Rural Physician Workforce Preservation Act

H.R. 3046, Medical Student Education Authorization Act of 2023, all provisions S. 1403, Medical Student Education Authorization Act of 2023, all provisions H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions H.R. 7258, Community TEAMS Act of 2024, all provisions S. 3968, Community TEAMS Act of 2024, all provisions S. 3022, IHS Workforce Parity Act of 2024 H.R. 1202, Resident Education Deferred Interest (REDI) Act, all provisions S. 704, Resident Education Deferred Interest (REDI) Act, all provisions H.R. 7725, To amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion, all provisions S. 4115, Embracing anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education (EDUCATE) Act, all provisions H.R. 8235, Rural Physician Workforce Preservation Act, all provisions Graduate Medical Education (GME)/Continuing Medical Education (CME) Pathways to practice Medical education/artificial Intelligence (AI)

Client expense: $6,590,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6445, Medicare Audiology Access Improvement Act, all provisions S. 2377, Medicare Audiology Access Improvement Act, all provisions H.R. 1610, Chiropractic Medicare Coverage Modernization Act, all provisions S. 799, Chiropractic Medicare Coverage Modernization Act, all provisions H.R. 4189, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions S. 2016, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions H.R. 1770, Equitable Community Access to Pharmacist Services Act, all provisions S. 2477, Equitable Community Access to Pharmacist Services Act, all provisions H.R. 751, Fair Access In Residency (FAIR) Act, all provisions H.R. 4968, GOLD CARD Act, all provisions H.R. 2713, Improving Care and Access to Nurses (I CAN) Act, all provisions S. 2418, Improving Care and Access to Nurses (I CAN) Act, all provisions H.R. 2583, Increasing Access to Quality Cardiac Rehabilitation Care Act, all provisions H.R. 6487, No Fees for EFTs Act, all provisions S. 3805, No Fees for EFTs Act, all provisions H.R. 977, Patient Access to Higher Quality Health Care Act of 2023, all provisions S. 470, Patient Access to Higher Quality Health Care Act of 2023, all provisions H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions H.R. 2630, Safe Step Act, all provisions S. 652, Safe Step Act, all provisions H.R. 7050, Substance Use Disorder Workforce Act, all provisions H.R. 7623, Telehealth Modernization Act of 2024, all provisions H.R. 2474, Strengthening Medicare for Patients and Providers Act, all provisions H.R. 6371, Provider Reimbursement Stability Act of 2023, all provisions H.R. 6545, Physician Fee Schedule Update and Improvements Act, all provisions H.R. 5378, Lower Costs, More Transparency Act, all provisions H.R. 6683, Preserving Seniors Access to Physicians Act of 2023, all provisions H.R. 5013, Value in Health Care Act of 2023, all provisions S. 3503, Value in Health Care Act of 2023, all provisions H.R. 8702, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4532, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4935, Physician Fee Stabilization Act, all provisions H.R. 10073, Medicare Patient Access and Practice Stabilization Act of 2024, all provisions H.R. 7856, PREVENT DIABETES Act, all provisions H.R. 3838, Preventing Maternal Deaths Reauthorization Act of 2023, all provisions S. 2415, Preventing Maternal Deaths Reauthorization Act of 2023, all provisions H.R. 8532, Connected MOM Act, all provisions S. 712, Connected MOM Act, all provisions H.R. 6369, To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models, all provisions H.R. 8404, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions S. 4330, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions H.R. 8235, Rural Physician Workforce Preservation Act, all provisions H.R. 1745, Medicare Fraud Detection and Deterrence Act of 2023, all provisions H.R. 1746, Preventing Medicare Telefraud Act, all provisions H.R. 8261, Preserving Telehealth, Hospital, and Ambulance Access Act, all provisions S. 1491, Pharmacy and Medically Underserved Areas Enhancement Act, all provisions S. 669, Increasing Mental Health Options Act of 2023, all provisions H.R. 7618, Stopping Addiction and Falls for the Elderly (SAFE) Act, all provisions H.R. 3730, Rural Health Clinic Burden Reduction Act, all provisions H.R. 7279, Remove Duplicative Unnecessary Clerical Exchanges (REDUCE) Act, all provisions H.R. 6230, Doctor Knows Best Act of 2023, all provisions H.R. 9572, Enhanced Enforcement of Health Coverage Act, all provisions H.R. 9001, Physician Led and Rural Access to Quality Care Act, all provisions S. 5218, Health Infrastructure Security and Accountability Act of 2024, all provisions S. 4054, Health Care Cybersecurity Improvement Act of 2024, all provisions H.R. 9572, Enhanced Enforcement of Health Coverage Act, all provisions Supporting Health Moms and Babies Act/draft Fewer Burdens for Better Healthcare Act/draft Medicaid Primary Care Improvement Act/Senate draft Opioid Workforce Act of 2021/Senate draft Electronic clinical quality measures (eCQM) reporting/draft Medicare program: Medicare physician payment/2.83% cut for FY2025 Medicare program: Payment reform/Medicare Part B cuts Medicare program: Medicare Economic Index (MEI) inflation update Medicare program: Budget neutrality reforms Medicare program: Merit-based Incentive Payment System (MIPS) reforms and penalties Medicare program: G2211 inherent complexity codes Medicare program: Protecting Access to Medicare Act (PAMA 2014)/clinical lab cut reforms Medicare Program: Medicare Access and CHIP Reauthorization Act (MACRA) physician burdens Medicare program: Alternative Payment Models (APMs) Medicare program: Advanced APMs reporting requirements Medicare program: APMs for rural physicians Medicare program: Graduate Medical Education (GME) cap flexibility Medicare program: Physician-owned hospitals Medicare program: Telehealth Medicare program: Prior Authorization Medicare program: Site neutral payment Medicare program: Physician-Focused Payment Model Technical Advisory Committee (PTAC) reform Medicare program: Sunsetting of web interface Medicare program: Access to claims data Medicare program: Coding Medicare program: Accountable Care Organization (ACO)/APM/Medicare Shared Savings Program Medicare program: Medicare Diabetes Prevention Program Medicare program: Physician burden Medicare program: Promoting Interoperability (PI) program Medicare program: Quality Payment Program Medicare program: Certified electronic health record technology and PI Medicare program: Shared Savings program Medicare program: Public Health Reporting and Data Exchange Medicare program: Patient engagement Medicare program: Medicare Advantage plans/Prior Authorization Medicare program: Physician-owned hospitals Medicare program: Medigap/modified community rating Medicare and Medicaid programs: Artificial intelligence Medicare and Medicaid programs: Substance use disorder Medicare and Medicaid programs: Cybersecurity/health care clearinghouses Medicare and Medicaid programs: Health IT Medicare and Medicaid programs: Interoperability Medicare and Medicaid programs: Mandatory models Medicaid and Medicare programs: Quality programs/physician choice Medicaid program: Maternal health Medicaid program: Maternal mortality

Legislation and regulation related to the Medicare Advantage program and Medicare/Medicaid coverage, care delivery and financing. HR 8260 Hospital Inpatient Services Modernization Act H.R. 8235 the Rural Physician Workforce Preservation Act H.R. 8261, the Preserving Telehealth, Hospital, and Ambulance Access Act HR 3171/S. 3018 The Improving Seniors Timely Access to Care Act H.R. 1110, KEEP Telehealth Options Act of 2023 H.R. 3875, Expanded Telehealth Access Act H.R. 5541, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act H.R. 5611, Helping Ensure Access to Local TeleHealth (HEALTH) Act of 2023 H.R. 6033, Supporting Patient Education And Knowledge (SPEAK) Act of 2023 H.R. 7149, Equal Access to Specialty Care Everywhere (EASE) Act of 2024 H.R. 7623, The Telehealth Modernization Act of 2024 H.R. 7711, To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program H.R. 7858, Telehealth Enhancement for Mental Health Act of 2024 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 H.R. 5386, Cutting Copays Act H.R. 5380, To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage H.R. 5372, Expanding Seniors Access to Lower Cost Medicines Act of 2023 S. 3059 the REAL Health Provider Act (Bennet, Tillis) S. 2973 Modernizing and Ensuring PBM Accountability Act H.R. 2880, the Protecting Patients Against PBM Abuses Act S.1002 - No UPCODE Act H.R. 3282, the Promoting Transparency and Healthy Competition in Medicare Act H.R. 3284, the Providers and Payers COMPETE Act H.R. 3237, To amend title XVIII of the Social Security Act to require each outpatient department of a provider to include a unique identification number on claims for services, and to require hospitals with an outpatient department of a provider to submit to the Centers for Medicare & Medicaid Services an attestation with respect to each outpatient department

