthcare professionals Impact of private equity on healthcare S.4381, Right to Contraception Act, Entirety Monitor the following: Mental Health Service Professional Demonstration Grant and the School-Based Mental Health Services Grant in FY2025 Supporting investments in school-based mental health professionals S.3612, the Access to Family Building Act H.R.7546/S.3860, the Nurse Overtime and Patient Safety Act S.3770, the Future Advancement of Academic Nursing Act S.3779 Child Suicide Prevention and Lethal Means Safety Act S.3701, the FACTS Act H.R.6914, the Pregnant Students Rights Act Private Equity and Healthcare Healthcare high school apprenticeships Safe staffing levels Indoor Air Quality and Outdoor pesticide school and environmental related issues Artificial Intelligence, Healthcare related issues S.1409, Kids Online Safety Act (KOSA), Entirety S.2660, Get Toxic Substances Out of Schools Act, Entirety Public Law 118-31, National Defense Authorization Act for Fiscal Year 2024, Teacher healthcare coverage H.R.485, the Protecting Health Care for All Patients Act Proposed regulation: File Code 1210-AC11, Requirements Related to the Mental Health Parity and Addiction Equity Act Safe staffing levels at nursing homes H.R.4771, the Childrens Health Insurance Program Permanency Act Affordable Drug Manufacturing Act, not introduced S.2530, the Mental Health of Educators and Staff Act Primary Care and Health Workforce Expansion Act (draft bill) Medicare drug negotiation program PMB reform H.R.5378, the Lower Costs, More Transparency Act Reauthorization of healthcare workforce programs S.2333, Pandemic and All-Hazards Preparedness and Response Act S.1113, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act Appropriations regarding but not limited to community violence intervention, School-Based Mental Health Services Professional Demonstration Grants/ School-Based Mental Health Services Grant Program, gun violence prevent and removing abortion prohibition language from future appropriations bills. H.R.3727 Teacher Health and Wellness Act S.1446, Nurse Corps Tax Parity Act H.R.3761/S.1774, Advancing Student Services in Schools Today Act H.R.3726, Student Mental Health Rights Act H.R.3305, Black Maternal Health Momnibus Act Funding for CDCs Social Determinants of Health program H.R.3682, Cady Housh and Gemesha Thomas Student Suicide Prevention Act of 2023, Entirety Public Law 117-169, Inflation Reduction Act, Prescription drug reform Public Law 117-159, Bipartisan Safer Communities Act Medicaid DSH Payments, Hospital funding formula Abortion Access related issues Supporting Trauma Informed Education Practices Act Restoring Hope for Mental Health and Well‐Being Act Health Force and Resilience Force Act Black Maternal Health Momnibus Act Student Loan Forgiveness for Frontline Health Workers Affordability of pharmaceuticals, generally Treating gun violence as a public health epidemic related issues The National Nurse Act, Entirety Telehealth issues H.R.12/S.701, the Women's Health Protection Act, Entirety Mental health supports for educators Closing Health Coverage Gaps for Public Servants Act Workplace Violence Prevention for Health Care and Social Service Worker Act Visas for international healthcare professionals Dobbs vs Jackson, United States Supreme Court decision Workplace violence related issues Green New Deal for Health, Entirety H.R.1485/S.727, Insulin for All Act H.R.1692, Health Care Affordability Act S.1139 A bill to apply prescription drug inflation rebates to drugs furnished in the commercial market Minimum staffing levels in skilled nursing facilities related issues Health Worker Shortage/Staffing Crisis ACCESS in Mental Health Act (draft bill) Mental Health CARE Act (draft bill) Supporting All Students Act (draft bill) Epi-pen Price Cap legislation, (draft bill) Funding for Medicare low-income outreach and enrollment efforts Public Law 118-47, Further Consolidated Appropriations Act, 2024, Division D - Departments of Labor, Health and Human Services, and Education, and related agencies for the fiscal year ending September 30, 2024, and for other purposes, FY2024, Opposing restrictions on reproductive rights Public Law 118-42, Consolidated Appropriations Act, 2024, Division B - Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, FY2024, Protect access to Mifepristone H.R. 4771, the Childrens Health Insurance Program Permanency Act S.3090/H.R.6004, the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act Prevention and Public Health Fund related issues H.R.6204, the See the Board Act Requirements Related to the Mental Health Parity and Addiction Equity Act, File Code 1210-AC11 Ensuring Safe Drinking Water at Schools, Lead & Copper Rule Improvements The Employee Retirement Income Security Act and related issues S.4445, The right to IVF Act, Reproductive healthcare and technology Rights and access to reproductive healthcare Department of Health and Human Services, Voter registration related issues on Federal Marketplace application Data Collection related issues Healthcare cybersecurity related issues

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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.

