Second Chances for Rural Hospitals Act

H.R. 5378 - Lower Costs, More Transparency Act - Re: Site Neutral and Hospital Price Transparency H.R. 3173/ S.5044 - "Improving Seniors' Timely Access to Care Act" - Re: Medicare Advantage Prior Authorization provisions H.R. 6430/ S.1110 - "The Assistance for Rural Community Hospitals (ARCH) Act" - Re: Discussions around Medicare rural extenders (LVH/MDH) H.R. 8246 - Second Chances for Rural Hospitals Act; S.4322 "Rural Emergency Hospital Designation Improvement Act" Re: discussions on protecting access to rural hospitals Payment delays and denials - Re: Medicare Advantage coverage requirements H.R. 8113 - "Transparency into State Directed Payments Act of 2024" - Re: Discussed importance of Medicaid payment adequacy Discussions around Medicaid DSH funding - Re: Medicaid DSH cut delay H.R. 7623/ S. 3967 - "Telehealth Modernization Act of 2024"; H.R. 8261 Preserving Telehealth, Hospital, and Ambulance Access Act; H.R. 4189/ S. 2016 - "CONNECT for Health Act of 2023"; H.R. 3432/ S. 3651 - "Telemental Health Care Access Act of 2023" - Re: Telehealth flexibilities CMMI Models - Re: Mandatory participation S. 5026 - SEPSIS Act re: sepsis prevention Discussions re: post-acute reimbursement and network adequacy

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions pertaining to CMS hospital directed payment program Discussions pertaining to reductions to the Medicaid disproportionate share hospital (DSH) program S 470 Patient Access to Higher Quality Health Care Act of 2023 (all sections of full text)(oppose) HR 977 Patient Access to Higher Quality Health Care Act of 2023 (all sections of full text) (oppose) HR 8246 Second Chances for Rural Hospitals Act (all sections of full text)(oppose) S 1869 Site-based Invoicing and Transparency Enhancement (SITE) Act (all sections of full text) Discussions relating to site neutral payment reform Discussions pertaining to prior authorization Monitored Medicare Advantage reform legislation on CMS action

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

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

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

Support HR 2665, the Supporting Safety Net Hospitals Act, which would repeal cuts to the Medicaid Disproportionate Share Hospital Program. Provide feedback on reforms to the Rural Emergency Hospital designation program: The Second Chances for Rural Hospitals Act (H.R. 8246) and the Rural Emergency Hospital Designation Improvement Act (S. 4322). Support the Rural Hospital Support Act (S. 1110) and the Assistance for Rural Community Hospitals Act (H.R. 6430), which extend or make permanent the Low Volume Adjustment and Medicare Dependent Hospital programs. Support the Improving Seniors Timely Access to Care Act (H.R. 8702/S. 4532), which would streamline prior authorization in Medicare Advantage and improve access to care. Support for the Hospital Inpatient Modernation Act (S. 4350/H.R. 8260), which extends telehealth flexibilities and the Hospital at Home program. Oppose efforts to advance Medicare site neutral payment policies, as seen in the Lower Costs, More Transparency Act (HR 5378). Submit comments to CMS on CMS-10856: Agency Information Collection Activities: Proposed Collection, specifically about attestations for providers participating in state directed payment programs. Submit comments to CMS on Re: CMS-1809-P; Proposed Rule - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, Including the Hospital Inpatient Quality Reporting Program; specifically, provisions related to the market basket payment update, the four walls exception to clinic services in Medicaid, changes to prior authorization for outpatient services, and health and safety standards of obstetrical services in hospitals/critical access hospitals.