No Bill No. - Congressional Primary Care Caucus No Bill No. - Black Maternal Health Momnibus Act No Bill No. - Medicare Physician Payment Reform No Bill No. - MACRA Implementation No Bill No. - CY2024 Medicare Physician Fee Schedule No Bill No. - CY 2024 Medicare Inpatient Prospective Payment System No Bill No. - Site Neutrality and Consolidation No Bill No. - CMS Prior Authorization Rules No Bill No. - Tobacco Users Quiet Act No Bill No. - G2211 Code (Physician Fee Schedule) No Bill No. - Reducing Medically Unnecessary Delays in Care Act No Bill No. - G2211 implementation/modifier 25 No Bill No. - HEALTH for Mom Act No Bill No. - Pay PCP Act No Bill No. - Seniors Timely Access to Care Act No Bill No. - CY25 Medicare Physician Fee Schedule No Bill No. - Physician Fee Stabilization Act (H.R. 952) Kids Access to Primary Care Act (H.R. 2400/S. 1165) The Reentry Act (H.R. 3074) Due Process Continuity of Care Act (H.R. 3766) Extending Access to Addiction Treatment Act (H.R. 4950/S. 2841) Improve Addiction Care Act (H.R. 4771) Children's Health Insurance Program Permanency Act (H.R. 4968) GOLD Card Act of 2023 (S. 2556) Improving Care for Youth Act (H.R. 5013) Value in Health Care Act (S. 2816) Medicaid for Every Child Act (H.R. 6545) Physician Fee Schedule Update and Improvements Act (H.R. 5434/S.3138) Stabilize Medicaid and CHIP Coverage Act (H.R. 5395) SURS Extension Act (H.R. 3487/S. 3805) No Fees for EFTs Act (S. 1316) Save Children's Coverage Act (H.R. 6997/S. 3010) Nutrition CARE Act (H.R. 6780/S. 2133) - Medically Tailored Home-Delivered Meals Demonstration Pilot Act (H.R. 8235) - Rural Physician Workforce Preservation Act (H.R. 7512) - Real-Time Benefit Tool Implementation Act (H.R. 1770/S. 2477) - Equitable Community Access to Pharmacist Act (S. 4349) - Electronic Prior Authorization for Prescription Drugs Act (H.R. 5434/S. 3138) - Stabilize Medicaid and CHIP Coverage Act (S. 5432) - Medicaid Primary Care Improvement Act (S. 5236) - Keeping Obstetrics Local Act

H.R.2389/S.1302 - Resident Physician Shortage Reduction Act of 2023 H.R.7050 - Substance Use Disorder Workforce Act Issue: Support increased Medicare funding for graduate medical education (GME). Draft Bipartisan Senate Medicare GME Expansion proposal Issue: Support increased Medicare funding for GME. Oppose duplicative teaching health system and hospital reporting and policies that increase regulatory burden. H.R.751 - Fair Access in Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. H.R.834/S.230 - Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals. GME Data Transparency Act of 2024 Issue: Educate Congress on teaching health system and hospital GME data collection practices and concerns related to duplicative reporting requirements. H.R.2584/S.2768 - Safety From Violence for Healthcare Employees (SAVE) Act Issue: Support legislation providing protection for health care workers by creating a criminal offense for knowingly assaulting or intimidating hospital workers and providing grants to reduce violence in hospitals. H.R.5378 - Lower Costs, More Transparency Act Issue: Oppose legislation that pays for workforce investments and mitigation of DSH cuts paid for by cuts to hospital outpatient departments. H.R.5013 - Value in Health Care Act Issue: Support legislation that ensures the continued move to value-based care. H.R.8235 - Rural Physician Workforce Preservation Act Issue: Educate Congress about the likely impact of legislation that would alter the distribution of Medicare-supported GME slots from the CAA, 2021 and 2023. Issue: Educate Congress on status of CMS distribution of the 1,000 new GME slots authorized by the Consolidated Appropriations Act, 2021 (P.L.116-260). Support CMS changing its distribution methodology to end the practice of super prioritization. Issue: Support Medicare GME per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose reduction of Medicare DGME/IME payments. Issue: Oppose the redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare. Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create budget neutral IME payments for outpatient services. Draft Senate Finance Medicare Physician Fee Schedule request for information Issue: Support efforts to reform the Medicare physician fee schedule. H.R.2474 - Strengthening Medicare for Patients and Providers Act Issue: Support legislation that reforms the Medicare Physician Fee Schedule by providing an annual inflation-based payment update based on the Medicare Economic Index (MEI). S.4338 - Pay PCPs Act Issue: Respond to Senate request for information on hybrid payments for Medicare physicians. P.L.118-42 - Consolidated Appropriations Act, 2024 H.R. 10445 - Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 P.L. 118-158 American Relief Act, 2025 Issues: Oppose reduction in Medicare hospital outpatient department reimbursement for drug administration and other services. Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital, and provider cuts. Support mitigation of Medicare Physician Fee Schedule cuts. Support delaying or eliminating scheduled cuts to the Medicaid disproportionate share hospital (DSH) program. Support extension of alternative payment model (APM) bonus. Support allowing hospitals to count costs and reimbursements for Medicaid patients with third-party coverage towards their DSH cap. Support extensions of Acute Hospital at Home program waiver of 24/7 nursing requirement and Medicare telehealth waivers and efforts to expand patient access to telehealth. H.R.2665 - The Supporting Safety Net Hospitals Act Issue: Support elimination of two years of scheduled reductions to the Medicaid DSH program. H.R.9351 - The Save Our Safety-Net Hospitals (SOS) Act Issue: Support allowing hospitals to count costs and reimbursements for Medicaid patients with third-party coverage towards their DSH cap. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives. Issue: Protect patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issue: Educate Congress and policymakers on the financial challenges facing teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Educate Congress on potential financial implications of entitlement reform on teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Support policies to close the Medicaid coverage gap and ensure access to coverage in non-expansion states, as well as financial incentives to help states maintain existing expansions. Support mandatory 12-month Medicaid coverage for post-partum individuals. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support extension of Medicare telehealth waivers and efforts to expand patient access to telehealth. Issue: Support policy to permanently remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services. H.R.1397 - The Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP. Issue: Support increased access to behavioral health and substance use disorder treatment services under Medicare and Medicaid. Support the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). H.R.2377/S.1000 - The Saving Access to Laboratory Services (SALSA) Act Issue: Support legislation to modify Medicare payment rates for clinical diagnostic laboratory services to avoid statutory cuts to these payments. Issue: Support authorization of Medicare advance and accelerated payments in the wake of cyberattacks on providers. H.R.2829 - Chronic Care Management Improvement Act of 2023 Issue: Support removing cost-sharing obligations from the chronic care management (CCM) code in Medicare.

HR 8260 Hospital Inpatient Services Modernization Act H.R. 8235 the Rural Physician Workforce Preservation Act H.R. 8261, the Preserving Telehealth, Hospital, and Ambulance Access Act HR 3171/S. 3018 The Improving Seniors Timely Access to Care Act H.R. 1110, KEEP Telehealth Options Act of 2023 H.R. 3875, Expanded Telehealth Access Act H.R. 5541, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act H.R. 5611, Helping Ensure Access to Local TeleHealth (HEALTH) Act of 2023 H.R. 6033, Supporting Patient Education And Knowledge (SPEAK) Act of 2023 H.R. 7149, Equal Access to Specialty Care Everywhere (EASE) Act of 2024 H.R. 7623, The Telehealth Modernization Act of 2024 H.R. 7711, To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program H.R. 7858, Telehealth Enhancement for Mental Health Act of 2024 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 H.R. 5386, Cutting Copays Act H.R. 5380, To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage H.R. 5372, Expanding Seniors Access to Lower Cost Medicines Act of 2023 S. 3059 the REAL Health Provider Act (Bennet, Tillis) S. 2973 Modernizing and Ensuring PBM Accountability Act H.R. 2880, the Protecting Patients Against PBM Abuses Act S.1002 - No UPCODE Act H.R. 3282, the Promoting Transparency and Healthy Competition in Medicare Act H.R. 3284, the Providers and Payers COMPETE Act H.R. 3237, To amend title XVIII of the Social Security Act to require each outpatient department of a provider to include a unique identification number on claims for services, and to require hospitals with an outpatient department of a provider to submit to the Centers for Medicare & Medicaid Services an attestation with respect to each outpatient department Legislation and regulation related to the Medicare Advantage program and Medicare/Medicaid coverage, care delivery and financing.