Client expense: $210,000 · 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

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

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

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

S 4445- The Right to IVF Act HR 6283- Delinking Revenue from Unfair Gouging (DRUG) Act HR 5378- Lower Costs, More Transparency Act HR 4895- Lowering Drug Costs for American Families HR 5796- Protecting Rural Seniors Access to Care Act HR 7513- Protecting America's Seniors Access to Care Act HR 485- Protecting Care for All Patients Care Act S 3679- Lorna Breen Health Care Provider Protection Reauthorization Act HJ Res 139, SJ Res 91- CRA to rescind nursing home staffing rule

Client expense: $680,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

-HR 5378 - Lower Costs More Transparency Act, Provisions related to pharmacy benefit manager and health plan transparency -HR 7513 - Protecting America's Seniors' Access to Care Act -HR 485 - Protecting Health Care for All Patients Act -HR 468 - Building America's Health Care Workforce Act -HR 3227 - Ensuring Seniors' Access to Quality Care Act -S 4381 - The Right to Contraception Act -HR 4367/S 2625 - FAMILY Act -HJ Res. 139/SJ Res. 91 - Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting" -HR 8114 - o prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services -HR 4818 - Treat and Reduce Obesity Act (Provisions related to Medicare coverage of anti-obesity medications and intensive behavioral therapy)

Client expense: $560,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Healthcare supply chain, resiliency, product continuity, domestic manufacturing, Protecting America's Seniors' Access to Care Act (S. 3410/H.R. 7513), Reauthorization of the Pandemic and All-Hazards Preparedness Act (S. 2333/H.R. 4421)

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Economic Council (NEC), Natl Security Council (NSC), SENATE, White House Office

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding 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 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill 15. Proposals regarding the Medicare Low Income Subsidy program 16. H.R. 7513, Protecting Americas Seniors Access to Care Act, entire 17. S. 3410, Protecting Rural Seniors Access to Care Act, entire bill 18. H.J.Res. 139, providing for Congressional disapproval of the CMS rule Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting," entire resolution 19. H.R. 8106, To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver, entire bill 20. H.R. 8107, Ensuring Access to Medicaid Buy-in Programs Act of 2024, entire bill 21. H.R. 8109, Money Follows the Person Permanency Act of 2024, entire bill 22. H.R. 8110, Protecting Married Seniors from Impoverishment Act of 2024, entire bill 23. H.R. 8018, Alleviating Barriers for Caregivers Act, entire bill 24. S. 3109, Alleviating Barriers for Caregivers Act, entire bill 25. Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program rule, entire rule

Client expense: $90,000 · Firm income: Not reported

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

Nurse staffing shortages Removing barriers to care Strengthening the nurse workforce and increasing the pipeline Nurse burn out and well-being Extension of COVID-19 public health emergency waivers Nurse overtime and patient safety (H.R.2713/S.2418) I CAN Act (S. 1150/H.R. 2411) National Nursing Workforce Center Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act Primary Care and Health Workforce Expansion Act (S.2840) Bipartisan Primary Care and Health Workforce Act (S.2815/H.R.7002) Nurse Faculty Shortage Reduction Act of 2023 (H.R. 3305/S. 1606) Black Maternal Health Momnibus Act (H.R. 7153 / S. 3679) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (S.3770/H.R.7266) Future Advancement of Academic Nursing Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Rural access to care, including issues surrounding home visiting programs, nurse residency programs, and prior authorization (H.Res.1208/S.Res.676) Supporting the goals and ideals of National Nurses Week, to be observed from May 6 through May 12, 2024. (H.R.) 8330 Stop Nurse Shortage Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Extension of COVID-19 public health emergency waiversNurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Meetings, Letters, Press Conference and Briefings in House and Senate on CMS Nursing Home Staffing Rule, and sharing SEIU strong Opposition to HR 5796, H.R. 7513, S. 3410, H.J. Res. 139 and S.J. Res. 91 that would prohibit the rule. Meeting in House in Opposition to HR 6860, the Restore Protections for Dialysis Patients Act (RPDPA) Letter and meetings in Opposition to H.R. 8114, Legislation that would prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services. Letter and meetings with House Offices in Opposition to H.R. 3227, Ensuring Seniors Access to Quality Care Act. Letter in Support for H.R. 7573, the Stop Unfair Medicaid Recoveries Act which seeks to halt unfair Medicaid recovery practices, and H.R. 8106 which proposes to remove institutional care criteria for Home and Community-Based Services (HCBS) eligibility, improving access and equity within the long-term care system.

