To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification.
Legislative Progress
Momentum (last 30 days)
0
score
0 actions · 0 new cosponsors · 0 votes
Speed vs cohort
87pct
208d open
vs 10,564 other HR bills in the 118th — cohort avg 68d
No CRS summary is available for this bill yet. The source title, actions, sponsors, and text versions below come from Congress.gov.
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Filing registrants (6)
2025 · second_quarter · Medicare/Medicaid
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Congress.gov source codes: 1000, Intro-H
Bills with similar content found using semantic analysis.
Sources: Congress.gov
Discuss with Congressional staff and HHS staff support for Medicare GME expansion and changes to GME program: 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; Rural Residency Planning and Development Act; concerns on Rural Physician Workforce Preservation Act; Senate Finance Committee proposals to increase GME slots. Discuss with Congressional staff opposition to Medicaid proposals in H.R.1: work requirements as a condition of coverage, changes to state-directed payments, reductions to Federal matching funds, reductions to the safe harbor threshold for provider taxes, sunsetting uniform tax waivers, rescission of Medicaid Eligibility rule and Medicaid/CHIP Access rule, reductions to retroactive coverage, reduction of reasonable opportunity window. Discuss technical amendment to CAA, 2021, Sec. 131 pertaining to Medicare GME with Congressional staff. Discuss with Congressional staff distribution methodology for Medicare GME slots created in the CAA, 2021. Discuss expiring COVID-19 Public Health Emergency (PHE) Medicare flexibilities with Congressional staff and HHS staff and support legislative proposals to extend PHE telehealth flexibilities and Acute Hospital Care at Home Waiver. Support extension of Medicare Dependent Hospital and Low-Volume Adjustment programs. Discuss opposition to Medicare site-neutral payment policies with Congressional staff. Oppose changes to NPIs for hospital outpatient departments (118th Congress: H.R. 7623, H.R. 4509, H.R. 7623 as amended, H.R. 4822). Discuss FY 2024 IPPS comments with Congressional, HHS staff: to increase payment update to hospitals, Transforming Episodic Accountability Model, AHEAD Model, and CAA, 2023 Sec 4122 GME slot distribution methodology. Discuss proposals that 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. Support certain changes to Medicaid DSH payments: support two-year elimination of Medicaid DSH cut scheduled for January 1, 2025; support Save Our Safety Net Hospitals Act to restore pre-CAA, 2021 DSH cap calculation methodology and include dual-eligible patients in state DSH cap calculation. Discuss Medicaid waiver with Congressional staff and HHS. Discuss CMMI initiatives on global budgets and primary care in NYS Medicaid waiver. Discuss Medicaid IMD exclusion policies with Congressional staff. Support legislation to increase Medicaid payment rates for labor and delivery services for certain hospitals (118th Congress: S.5236). Oppose CMS final rule to establish minimum nurse staffing in Medicare- and Medicaid-certified long-term care facilities (89 FR 40876) and support legislative efforts to repeal rule. Support Medicare Advantage prior authorization reforms - Improving Seniors Timely Access to Care Act (H.R. 3514/S. 1816). Discuss wage index issues with Congressional staff: H.R. 8561 to address MA local area growth under projection, FY 2025 IPPS/LTCH interim final rule, indirect medical education (IME) payments to hospitals. Meet with CMS leadership to discuss Medicare and Medicaid issues: prior authorization and MA insurance denials, concerns on mandatory participation for AHEAD and TEAM models, Medicare support for health care workforce; support for telehealth flexibilities and Acute Hospital Care at Home waiver extension. Discuss Medicare wage index issues with CMS. Discuss Medicaid Section 1332 waiver with Congressional staff. Urge delayed enforcement of CMS final rule prohibiting nurses from performing glucose tests using high-complexity devices in point-of-care situations.