H.R.2389/S.1302 - Resident Physician Shortage Reduction Act of 2023 H.R.7050 - Substance Use Disorder Workforce Act Issue: Support increased Medicare funding for graduate medical education (GME). Draft Bipartisan Senate Medicare GME Expansion proposal Issue: Support increased Medicare funding for GME. Oppose duplicative teaching health system and hospital reporting and policies that increase regulatory burden. H.R.751 - Fair Access in Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. H.R.834/S.230 - Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals. H.R.2584/S.2768 - Safety From Violence for Healthcare Employees (SAVE) Act Issue: Support legislation providing protection for health care workers by creating a criminal offense for knowingly assaulting or intimidating hospital workers and providing grants to reduce violence in hospitals. H.R.5378 - Lower Costs, More Transparency Act Issue: Oppose legislation that pays for workforce investments and mitigation of DSH cuts paid for by cuts to hospital outpatient departments. H.R.5013 - Value in Health Care Act Issue: Support legislation that ensures the continued move to value-based care. H.R.8235 - Rural Physician Workforce Preservation Act Issue: Educate Congress about the likely impact of legislation that would alter the distribution of Medicare-supported GME slots from the CAA, 2021 and 2023. Issue: Educate Congress on status of CMS distribution of the 1,000 new GME slots authorized by the Consolidated Appropriations Act, 2021 (P.L.116-260). Support CMS changing its distribution methodology to end the practice of super prioritization. Issue: Support Medicare GME per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose reduction of Medicare DGME/IME payments. Issue: Oppose the redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare. Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create budget neutral IME payments for outpatient services. Draft Senate Finance Medicare Physician Fee Schedule request for information Issue: Support efforts to reform the Medicare physician fee schedule. H.R.2474 - Strengthening Medicare for Patients and Providers Act Issue: Support legislation that reforms the Medicare Physician Fee Schedule by providing an annual inflation-based payment update based on the Medicare Economic Index (MEI). S.4338 - Pay PCPs Act Issue: Respond to Senate RFI on hybrid payments for Medicare physicians. P.L.118-42 - Consolidated Appropriations Act, 2024 Issues: Oppose reduction in Medicare hospital outpatient department reimbursement for drug administration and other services. Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital, and provider cuts. Support mitigation of Medicare Physician Fee Schedule cuts. Support delaying or eliminating scheduled cuts to the Medicaid disproportionate share hospital (DSH) program. Support extension of alternative payment model (APM) bonus. H.R.2665 - The Supporting Safety Net Hospitals Act Issue: Support eliminating two years worth of scheduled reductions to the Medicaid DSH program. H.R.9351 - The Save Our Safety-Net Hospitals (SOS) Act Issue: Support allowing hospitals to count costs and reimbursements for Medicaid patients with third-party coverage towards their DSH cap. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives. Issue: Protect patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issue: Educate Congress and policymakers on the financial challenges facing teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Educate Congress on potential financial implications of entitlement reform on teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Support policies to close the Medicaid coverage gap and ensure access to coverage in non-expansion states, as well as financial incentives to help states maintain existing expansions. Support mandatory 12-month Medicaid coverage for post-partum individuals. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support extension of Medicare telehealth waivers and efforts to expand patient access to telehealth. Issue: Support policy to permanently remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services. H.R.1397 - The Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP. Issue: Support increased access to behavioral health and substance use disorder treatment services under Medicare and Medicaid. Support the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). H.R.2377/S.1000 - The Saving Access to Laboratory Services (SALSA) Act Issue: Support legislation to modify Medicare payment rates for clinical diagnostic laboratory services to avoid statutory cuts to these payments. Issue: Support authorization of Medicare advance and accelerated payments in the wake of cyberattacks on providers. H.R.2829 - Chronic Care Management Improvement Act of 2023 Issue: Support removing cost-sharing obligations from the chronic care management (CCM) code in Medicare.

H.R.2389/S.1302 - Resident Physician Shortage Reduction Act of 2023 H.R.7050 - Substance Use Disorder Workforce Act Issue: Support increased Medicare funding for graduate medical education (GME). Draft Bipartisan Senate Medicare GME Expansion proposal Issue: Support increased Medicare funding for GME. Oppose duplicative teaching health system and hospital reporting and policies that increase regulatory burden. H.R.751 - Fair Access in Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. H.R.834/S.230 - Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals. H.R.2584/S.2768 - Safety From Violence for Healthcare Employees (SAVE) Act Issue: Support legislation providing protection for health care workers by creating a criminal offense for knowingly assaulting or intimidating hospital workers and providing grants to reduce violence in hospitals. H.R.5378 - Lower Costs, More Transparency Act Issue: Oppose legislation that pays for workforce investments and mitigation of DSH cuts paid for by cuts to hospital outpatient departments. H.R.5013 - Value in Health Care Act Issue: Support legislation that ensures the continued move to value-based care. H.R.8235 - Rural Physician Workforce Preservation Act Issue: Educate Congress about the likely impact of legislation that would alter the distribution of Medicare-supported GME slots from the CAA, 2021 and 2023. Issue: Educate Congress on status of CMS distribution of the 1,000 new GME slots authorized by the Consolidated Appropriations Act, 2021 (P.L.116-260). Support CMS changing its distribution methodology to end the practice of super prioritization. Issue: Support Medicare GME per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose reduction of Medicare DGME/IME payments. Issue: Oppose the redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare. Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create budget neutral IME payments for outpatient services. Draft Senate Finance Medicare Physician Fee Schedule request for information Issue: Support efforts to reform the Medicare physician fee schedule. H.R.2474 - Strengthening Medicare for Patients and Providers Act Issue: Support legislation that reforms the Medicare Physician Fee Schedule by providing an annual inflation-based payment update based on the Medicare Economic Index (MEI). S.4338 - Pay PCPs Act Issue: Respond to Senate RFI on hybrid payments for Medicare physicians. P.L.118-42 - Consolidated Appropriations Act, 2024 Issues: Oppose reduction in Medicare hospital outpatient department reimbursement for drug administration and other services. Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital, and provider cuts. Support mitigation of Medicare Physician Fee Schedule cuts. Support delaying or eliminating scheduled cuts to the Medicaid disproportionate share hospital (DSH) program. Support extension of alternative payment model (APM) bonus. H.R.2665 - The Supporting Safety Net Hospitals Act Issue: Support eliminating two years worth of scheduled reductions to the Medicaid DSH program. H.R.9351 - The Save Our Safety-Net Hospitals (SOS) Act Issue: Support allowing hospitals to count costs and reimbursements for Medicaid patients with third-party coverage towards their DSH cap. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives. Issue: Protect patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issue: Educate Congress and policymakers on the financial challenges facing teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Educate Congress on potential financial implications of entitlement reform on teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Support policies to close the Medicaid coverage gap and ensure access to coverage in non-expansion states, as well as financial incentives to help states maintain existing expansions. Support mandatory 12-month Medicaid coverage for post-partum individuals. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support extension of Medicare telehealth waivers and efforts to expand patient access to telehealth. Issue: Support policy to permanently remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services. H.R.1397 - The Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP. Issue: Support increased access to behavioral health and substance use disorder treatment services under Medicare and Medicaid. Support the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). H.R.2377/S.1000 - The Saving Access to Laboratory Services (SALSA) Act Issue: Support legislation to modify Medicare payment rates for clinical diagnostic laboratory services to avoid statutory cuts to these payments. Issue: Support authorization of Medicare advance and accelerated payments in the wake of cyberattacks on providers. H.R.2829 - Chronic Care Management Improvement Act of 2023 Issue: Support removing cost-sharing obligations from the chronic care management (CCM) code in Medicare.