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

- 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

S. 3565, Affordable Connectivity Program Extension Act of 2024, all provisions; Draft Bill, Sustain 340B Program Discussion Draft, Issues pertaining to 340B Program access; S. 1302/H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions; S. 3679/H.R. 7153, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, all provisions; S.2415, Preventing Maternal Deaths Reauthorization Act, all provisions; H.R. 7931, Preserving Emergency Access in Key Sites Act (PEAKS) , all provisions; H.R. 8245, Rural Hospital Stabilization Act , all provisions; H.R. 8246, Second Chances for Rural Hospitals Act, all provisions; S.940/ H.R. 1711, Rural America Health Corps Act, all provisions; S.665 / H.R. 4942, Conrad State 30 and Physician Access Reauthorization Act, all provisions; S. 3211/ H.R. 6205, Healthcare Workforce Resilience Act, all provisions; S. 3765 / H.R. 6960, Emergency Medical Services for Children Reauthorization Act of 2024, all provisions; H.R. 7635, The 340B PATIENTS Act, all provisions; H.R.8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net (340B ACCESS) Act, Issues pertaining to 340B Program access; S. 2364, Mapping Americas Pharmaceutical Supply Act, all provisions; S. 1961, Pharmaceutical Supply Chain Risk Assessment Act of 2023, all provisions; S. 2510, RAPID Reserve Act, all provisions; S. 2362, Drug Shortage Prevention Act, all provisions; Draft Bill, the Drug Shortage Prevention and Mitigation Act, Issues pertaining to proposed solutions to address generic drug shortages; S. 862, Restoring America's Health Care Workforce and Readiness Act, all provisions; HR 2584/ S.2768, Safety From Violence for Healthcare Employees (SAVE) Act, all provisions; S.4079/H.R. 8383, Rural Obstetrics Readiness Act , all provisions; H.R. 8186, Healthy Affordable Housing Act, all provisions; S. 4289, Medical Debt Cancellation Act, all provisions; S. 4054, Health Care Cybersecurity Improvement Act of 2024, all provisions; S. 3770/ H.R. 7266, "The Future Advancement of Academic Nursing (FAAN Act)", all provisions; S. 1176 / H.R. 2663, Workplace Violence Prevention for Health Care and Social Service Workers Act, all provisions; H.R. 977/S. 470, Patient Access to Higher Quality Care Act, all provisions; Draft Bill, Family Health Affordability Act, all provisions; Draft Bill, HEALTH for MOM Act, all provisions; U.S. Department of Labor, Health Plan Accountability, health plan accountability; Office of the U.S. Trade Representative, Section 301 Tariffs, Issues related to tariffs on health care products manufactured in China; Federal Emergency Management Agency (FEMA), Public Assistance for COVID expenses, Issues related to distribution of public assistance funds to hospitals; Administration for Strategic Preparation & Response (ASPR / HHS), Pediatric Emergencies, Issues related to Pediatric Disaster Care Centers of Excellence; U.S. Department of State Immigration, Issues related to visas for foreign-trained health care workers; Immediate Office of the Secretary (IOS - HHS), Medical Debt, Issues related to how hospitals address medical debt; Cyber Security, Issues pertaining to Change Health Care cyber attack, breach notifications and ongoing cyber risks to the health care field; Lab Developed Tests (LDTs), Issues related to proposed regulatory oversight of Lab Developed Tests (LDTs); Employment Retirement Income Security Act (ERISA), ERISA improvements; Artificial Intelligence (AI), AI use in health care; Rural Health Care Access, Issues to protect access to rural health care; Prescription drug shortages, Issues pertaining to Drug shortages, supply chains; Hospital mergers and acquisitions, Issues pertaining to hospital consolidation, mergers an acquisition, community benefit, physician practice acquisition; Workforce nurse staffing mandate, workforce development programs; Maternal Health and Child Health, Access to maternal and child health care and addressing related workforce shortages; Behavioral Health, Related to expanding access to care and reducing regulatory barriers; Price Transparency, Issues related to hospital price transparency; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage; Medical Debt, Issues specific to medical debt incurred by patients and hospital billing and collection practices; Physician Owned Hospitals, Physician-owned hospitals; Tax-exempt status, not-for-profit hospitals' tax exempt status; Health Professions Diversity, Increasing health professionals of color, National health service corps; centers of excellence; health careers opportunity programs.