Client expense: $230,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Nurse staffing shortages Removing barriers to care Strengthening the nurse workforce and increasing the pipeline Nurse burn out and well-being Extension of COVID-19 public health emergency waivers Nurse overtime and patient safety (H.R.2713/S.2418) I CAN Act (S. 1150/H.R. 2411) National Nursing Workforce Center Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act Primary Care and Health Workforce Expansion Act (S.2840) Bipartisan Primary Care and Health Workforce Act (S.2815/H.R.7002) Nurse Faculty Shortage Reduction Act of 2023 (H.R. 3305/S. 1606) Black Maternal Health Momnibus Act (H.R. 7153 / S. 3679) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (S.3770/H.R.7266) Future Advancement of Academic Nursing Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Rural access to care, including issues surrounding home visiting programs, nurse residency programs, and prior authorization (H.Res.1208/S.Res.676) Supporting the goals and ideals of National Nurses Week, to be observed from May 6 through May 12, 2024. (H.R.8330) Stop Nurse Shortages Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Extension of COVID-19 public health emergency waivers Nurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

No bill number. Discussed medically necessary dental coverage and oral health care in Medicare. No bill number. Discussed Medicare coverage for telehealth services. No bill number. Discussed workforce training, physician reimbursement, and Medicare provider access. No bill number. Discussed Improving Seniors Timely Access to Care Act of 2024. H.R. 2407, the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act. No bill number. Discussed Medicaid estate recovery. No bill number. Discussed Medicare Advantage data. H.R. 3549/ S. 1703, the PACE Part D Choice Act of 2023. No bill number. Discussed family caregivers and Medicare and Medicaid policy. No bill number. Discussed Medicare FY25 Skilled Nursing Facility Payment Proposed Rule. No bill number. Discussed Medicare FY25 Hospital Inpatient Payment Proposed Rule. No bill number. Discussed hospitals and a buffer of essential medicines. No bill number. Discussed Medicaid unwinding. H.R. 8114, To prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services. No bill number. Discussed Care Executive Order. H.R. 8018, the Alleviating Barriers for Caregivers Act. S. 3109, Alleviating Barriers for Caregivers Act. S. 3766/H.R. 7274, Connecting Caregivers to Medicare Act. No bill number. Discussed Acute Hospital Care at Home waiver and family caregivers. No bill number. Discussed family caregivers, direct care workers, care at home, and in other settings. S. 4120/H.R. 7994, the Long-Term Care Workforce Support Act. H.R. 8094, to amend Title XIX of the Social Security Act to modify certain asset recovery rules. H.R. 7573, the Stop Unfair Medicaid Recoveries Act. No bill number. Discussed the Coordinating Care for Veterans and Wounded Warriors Act. No bill number. Discussed nursing home staffing standards. No bill number. Discussed Medicare home health and hospice benefits. No bill number. Discussed health care coverage expansion. H.R. 8331/S. 4280, the Essential Caregivers Act. H.R. 7442, Philippine Medicare Portability Study Act. H.R. 3227, the Ensuring Seniors Access to Quality Care Act. H.R. 8244, Ensuring Seniors Access to Quality Care Act. H.R.468, the Building Americas Health Care Workforce Act. HR 7513/S.3410, the Protecting Americas Seniors Access to Care Act. H.J.Res.139, Providing for Congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. S.J.Res.91, A joint resolution providing for congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting" S.4137, the Improving Access to Medicare Coverage Act of 2024.

Client expense: $5,170,000 · Firm income: Not reported

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