H.R. 3046, Medical Student Education Authorization Act of 2023, all provisions S. 1403, Medical Student Education Authorization Act of 2023, all provisions H.R. 1202, Resident Education Deferred Interest (REDI) Act, all provisions S. 704, Resident Education Deferred Interest (REDI) Act, all provisions H.R. 2761, Specialty Physicians Advancing Rural Care (SPARC) Act, all provisions S. 705, Specialty Physicians Advancing Rural Care (SPARC) Act, all provisions H.R. 7050, Substance Use Disorder Workforce Act, all provisions H.R. 7258, Community TEAMS Act of 2024, all provisions S. 3968, Community TEAMS Act of 2024, all provisions S. 3022, IHS Workforce Parity Act of 2023, all provisions H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions H.R. 751, Fair Access In Residency (FAIR) Act, all provisions H.R. 8318, Tribal Tax and Investment Reform Act of 2024, provisions relating to sections 12 and 13 H.R. 4829, Physical Therapist Workforce and Patient Access Act of 2023, all provisions H.R. 7725, To amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion, all provisions S. 4115, Embracing anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education (EDUCATE) Act, all provisions H.R. 8235, Rural Physician Workforce Preservation Act, all provisions Opioid Workforce Act/draft Pathways to Practice GME cap flexibility GME funding Liaison Committee on Medical Education Medical education/Artificial Intelligence (AI)

Client expense: $5,330,000 · Firm income: Not reported

H.R. 6645, Medicare Audiology Access Improvement Act of 2023, all provisions S. 2377, Medicare Audiology Access Improvement Act of 2023, all provisions H.R. 1610, Chiropractic Medicare Coverage Modernization Act of 2023, all provisions S. 799, Chiropractic Medicare Coverage Modernization Act of 2023, all provisions H.R. 4189, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023, all provisions S. 2016, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023, all provisions H.R. 8532, Connected MOM Act, all provisions S. 712, Connected MOM Act, all provisions H.R. 1770, Equitable Community Access to Pharmacist Services Act, all provisions S. 2477, Equitable Community Access to Pharmacist Services Act, all provisions H.R. 751, Fair Access In Residency (FAIR) Act, all provisions H.R. 4968, Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act of 2023, all provisions H.R. 2713, Improving Care and Access to Nurses (I CAN) Act, all provisions S. 2418, Improving Care and Access to Nurses (I CAN) Act, all provisions H.R. 2583, Increasing Access to Quality Cardiac Rehabilitation Care Act of 2023, all provisions H.R. 6487, No Fees for EFTs Act, all provisions S. 3805, No Fees for EFTs Act, all provisions H.R. 977, Patient Access to Higher Quality Health Care Act of 2023, all provisions S. 470, Patient Access to Higher Quality Health Care Act of 2023, all provisions H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions H.R. 7050, Substance Use Disorder Workforce Act, all provisions H.R. 7623, Telehealth Modernization Act of 2024, all provisions H.R. 2474, Strengthening Medicare for Patients and Providers Act, all provisions H.R. 830, Help Ensure Lower Patient (HELP) Copays Act, all provisions S. 1375, Help Ensure Lower Patient (HELP) Copays Act, all provisions H.R. 6371, Provider Reimbursement Stability Act of 2023, all provisions H.R. 6545, Physician Fee Schedule Update and Improvements Act, all provisions H.R. 5378, Lower Costs, More Transparency Act, all provisions H.R. 6683, Preserving Seniors Access to Physicians Act of 2023, all provisions H.R. 5013, Value in Health Care Act of 2023, all provisions S. 3503, Value in Health Care Act of 2023, all provisions H.R. 8702, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4532, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4518, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4935, Physician Fee Stabilization Act, all provisions H.R. 6366, To amend title XVIII of the Social Security Act with respect to the work geographic index for physician payments under the Medicare program, and to revise the phase-in of clinical laboratory test payment changes under such program, all provisions H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024, provisions relating to Medicare payments H.R. 7931, Preserving Emergency Access in Key Sites (PEAKS) Act, all provisions S. 4338, Pay PCPs Act of 2024, all provisions H.R. 8563, Preserving Access To Care in Hawaii (PATCH) Act, all provisions S. 4395, Protecting Access To Care in Hawaii (PATCH) Act, all provisions H.R. 6369, To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models, all provisions H.R. 7665, ACO Assignment Improvement Act of 2024, all provisions S. 3939, ACO Assignment Improvement Act of 2024, all provisions H.R. 8404, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions S. 4330, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions H.R. 4829, Physical Therapist Workforce and Patient Access Act of 2023, all provisions H.R. 8235, Rural Physician Workforce Preservation Act, all provisions H.R. 1745, Medicare Fraud Detection and Deterrence Act of 2023, all provisions H.R. 1746, Preventing Medicare Telefraud Act, all provisions H.R. 8261, Preserving Telehealth, Hospital, and Ambulance Access Act, all provisions S. 1491, Pharmacy and Medically Underserved Areas Enhancement Act, all provisions S. 669, Increasing Mental Health Options Act of 2023, all provisions H.R. 7618, Stopping Addiction and Falls for the Elderly (SAFE) Act, all provisions H.R. 3730, Rural Health Clinic Burden Reduction Act, all provisions H.R. 7279, Remove Duplicative Unnecessary Clerical Exchanges (REDUCE) Act, all provisions H.R. 7708, Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, all provisions S. 3508, Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, all provisions H.R. 9001, Physician Led and Rural Access to Quality Care Act, all provisions S. 5218, A bill to amend titles XI and XVIII of the Social Security Act to strengthen, increase oversight of, and compliance with, security standards for health information, and for other purposes, all provisions S. 4054, Health Care Cybersecurity Improvement Act of 2024, all provisions H.R. 8588, Linking Seniors to Needed Legal Services Act of 2024, all provisions H.R. 5526, Seniors Access to Critical Medications Act of 2024, all provisions H.R. 9129, Patient Debt Relief Act, all provisions Fewer Burdens for Better Care Act/draft MACRA/MIPS program reform legislation/draft FY 2025 Medicare physician payment increase/draft Medical Chaperones in Medicare/draft Medicare program: No Surprises Act implementation Medicare program: 21st Century Cures Act implementation Medicare program: FY 2025 Physician payment cut Medicare program: Information Blocking Disincentives Medicare program: Merit-based Incentive Payment System (MIPS) reform Medicare program: Medicare Economic Index (MEI) Medicare program: Medicare Access and CHIP Reauthorization Act (MACRA) reform Medicare program: Budget neutrality reforms/Inflationary update Medicare program: G2211 Inherent complexity code Medicare program: Protecting Access to Medicare Act (PAMA 2014) lab cut reform Medicare program: High-cost disposable services payment Medicare program: Medicare Administrative Contractor/local-coverage determinations Medicare program: Making Care Primary alternative payment models (APM) Medicare program: Rural physicians APM Medicare program: Site neutral payment Medicare program: Physician-owned hospitals Medicare program: Graduate Medical Education (GME) funding Medicare program: Audio-visual supervision of residents/permanent expansion Medicare program: Conditions of Participation (COP)/Obstetrical service Medicare program: MACRA/physician burdens Medicare program: Health Information Technology/physician burdens Medicare program: Prior authorization/Medicare Advantage plans Medicare program: Interoperability/data sharing/information blocking/provider disincentives Medicare program: Promoting interoperability reporting Medicare program: Trusted exchange framework/common agreement Medicare program: Data segmentation Medicare program: Quality payment program Medicare program: Medicare Shared Savings Program/Advanced APM Medicare program: Public health reporting and data exchange Medicare program: Accountable Care Organizations/APM flexibilities Medicare program: Certified Electronic Health Record (EHR) Technology Medicare program: Physician Practice Information (PPI) survey/practice expense Medicare program: MIPS Value Pathways (MVPs)/APMs Medicare program: Telehealth flexibilities Medicare and Medicaid programs: Data Privacy and Cybersecurity Medicare and Medicaid programs: Health Insurance Portability and Accountability Act (HIPAA)/electronic records