S. 3565, Affordable Connectivity Program Extension Act of 2024, all provisions; Draft Bill, Sustain 340B Program Discussion Draft, Issues pertaining to 340B Program access; S. 1302/H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions; S. 3679/H.R. 7153, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, all provisions; S.2415, Preventing Maternal Deaths Reauthorization Act, all provisions; H.R. 7931, Preserving Emergency Access in Key Sites Act (PEAKS) , all provisions; H.R. 8245, Rural Hospital Stabilization Act , all provisions; H.R. 8246, Second Chances for Rural Hospitals Act, all provisions; S.940/ H.R. 1711, Rural America Health Corps Act, all provisions; S.665 / H.R. 4942, Conrad State 30 and Physician Access Reauthorization Act, all provisions; S. 3211/ H.R. 6205, Healthcare Workforce Resilience Act, all provisions; S. 3765 / H.R. 6960, Emergency Medical Services for Children Reauthorization Act of 2024, all provisions; H.R. 7635, The 340B PATIENTS Act, all provisions; H.R.8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net (340B ACCESS) Act, Issues pertaining to 340B Program access; S. 2364, Mapping Americas Pharmaceutical Supply Act, all provisions; S. 1961, Pharmaceutical Supply Chain Risk Assessment Act of 2023, all provisions; S. 2510, RAPID Reserve Act, all provisions; S. 2362, Drug Shortage Prevention Act, all provisions; Draft Bill, the Drug Shortage Prevention and Mitigation Act, Issues pertaining to proposed solutions to address generic drug shortages; S. 862, Restoring America's Health Care Workforce and Readiness Act, all provisions; HR 2584/ S.2768, Safety From Violence for Healthcare Employees (SAVE) Act, all provisions; S.4079/H.R. 8383, Rural Obstetrics Readiness Act , all provisions; H.R. 8186, Healthy Affordable Housing Act, all provisions; S. 4289, Medical Debt Cancellation Act, all provisions; S. 4054, Health Care Cybersecurity Improvement Act of 2024, all provisions; S. 3770/ H.R. 7266, "The Future Advancement of Academic Nursing (FAAN Act)", all provisions; S. 1176 / H.R. 2663, Workplace Violence Prevention for Health Care and Social Service Workers Act, all provisions; H.R. 977/S. 470, Patient Access to Higher Quality Care Act, all provisions; Draft Bill, Family Health Affordability Act, all provisions; Draft Bill, HEALTH for MOM Act, all provisions; U.S. Department of Labor, Health Plan Accountability, health plan accountability; Office of the U.S. Trade Representative, Section 301 Tariffs, Issues related to tariffs on health care products manufactured in China; Federal Emergency Management Agency (FEMA), Public Assistance for COVID expenses, Issues related to distribution of public assistance funds to hospitals; Administration for Strategic Preparation & Response (ASPR / HHS), Pediatric Emergencies, Issues related to Pediatric Disaster Care Centers of Excellence; U.S. Department of State Immigration, Issues related to visas for foreign-trained health care workers; Immediate Office of the Secretary (IOS - HHS), Medical Debt, Issues related to how hospitals address medical debt; Cyber Security, Issues pertaining to Change Health Care cyber attack, breach notifications and ongoing cyber risks to the health care field; Lab Developed Tests (LDTs), Issues related to proposed regulatory oversight of Lab Developed Tests (LDTs); Employment Retirement Income Security Act (ERISA), ERISA improvements; Artificial Intelligence (AI), AI use in health care; Rural Health Care Access, Issues to protect access to rural health care; Prescription drug shortages, Issues pertaining to Drug shortages, supply chains; Hospital mergers and acquisitions, Issues pertaining to hospital consolidation, mergers an acquisition, community benefit, physician practice acquisition; Workforce nurse staffing mandate, workforce development programs; Maternal Health and Child Health, Access to maternal and child health care and addressing related workforce shortages; Behavioral Health, Related to expanding access to care and reducing regulatory barriers; Price Transparency, Issues related to hospital price transparency; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage; Medical Debt, Issues specific to medical debt incurred by patients and hospital billing and collection practices; Physician Owned Hospitals, Physician-owned hospitals; Tax-exempt status, not-for-profit hospitals' tax exempt status; Health Professions Diversity, Increasing health professionals of color, National health service corps; centers of excellence; health careers opportunity programs.