Fair Access In Residency (FAIR) Act (H.R. 751) Rural Physician Workforce Production Act (S. 230/H.R. 834) Resident Physician Shortage Reduction Act of 2023 (S. 1302/H.R. 2389) Council on Graduate Medical Education Medicare Payment Advisory Commission Inpatient Prospective Payment System Consolidated Appropriations Act, 2021 (PL 116-260) Community Training, Education and Access for Medical Students (Community TEAMS) Act (S. 3968, H.R. 7258) National Health Service Corps Teaching Health Centers Graduate Medical Education NIH Osteopathic Funding and Representation 21st Century Cures Act and Cures 2.0 Substance Use Disorder Workforce Act of 2024 (H.R. 7050) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (S. 3679, H.R. 7153) Rural Physician Workforce Preservation Act (H.R. 8235) Rural Residency Planning and Development Act of 2024 (H.R. 7855) Physician Preceptor Tax Credit Pandemic and All-Hazards Preparedness Act (PL 109-417) Public Health Infrastructure Saves Lives Act (S. 1995) Physician Fee Stabilization Act (S.4935) Rural Health Preceptor Tax Fairness Act (H.R.8738) Telehealth Modernization Act of 2024 (H.R.7623/S.3967)

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

Advocate for proposals to provide direct financial support to safety net hospitals with Congressional staff. Discuss support for the 340B Drug Pricing Program with Congressional staff and discuss certain changes: oppose 340B ACCESS Act (H.R. 7635), comment on SUSTAIN 340B Act discussion draft, support PATIENTS Act (H.R. 7635). Discuss legislative proposals with Congressional staff to stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support); make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Discuss Medicare Graduate Medical Education (GME) provisions in the Consolidated Appropriations Act (CAA), 2021 and CAA, 2023 with HHS staff. Discuss with Congressional staff support for Medicare GME expansion: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act (H.R. 7050); additional GME slots in CAA, 2021 and CAA, 2023; Rural Residency Planning and Development Act (H.R. 7855). Oppose Rural Physician Workforce Preservation Act (H.R. 8235) and modifications to ongoing distribution of CAA, 2021 Section 126 GME slots. Discuss with HHS staff and Congressional staff recommendations to address workforce shortages for nursing and ancillary health care workforce with Congressional staff: faculty recruitment and retention, additional financial support for supervision and precepting students, Medicare payment for nursing and allied health, testing new workforce models, establishing incentives and early recruitment strategies, providing funding for clinical training site, and immigration reforms that expedite entry for foreign health care workers. Support passage of the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S.2768). Support revisions to Conrad 30 waiver program to increase the number of foreign physicians that may remain in the US after completing GME: S.665/H.R.4942, S.2719/H.R.6980, H.R. 4875. Meet with Congressional staff to discuss technical amendment to CAA, 2021, Section 131. Respond to Senate Finance Committee request for information on Medicare GME and offer recommendations. Discuss opposition to site-neutral payment policies with Congressional staff. Educate Congressional staff on hospital price transparency federal rule (84 FR 65602). Meet with Congressional staff to discuss H.R. 5378, the Lower Costs, More Transparency Act of 2023, and comment on following proposals in bill: support for delay of Medicaid DSH cut, codification and expansion of Federal price transparency rule, oppose National Provider Identifier (NPI) requirements for hospital outpatient departments, oppose changes to 340B drug pricing program, support reauthorization of Community Health Centers, support reauthorization of National Health Service Corps, support reauthorization of Teaching Health Center Graduate Medical Education funding. Oppose Medicare site-neutral cuts, Medicare sequester cuts, and NPI proposals in H.R. 4822. Oppose changes to NPIs for hospital outpatient departments (H.R. 7623, H.R. 4509, H.R. 7623 as amended). Comment on legislative proposals in S.2840, the Primary Care and Health Workforce Expansion Act: oppose eliminating facility fees, oppose requiring a separate identification number for off-campus hospital outpatient departments. Discuss S.3430, the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, with Congressional staff. Discuss hospital and health provisions in CAA, 2024 (H.R. 4366) with HHS staff. Discuss expiring COVID-19 Public Health Emergency Medicare flexibilities with Congressional staff and HHS staff and support legislative proposals to extend PHE telehealth flexibilities and Acute Hospital Care at Home Waiver: H.R. 7623. Support public health extenders and elimination of Medicaid DSH cut in CAA, 2024 (H.R. 4366). Meet with Congressional staff to discuss proposals for financial relief for hospitals affected by the Change Healthcare cyberattack. Oppose legislative proposals to impose financial penalties on hospitals relating to minimum cybersecurity standards (S.5218). Discuss legislative proposals to regulate the use of artificial intelligence in health care delivery with Congressional staff. Support S.5026, SEPSIS Act. Discuss FEMA COVID-19 Public Assistance payouts with Congressional staff. Discuss FDA final rule to regulate laboratory developed tests (89 FR 37286) with Congressional staff. Support passage of Improving Seniors Timely Access to Care Act (S. 4532/H.R. 8702). Discuss legislative proposals on consumer medical debt with Congressional staff. Discuss life safety building code requirements with HHS.

No Bill No. - Congressional Primary Care Caucus No Bill No. - Black Maternal Health Momnibus Act No Bill No. - Medicare Physician Payment Reform No Bill No. - MACRA Implementation No Bill No. - CY2024 Medicare Physician Fee Schedule No Bill No. - CY 2024 Medicare Inpatient Prospective Payment System No Bill No. - Site Neutrality and Consolidation No Bill No. - CMS Prior Authorization Rules No Bill No. - Tobacco Users Quiet Act No Bill No. - G2211 Code (Physician Fee Schedule) No Bill No. - Reducing Medically Unnecessary Delays in Care Act No Bill No. - G2211 implementation/modifier 25 No Bill No. - HEALTH for Mom Act No Bill No. - Pay PCP Act No Bill No. - Seniors Timely Access to Care Act No Bill No. - CY25 Medicare Physician Fee Schedule No Bill No. - Physician Fee Stabilization Act (H.R. 952) Kids Access to Primary Care Act (H.R. 2400/S. 1165) The Reentry Act (H.R. 3074) Due Process Continuity of Care Act (H.R. 3766) Extending Access to Addiction Treatment Act (H.R. 4950/S. 2841) Improve Addiction Care Act (H.R. 4771) Children's Health Insurance Program Permanency Act (H.R. 4968) GOLD Card Act of 2023 (S. 2556) Improving Care for Youth Act (H.R. 5013) Value in Health Care Act (S. 2816) Medicaid for Every Child Act (H.R. 6545) Physician Fee Schedule Update and Improvements Act (H.R. 5434/S.3138) Stabilize Medicaid and CHIP Coverage Act (H.R. 5395) SURS Extension Act (H.R. 3487/S. 3805) No Fees for EFTs Act (S. 1316) Save Children's Coverage Act (H.R. 6997/S. 3010) Nutrition CARE Act (H.R. 6780/S. 2133) - Medically Tailored Home-Delivered Meals Demonstration Pilot Act (H.R. 8235) - Rural Physician Workforce Preservation Act (H.R. 7512) - Real-Time Benefit Tool Implementation Act (H.R. 1770/S. 2477) - Equitable Community Access to Pharmacist Act (S. 4349) - Electronic Prior Authorization for Prescription Drugs Act (H.R. 5434/S. 3138) - Stabilize Medicaid and CHIP Coverage Act

No Bill No. - Congressional Primary Care Caucus No Bill No. - Black Maternal Health Momnibus Act No Bill No. - Medicare Physician Payment Reform No Bill No. - MACRA Implementation No Bill No. - CY2024 Medicare Physician Fee Schedule No Bill No. - CY 2024 Medicare Inpatient Prospective Payment System No Bill No. - Site Neutrality and Consolidation No Bill No. - CMS Prior Authorization Rules No Bill No. - Tobacco Users Quiet Act No Bill No. - G2211 Code (Physician Fee Schedule) No Bill No. - Reducing Medically Unnecessary Delays in Care Act No Bill No. - G2211 implementation/modifier 25 No Bill No. - HEALTH for Mom Act No Bill No. - Pay PCP Act No Bill No. - Seniors Timely Access to Care Act (H.R. 952) Kids Access to Primary Care Act (H.R. 2400/S. 1165) The Reentry Act (H.R. 3074) Due Process Continuity of Care Act (H.R. 3766) Extending Access to Addiction Treatment Act (H.R. 4950/S. 2841) Improve Addiction Care Act (H.R. 4771) Children's Health Insurance Program Permanency Act (H.R. 4968) GOLD Card Act of 2023 (S. 2556) Improving Care for Youth Act (H.R. 5013) Value in Health Care Act (S. 2816) Medicaid for Every Child Act (H.R. 6545) Physician Fee Schedule Update and Improvements Act (H.R. 5434/S.3138) Stabilize Medicaid and CHIP Coverage Act (H.R. 5395) SURS Extension Act (H.R. 3487/S. 3805) No Fees for EFTs Act (S. 1316) Save Children's Coverage Act (H.R. 6997/S. 3010) Nutrition CARE Act (H.R. 6780/S. 2133) - Medically Tailored Home-Delivered Meals Demonstration Pilot Act (H.R. 8235) - Rural Physician Workforce Preservation Act (H.R. 7512) - Real-Time Benefit Tool Implementation Act

Client expense: $1,045,426 · Firm income: Not reported

- Corresponded and provided Medicare Advantage webinar link to a member of the Missouri Congressional delegation health staffer. - Convened in person visits with members of the Missouri Congressional delegation to discuss Missouri hospital issues. - Corresponded with members of the Missouri Congressional delegation health stafffer regarding in person visits. - Corresponded with a member of the Missouri Congressional delegation health staffer regarding their departure from position with congressional delegate. - Corresponded with members of the Missouri Congressional delegation health staffers regarding Nursing Home Minimum Staffing Rule. - Corresponded with a member of the Missouri Congressional delegation health staffer regarding Witness Bios and Testimony. - Corresponded with members of the Missouri Congressional delegation health staffers regarding HR 8245, HR 8261, HR 8144, HR 8246 and HR 8235. - Corresponded with members of the Missouri Congressional delegation health staffers regarding Critical Access Hospitals and OB Carve Out proposed legislation. - Corresponded with a member of the Missouri Congressional delegation health staffer regarding Humana Medicare Advantage Authorization example - Corresponded with a member of the Missouri Congressional delegation health staffer regarding FEMA status of a Missouri hospital. - Corresponded with members of the Missouri Congressional delegation regarding issues facing Missouri hospitals this quarter.

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

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.

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.

H.R. 8235 the Rural Physician Workforce Preservation Act H.R. 8261, the Preserving Telehealth, Hospital, and Ambulance Access Act HR 3171/S. 3018 The Improving Seniors Timely Access to Care Act H.R. 1110, KEEP Telehealth Options Act of 2023 H.R. 3875, Expanded Telehealth Access Act H.R. 5541, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act H.R. 5611, Helping Ensure Access to Local TeleHealth (HEALTH) Act of 2023 H.R. 6033, Supporting Patient Education And Knowledge (SPEAK) Act of 2023 H.R. 7149, Equal Access to Specialty Care Everywhere (EASE) Act of 2024 H.R. 7623, The Telehealth Modernization Act of 2024 H.R. 7711, To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program H.R. 7858, Telehealth Enhancement for Mental Health Act of 2024 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 H.R. 5386, Cutting Copays Act H.R. 5380, To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage H.R. 5372, Expanding Seniors Access to Lower Cost Medicines Act of 2023 S. 3059 the REAL Health Provider Act (Bennet, Tillis) S. 2973 Modernizing and Ensuring PBM Accountability Act H.R. 2880, the Protecting Patients Against PBM Abuses Act S.1002 - No UPCODE Act H.R. 3282, the Promoting Transparency and Healthy Competition in Medicare Act H.R. 3284, the Providers and Payers COMPETE Act H.R. 3237, To amend title XVIII of the Social Security Act to require each outpatient department of a provider to include a unique identification number on claims for services, and to require hospitals with an outpatient department of a provider to submit to the Centers for Medicare & Medicaid Services an attestation with respect to each outpatient department Legislation and regulation related to the Medicare Advantage program and Medicare/Medicaid coverage, care delivery and financing.

H.R.2389/S.1302 - Resident Physician Shortage Reduction Act of 2023 H.R.7050 - Substance Use Disorder Workforce Act Draft Bipartisan Senate Medicare GME Expansion proposal Issue: Support increased Medicare funding for graduate medical education (GME). H.R.751 - Fair Access in Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. H.R.834/S.230 - Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare GME payment formulas that reduce current DGME/IME payments to teaching hospitals. H.R.2584/S.2768 - Safety From Violence for Healthcare Employees (SAVE) Act Issue: Support legislation providing protection for health care workers by creating a criminal offense for knowingly assaulting or intimidating hospital workers and providing grants to reduce violence in hospitals. H.R.5378 - Lower Costs, More Transparency Act Issue: Oppose legislation that pays for workforce investments and mitigation of DSH cuts paid for by cuts to hospital outpatient departments. H.R.5013 - Value in Health Care Act Issue: Support legislation that ensures the continued move to value-based care. H.R.8235 - Rural Physician Workforce Preservation Act Issue: Educate Congress about the likely impact of legislation that would alter the distribution of Medicare-supported GME slots from the CAA, 2021 and 2023. Issue: Educate Congress on status of CMS distribution of the 1,000 new GME slots authorized by the Consolidated Appropriations Act, 2021 (P.L.116-260). Support CMS changing its distribution methodology to end the practice of super prioritization. Issue: Support Medicare GME per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose reduction of Medicare GME/IME payments. Issue: Oppose the redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare. Draft Senate Finance Medicare Physician Fee Schedule request for information Issue: Support efforts to reform the Medicare physician fee schedule. H.R.2474 - Strengthening Medicare for Patients and Providers Act Issue: Support legislation that reforms the Medicare Physician Fee Schedule by providing an annual inflation-based payment update based on the Medicare Economic Index (MEI). S.4338 - Pay PCPs Act Issue: Respond to Senate RFI on hybrid payments for Medicare physicians. P.L.118-42 - Consolidated Appropriations Act, 2024 Issues: Oppose reduction in Medicare hospital outpatient department reimbursement for drug administration and other services. Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital, and provider cuts. Support mitigation of Medicare Physician Fee Schedule cuts. Support delaying or eliminating scheduled cuts to the Medicaid disproportionate share hospital (DSH) program. Support extension of alternative payment model (APM) bonus. H.R.2665 - The Supporting Safety Net Hospitals Act Issue: Support eliminating two years worth of scheduled reductions to the Medicaid DSH program. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives. Issue: Protect patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issue: Educate Congress and policymakers on the financial challenges facing teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Educate Congress on potential financial implications of entitlement reform on teaching hospitals and health systems, medical schools, and faculty practices and the impact on patients access to care and the nations health. Issue: Support policies to close the Medicaid coverage gap and ensure access to coverage in non-expansion states, as well as financial incentives to help states maintain existing expansions. Support mandatory 12-month Medicaid coverage for post-partum individuals. Issue: Oppose efforts by states to impose work or other community engagement activities as a requirement for continued Medicaid eligibility or coverage for certain Medicaid beneficiaries. Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. Issue: Support extension of Acute Hospital at Home program waiver of 24/7 nursing requirement. Issue: Support extension of Medicare telehealth waivers and efforts to expand patient access to telehealth. Issue: Support policy to permanently remove requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services. H.R.1397 - The Telehealth Improvement for Kids Essential Services Act Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP. Issue: Support increased access to behavioral health and substance use disorder treatment services under Medicare and Medicaid. Support the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). Issue: Support creation of new Medicare outpatient IME payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create budget neutral IME payments for outpatient services. H.R.2377/S.1000 - The Saving Access to Laboratory Services (SALSA) Act Issue: Support legislation to modify Medicare payment rates for clinical diagnostic laboratory services to avoid statutory cuts to these payments. Issue: Support authorization of Medicare advance and accelerated payments in the wake of cyberattacks on providers. H.R.2829 - Chronic Care Management Improvement Act of 2023 Issue: Support removing cost-sharing obligations from the chronic care management (CCM) code in Medicare.