H.R. 618, Improving Access to Workers Compensation for Injured Federal Workers Act, all provisions S. 131, Improving Access to Workers Compensation for Injured Federal Workers Act of 2023, all provisions H.R. 2923, Living Donor Protection Act of 2023, all provisions S. 1384, Living Donor Protection Act of 2023, all provisions H.R. 1359, Modernizing Opioid Treatment Access Act, all provisions S. 644, Modernizing Opioid Treatment Access Act, all provisions H.R. 6487, No Fees for EFTs Act, all provisions S. 3805, No Fees for EFTs Act, all provisions H.R. 766, Dr. Michael C. Burgess Preventive Health Savings Act, all provisions S. 114, Dr. Michael C. Burgess Preventive Health Savings Act, all provisions H.R. 2630, Safe Step Act, all provisions S. 652, Safe Step Act, all provisions S. 2840, Bipartisan Primary Care and Health Workforce Act, all provisions S. 113, Prescription Pricing for the People Act of 2023, all provisions H.R. 7153, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, al provisions S. 3679, Dr. Lorna Breen Health Care Provider Protection Reauthorization 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 S. 127, Pharmacy Benefit Manager Transparency Act of 2023, all provisions H.R. 8325, Physician and Patient Safety Act, all provisions S. 4278, Physician and Patient Safety Act, all provisions H.R. 6475, Health Disparity Zones Act of 2023, all provisions H.R. 3417, Facilitating Accountability In Reimbursements (FAIR) Act, all provisions H.R. 7931, Preserving Emergency Access in Key Sites (PEAKS) Act, all provisions H.R. 8245, Rural Hospital Stabilization Act, all provisions H.R. 8246, Second Chances for Rural Hospitals Act, all provisions H.R. 6230, Doctor Knows Best Act of 2023, all provisions S. 4349, A bill to require private health plans to provide for secure electronic transmission of prior authorization requests for prescription drugs, all provisions H.R. 6881, AI Foundation Model Transparency Act of 2023, all provisions H. Res. 217, Supporting the designation of March 2023 as Endometriosis Awareness Month, all provisions S. Res. 90, A resolution recognizing the significance of endometriosis as an unmet chronic disease for women and designating March 2023 as "Endometriosis Awareness Month, all provisions H.R. 1310, States Handling Access to Reciprocity for Employment (SHARE) Act, all provisions H.R. 8818, American Privacy Rights Act of 2024, all provisions H.R. 2584, Safety From Violence for Healthcare Employees Act, all provisions S. 2768, Safety From Violence for Healthcare Employees Act, all provisions H.R. 6766, Transparency, Readability, Understandability, Truth, and Helpfulness (TRUTH) in Labeling Act, all provisions S. 3512, Transparency, Readability, Understandability, Truth, and Helpfulness (TRUTH) in Labeling Act, all provisions H.R. 7002, Nurse Faculty Shortage Reduction Act of 2024, all provisions H.R. 6033, Supporting Patient Education And Knowledge (SPEAK) Act of 2023, provisions relating to telehealth/equity 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. 206, Healthy Technology Act of 2023, all provisions Dr. Paul Farmer Global Health Training Act/draft Health Over Wealth Act/draft Mental Health Parity and Addiction Equity Act implementation Physician-practice ownership Maternal health Food is medicine Coding AI in health care/principles Digital health/regulation Diet-related disease Prescription drug shortages Rural health care Telehealth Sexual orientation policies CHANGE Healthcare cyberattack/HIPAA Data privacy Buprenorphine/barriers to access Drug overdose epidemic Infectious diseases Health equity Reproductive health Augmented intelligence Cybersecurity Substance Use Disorder Prior authorization Put Water on MyPlate/better beverage choices Pharmacy Benefit Managers Biologics/biosimilars Farm policy/food security/clean air and water

Support HR 2665, the Supporting Safety Net Hospitals Act, which would repeal cuts to the Medicaid Disproportionate Share Hospital Program. Request congressional engagement on Informational Bulletin released by CMS on February 17, 2023 related to permissible state financing arrangements in the Medicaid program. Request Congressional engagement for critical access hospitals that are paid below cost by Medicare Advantage plans. H.R. 4366 - Consolidated Appropriations Act of 2024 - supporting provision to delay cuts to the Medicaid Disproportionate Share hospital program, extend rural hospital funding programs, and extend telehealth flexibilities. Oppose efforts to include site neutral payment reforms. Provide feedback on reforms to the Rural Emergency Hospital designation program: The Second Chances for Rural Hospitals Act (H.R. 8246) and the Rural Emergency Hospital Designation Improvement Act (S. 4322). Provide feedback on draft legislation to extend//make permanent certain rural hospital payment programs: Healthcare Enhancement for Americas Rural Towns Act (HEART) Act. Submitted comments to CMS in response to an RFI about Medicare Advantage Data (CMS-4207-NC), specifically on contracting, prior authorization and coverage, payment denials and appeals, payment rates, and supplemental benefits. Submitted comments to CMS on the Inpatient Prospective Payment System (PPS) for Hospitals (CMS-1808), specifically about inadequate payment rates, generally, and for the Medicare Disproportionate Share Hospital program, and an enhanced rural labor and delivery payment add-on. Submitted comments to CMS on the Inpatient Psych PPS proposed rule (CMS-1806), specifically about inadequate payment rates. Submitted comments to CMS about the Inpatient Rehab PPS proposed rule (CMS-1804), specifically about inadequate payment rates. Submitted comments to CMS about the Skilled Nursing Facility PPS proposed rule (CMS-1802), specifically about inadequate payment rates.

- 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