H.R. 3046, Medical Student Education Authorization Act of 2023, all provisions S. 1403, Medical Student Education Authorization Act of 2023, all provisions H.R. 1202, Resident Education Deferred Interest (REDI) Act, all provisions S. 704, Resident Education Deferred Interest (REDI) Act, all provisions H.R. 2761, Specialty Physicians Advancing Rural Care (SPARC) Act, all provisions S. 705, Specialty Physicians Advancing Rural Care (SPARC) Act, all provisions H.R. 7258, Community Training, Education, and Access for Medical Students (Community TEAMS) Act of 2024, all provisions S. 3968, Community Training, Education, and Access for Medical Students (Community TEAMS) Act of 2024, all provisions S. 3022, IHS Workforce Parity Act of 2023, all provisions H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions H.R. 751, Fair Access In Residency (FAIR) Act, all provisions H.R. 7050, Substance Use Disorder Workforce Act, all provisions H.R. 4829, Physical Therapist Workforce and Patient Access Act of 2023, provisions relating to National Health Service Corps Loan Repayment program H.R. 7725, To amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion, all provisions S. 4115, Embracing anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education (EDUCATE) Act, all provisions H.R. 8318, Tribal Tax and Investment Reform Act of 2024, provisions relating to student loans H.R. 8235, Rural Physician Workforce Preservation Act, provisions relating to GME H.R. 7855, Rural Residency Planning and Development Act of 2024, all provisions Opioid Workforce Act/draft IHS Health Professions Tax Fairness Act/draft Childrens Hospitals Graduate Medical Education (CHGME) program/FY 2025 funding Pathways to Practice GME cap flexibility Rural health care

H.R. 6445, Medicare Audiology Access Improvement Act of 2023, all provisions S. 2377, Medicare Audiology Access Improvement Act of 2023, all provisions H.R. 1610, Chiropractic Medicare Coverage Modernization Act of 2023, all provisions S. 799, Chiropractic Medicare Coverage Modernization Act of 2023, all provisions H.R. 4189, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023, all provisions S. 2016, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023, all provisions S. 712, Connected MOM Act, all provisions H.R. 5066, Tech to Save Moms Act, all provisions H.R. 1770, Equitable Community Access to Pharmacist Services Act, all provisions S. 2477, Equitable Community Access to Pharmacist Services Act, all provisions H.R. 751, Fair Access In Residency (FAIR) Act, all provisions H.R. 4968, Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act of 2023 H.R. 2713, Improving Care and Access to Nurses (ICAN) Act, all provisions S. 2418, Improving Care and Access to Nurses (ICAN) Act, all provisions H.R. 2583, Increasing Access to Quality Cardiac Rehabilitation Care Act of 2023, all provisions H.R. 977, Patient Access to Higher Quality Health Care Act of 2023, all provisions S. 470, Patient Access to Higher Quality Health Care Act of 2023, all provisions H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions H.R. 7050, Substance Use Disorder Workforce Act, all provisions H.R. 7623, Telehealth Modernization Act of 2024, all provisions S. 3967, Telehealth Modernization Act, all provisions H.R. 2474, Strengthening Medicare for Patients and Providers Act, all provisions H.R. 6371, Provider Reimbursement Stability Act of 2023, all provisions H.R. 6545, Physician Fee Schedule Update and Improvements Act, all provisions H.R. 5378, Lower Costs, More Transparency Act, all provisions H.R. 6683, Preserving Seniors Access to Physicians Act of 2023, all provisions H.R. 5013, Value in Health Care Act of 2023, all provisions S. 3503, Value in Health Care Act of 2023, all provisions H.R. 7856, Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies (PREVENT DIABETES) Act, all provisions S. 4094, Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies (PREVENT DIABETES) Act, all provisions H.R. 8702, To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, all provisions S. 4532, A bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, all provisions H.R. 6366, To amend title XVIII of the Social Security Act with respect to the work geographic index for physician payments under the Medicare program, and to revise the phase-in of clinical laboratory test payment changes under such program, all provisions S. 4338, Pay PCPs Act of 2024, all provisions H.R. 8261, Preserving Telehealth, Hospital, and Ambulance Access Act, all provisions S. 1491, Pharmacy and Medically Underserved Areas Enhancement Act, all provisions S. 669, Increasing Mental Health Options Act of 2023, all provisions H.R. 7618, Stopping Addiction and Falls for the Elderly (SAFE) Act, all provisions H.R. 7254, Hearing Device Coverage Clarification Act, all provisions S. 3059, Requiring Enhanced & Accurate Lists of Health Providers Act, all provisions H.R. 7708, To amend title XVIII of the Social Security Act to require MA organizations offering network-based plans to maintain an accurate provider directory, and for other purposes, all provisions S. 4054, Health Care Cybersecurity Improvement Act of 2024, all provisions H.R. 1691, Ensuring Patient Access to Critical Breakthrough Products Act of 2023, all provisions H.R. 2407, Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act, all provisions H.R. 4818, Treat and Reduce Obesity Act of 2023, all provisions H.R. 8816, American Medical Innovation and Investment Act of 2024, all provisions H.R. 6369, To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models, all provisions H.R. 7665, ACO Assignment Improvement Act of 2024, all provisions S. 3939, ACO Assignment Improvement Act of 2024, all provisions H.R. 8404, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions S. 4330, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions H.R. 8235, Rural Physician Workforce Preservation Act, all provisions H.R. 1745, Medicare Fraud Detection and Deterrence Act of 2023, provisions related to telehealth H.R. 1746, Preventing Medicare Telefraud Act, all provisions H.R. 8532, To identify and address barriers to coverage of remote physiologic devices under State Medicaid programs to improve maternal and child health outcomes for pregnant and postpartum women, all provisions S. 4350, Hospital Inpatient Services Modernization Act, 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. 7279, Remove Duplicative Unnecessary Clerical Exchanges (REDUCE) Act, all provisions S. 971, Due Process Continuity of Care Act, all provisions Data-Driven Performance Payment System/draft Fewer Burdens for Better Healthcare Act/draft Supporting Healthy Moms and Babies Act/draft Medicare program: Improving Seniors Timely Access to Care Act implementation Medicare program: No Surprises Act implementation Medicare program: 21st Century Cures Act implementation Medicare program: Medicare physician payment reform Medicare program: Medicare Access and CHIP Reauthorization Act (MACRA)/physician burdens Medicare program: Merit-based Incentive Payment System (MIPS) Medicare program: MIPS Value Pathways Medicare program: MIPS/timely, actionable data Medicare program: Site neutral payments Medicare program: Information blocking Medicare program: Alternative Payment Models (APMs) Medicare program: Physician payment/inflation/practice costs Medicare program: High-cost disposable services/payment Medicare program: Prior authorization Medicare program: Hospital-at-Home Extension Medicare program: Prescriber-facing real-time benefit tools Medicare program: Accountable Care Organizations (ACO) Medicare program: ACO/APM flexibilities Medicare program: Medicare Shared Savings Program/regulatory changes Medicare program: Shared Savings Program/Promoting Interoperability/Certified EHR Technology Medicare program: Primary care payment reform Medicare program: Chronic care Medicare program: Diabetes Prevention Program Medicare program: Graduate Medical Education Medicare program: Medicare Administrative Contractors (MACs)/Local Coverage Article (LCA)/Local Coverage Determination (LCD) Medicare program: Quality Payment Program/physician burdens Medicare program: Medicare Shared Savings Program/Advanced APM reporting requirements Medicare program: Patient engagement Medicare program: Health IT/physician burdens Medicare program: Provider feedback/quality and efficiency measures Medicare and Medicaid programs: CHANGE Healthcare cyberattack Medicare and Medicaid programs: Rural health care Medicare and Medicaid programs: Data privacy Medicare and Medicaid programs: Pharmacy Benefit Managers Medicaid program: Maternal mortality

Advocate for proposals to provide direct financial support to safety net hospitals with Congressional staff. Discuss support for the 340B Drug Pricing Program with Congressional staff and oppose certain changes. Respond to Senate request for information on 340B Drug Pricing Program - SUSTAIN 340B Act discussion draft. Oppose 340B ACCESS Act (H.R. 7635). Discuss legislative proposals with Congressional staff to stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support); make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Discuss Medicare Graduate Medical Education (GME) provisions in the Consolidated Appropriations Act (CAA), 2021 and CAA, 2023 with HHS staff. Discuss with Congressional staff support for Medicare GME expansion: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act; additional GME slots in CAA, 2021 and CAA, 2023. Support the Rural Residency Planning and Development Act (H.R. 7855) to provide grant funding for rural hospitals seeking to develop GME programs. Oppose Rural Physician Workforce Preservation Act (H.R. 8235) and modifications to ongoing distribution of CAA, 2021 Section 126 GME slots. Discuss with Congressional staff legislative recommendations to address workforce shortages for nursing and ancillary health care workforce with Congressional staff: faculty recruitment and retention, additional financial support for supervision and precepting students, Medicare payment for nursing and allied health, testing new workforce models, establishing incentives and early recruitment strategies, providing funding for clinical training site, and immigration reforms that expedite entry for foreign health care workers. Support passage of the Safety from Violence for Healthcare Employees (SAVE) Act to create legal penalties for individuals who assault or intimidate hospital employees. Support revisions to Conrad 30 waiver program to increase the number of foreign physicians that may remain in the US after completing GME: S.665/H.R.4942, S.2719/H.R.6980, H.R. 4875. Meet with Congressional staff to discuss technical amendment to CAA, 2021 Section 131. Respond to Senate Finance Committee request for information on Medicare GME and offer recommendations. Discuss federal support for nursing and allied health workforce with HHS staff. Discuss opposition to site-neutral payment policies with Congressional staff. Educate Congressional staff on hospital price transparency federal rule (84 FR 65602). Meet with Congressional staff to discuss H.R. 5378, the Lower Costs, More Transparency Act of 2023, and comment on following proposals in bill: support for delay of Medicaid DSH cut, codification and expansion of Federal price transparency rule, oppose National Provider Identifier requirements for hospital outpatient departments, oppose changes to 340B drug pricing program, support reauthorization of Community Health Centers, support reauthorization of National Health Service Corps, support reauthorization of Teaching Health Center Graduate Medical Education funding. Oppose Medicare site-neutral cuts, sequester cuts, and national provider identifier proposals in H.R. 4822, the Health Care Price Transparency Act of 2023. Oppose H.R. 4509 to require a separate unique health identifier for hospital outpatient departments. Oppose changes to national provider identifier requirements in H.R. 7623. Comment on legislative proposals in S.2840, the Primary Care and Health Workforce Expansion Act: oppose eliminating facility fees, oppose requiring a separate identification number for off-campus hospital outpatient departments. Discuss S.3430, the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, with Congressional staff. Discuss hospital and health provisions in CAA, 2024 (H.R. 4366) with HHS staff. Discuss telehealth issues with Congressional staff and support legislative proposals to extend PHE telehealth flexibilities. Support legislative proposals for additional extension of the Acute Hospital Care at Home waiver. Support public health extenders and elimination of Medicaid DSH cut in CAA, 2024 (H.R. 4366) and discuss with Congressional staff. Meet with Congressional staff to discuss proposals for financial relief for hospitals affected by the Change Healthcare cyberattack. Oppose legislative proposals to impose financial penalties on hospitals relating to minimum cybersecurity standards. Discuss legislative proposals to regulate the use of artificial intelligence in health care delivery with Congressional staff. Discuss federal legislative proposals for sepsis reporting with Congressional staff. Discuss Earned Income Tax Credit and opposition to ERTC proposal in the Tax Relief for American Families and Workers Act of 2024 with Congressional staff. Discuss FEMA COVID-19 Public Assistance payouts with Congressional staff. Discuss FDA final rule to regulate laboratory developed tests (89 FR 37286) with Congressional staff. Support passage of Improving Seniors Timely Access to Care Act (S. 4532/H.R. 8702).

Fair Access In Residency (FAIR) Act (H.R. 751) Rural Physician Workforce Production Act (S. 230/H.R. 834) Resident Physician Shortage Reduction Act of 2023 (S. 1302/H.R. 2389) Council on Graduate Medical Education Medicare Payment Advisory Commission Inpatient Prospective Payment System (SCH/MDH Issue) Consolidated Appropriations Act, 2021 (PL 116-260) Community Training, Education and Access for Medical Students (Community TEAMS) Act (S. 3968, H.R. 7258) National Health Service Corps Teaching Health Centers Graduate Medical Education NIH Osteopathic Funding and Representation Substance Use Disorder Workforce Act of 2024 (H.R. 7050) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (S. 3679, H.R. 7153) Medically Tailored Home-Delivered Meals Demonstration Pilot Act (S. 2133, H.R. 6780) Rural Physician Workforce Preservation Act (H.R. 8235) Rural Residency Planning and Development Act of 2024 (H.R. 7855) Physician Preceptor Tax Credit Pandemic and All-Hazards Preparedness Act (PL 109-417) Public Health Infrastructure Saves Lives Act (S. 1995)

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

- Corresponded and provided Medicare Advantage webinar link to a member of the Missouri Congressional delegation health staffer. - Convened in person visits with members of the Missouri Congressional delegation to discuss Missouri hospital issues. - Corresponded with members of the Missouri Congressional delegation health stafffer regarding in person visits. - Corresponded with a member of the Missouri Congressional delegation health staffer regarding their departure from position with congressional delegate. - Corresponded with members of the Missouri Congressional delegation health staffers regarding Nursing Home Minimum Staffing Rule. - Corresponded with a member of the Missouri Congressional delegation health staffer regarding Witness Bios and Testimony. - Corresponded with members of the Missouri Congressional delegation health staffers regarding HR 8245, HR 8261, HR 8144, HR 8246 and HR 8235. - Corresponded with members of the Missouri Congressional delegation health staffers regarding Critical Access Hospitals and OB Carve Out proposed legislation. - Corresponded with a member of the Missouri Congressional delegation health staffer regarding Humana Medicare Advantage Authorization example - Corresponded with a member of the Missouri Congressional delegation health staffer regarding FEMA status of a Missouri hospital. - Corresponded with members of the Missouri Congressional delegation regarding issues facing Missouri hospitals this quarter.

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

No Bill No. - Congressional Primary Care Caucus No Bill No. - Black Maternal Health Momnibus Act No Bill No. - Medicare Physician Payment Reform No Bill No. - MACRA Implementation No Bill No. - CY2024 Medicare Physician Fee Schedule No Bill No. - CY 2024 Medicare Inpatient Prospective Payment System No Bill No. - Site Neutrality and Consolidation No Bill No. - CMS Prior Authorization Rules No Bill No. - Tobacco Users Quiet Act No Bill No. - G2211 Code (Physician Fee Schedule) No Bill No. - Reducing Medically Unnecessary Delays in Care Act No Bill No. - G2211 implementation/modifier 25 No Bill No. - HEALTH for Mom Act No Bill No. - Pay PCP Act No Bill No. - Seniors Timely Access to Care Act (H.R. 952) Kids Access to Primary Care Act (H.R. 2400/S. 1165) The Reentry Act (H.R. 3074) Due Process Continuity of Care Act (H.R. 3766) Extending Access to Addiction Treatment Act (H.R. 4950/S. 2841) Improve Addiction Care Act (H.R. 4771) Children's Health Insurance Program Permanency Act (H.R. 4968) GOLD Card Act of 2023 (S. 2556) Improving Care for Youth Act (H.R. 5013) Value in Health Care Act (S. 2816) Medicaid for Every Child Act (H.R. 6545) Physician Fee Schedule Update and Improvements Act (H.R. 5434/S.3138) Stabilize Medicaid and CHIP Coverage Act (H.R. 5395) SURS Extension Act (H.R. 3487/S. 3805) No Fees for EFTs Act (S. 1316) Save Children's Coverage Act (H.R. 6997/S. 3010) Nutrition CARE Act (H.R. 6780/S. 2133) - Medically Tailored Home-Delivered Meals Demonstration Pilot Act (H.R. 8235) - Rural Physician Workforce Preservation Act (H.R. 7512) - Real-Time Benefit Tool Implementation Act

Client expense: $1,045,426 · Firm income: Not reported