Client expense: $570,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2025 · first_quarter · Medicare/Medicaid
Discuss with Congressional staff and HHS staff support for Medicare GME expansion and changes to GME program: 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); concerns on Rural Physician Workforce Preservation Act; Senate Finance Committee proposals to increase GME slots. Discuss technical amendment to CAA, 2021, Sec. 131 pertaining to Medicare GME with Congressional staff. Discuss with Congressional staff distribution methodology for Medicare GME slots created in the CAA, 2021. Discuss expiring COVID-19 Public Health Emergency (PHE) Medicare flexibilities with Congressional staff and HHS staff and support legislative proposals to extend PHE telehealth flexibilities and Acute Hospital Care at Home Waiver. Support extension of Medicare Dependent Hospital and Low-Volume Adjustment programs. Support proposals to reduce payment cut in CY 2025 Physician Fee Schedule final rule. Discuss opposition to Medicare site-neutral payment policies with Congressional staff. Oppose changes to NPIs for hospital outpatient departments (H.R. 7623, H.R. 4509, H.R. 7623 as amended, H.R. 4822). Comment on FY 2024 IPPS rule to increase payment update to hospitals, Transforming Episodic Accountability Model, AHEAD Model, and CAA, 2023 Sec 4122 GME slot distribution methodology, and discuss comments with Congressional staff and CMS staff. Discuss proposals that 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 with Congressional staff opposition to proposals to reduce the Medicaid program: work requirements as a condition of coverage, changes to state-directed payments, block grants, per capita caps, reductions to federal matching funds, reductions to the safe harbor threshold for provider taxes, rescission of Medicaid Eligibility rule and Medicaid/CHIP Access rule. Support certain changes to Medicaid DSH payments: support two-year elimination of Medicaid DSH cut scheduled for January 1, 2025; support Save Our Safety Net Hospitals Act (H.R. 9351) to restore pre-CAA, 2021 DSH cap calculation methodology and include dual-eligible patients in state DSH cap calculation. Discuss Medicaid waiver proposal with Congressional staff and HHS. Discuss CMMI initiatives on global budgets and primary care in NYS Medicaid waiver. Discuss Medicaid IMD exclusion policies with Congressional staff. Support legislation to increase Medicaid payment rates for labor and delivery services for certain hospitals (118th Congress: S.5236). Discuss with Congressional staff support for CMS approval of Medicaid managed care organization tax proposed in New York State budget. Oppose CMS final rule to establish minimum nurse staffing in Medicare- and Medicaid-certified long-term care facilities (89 FR 40876) and support legislative efforts to repeal rule. Support Medicare Advantage prior authorization reforms - Improving Seniors Timely Access to Care Act (118th Congress: S. 4532/H.R. 8702). Discuss wage index issues with Congressional staff: H.R. 8561 to address MA local area growth under projection, FY 2025 IPPS/LTCH interim final rule, indirect medical education (IME) payments to hospitals. Meet with CMS leadership to discuss Medicare and Medicaid issues: prior authorization and MA insurance denials, concerns on mandatory participation for AHEAD and TEAM models, Medicare support for health care workforce; support for telehealth flexibilities and Acute Hospital Care at Home waiver extension. Discuss Medicare wage index issues with CMS. Discuss Medicare Part B payment for unlicensed physicians with CMS. Support New York State Essential Plan (Medicaid Section 1332 Waiver) and oppose proposals to reduce coverage. Urge delayed enforcement of CMS final rule prohibiting nurses from performing glucose tests using high-complexity devices in point-of-care situations.
Client expense: $530,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE
2024 · fourth_quarter · Medicare/Medicaid
Same-day billing restrictions in Medicaid; Medicare Advantage & MA Rate Notice H.R.5819 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care Act To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Rep. Steel, Michelle [R-CA-45] H.R. 7149, Equal Access to Specialty Care Everywhere (EASE) Act of 2024 To amend title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries. Sponsor: Rep. Steel, Michelle [R-CA-45] S.4078 - EASE Act of 2024 To amend title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries. Sponsor: Sen. Mullin, Markwayne [R-OK] H.R.5746 - Addressing Whole Health in Medicare Advantage Act To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. Sponsor: Rep. Bilirakis, Gus M. [R-FL-12] H.R.4758 - Accelerating Kids Access to Care Act To amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines, and for other purposes. Sponsor: Rep. Trahan, Lori [D-MA-3] H.R. 4605, Healthy Moms and Babies Act To amend titles XIX and XXI of the Social Security Act to improve maternal health coverage under Medicaid and CHIP, and for other purposes. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] S.948 - Healthy Moms and Babies Act To amend titles XIX and XXI of the Social Security Act to improve maternal health coverage under Medicaid and CHIP, and for other purposes. Sponsor: Sen. Grassley, Chuck [R-IA] H.R. 7623, Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 7996, Improving CARE for Youth Act To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Rep. Dunn, Neal P. [R-FL-2] S.2556 - Improving CARE for Youth Act To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Sen. Carper, Thomas R. [D-DE] H.R. 5380 - To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. Sarbanes, John P. [D-MD-3] H.R. 5388 - Supporting Innovation for Seniors Act To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. Sponsor: Rep. Balderson, Troy [R-OH-12] H.R. 8561 - To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification. Sponsor: Rep. Tenney, Claudia [R-NY-24]
Client expense: $269,075 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2024 · fourth_quarter · Medicare/Medicaid
Same-day billing restrictions in Medicaid; Medicare Advantage & MA Rate Notice S.1378 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care Act) To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Sen. Cortez Masto, Catherine [D-NV] H.R.5819 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care Act To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Rep. Steel, Michelle [R-CA-45] H.R. 7149, Equal Access to Specialty Care Everywhere (EASE) Act of 2024 To amend title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries. Sponsor: Rep. Steel, Michelle [R-CA-45] S.4078 - EASE Act of 2024 To amend title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries. Sponsor: Sen. Mullin, Markwayne [R-OK] H.R. 8532, Connected MOM Act (House only) 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 Sponsor: Sen. Cassidy, Bill [R-LA] S.712 - Connected MOM Act 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. Sponsor: Sen. Cassidy, Bill [R-LA] H.R.5746 - Addressing Whole Health in Medicare Advantage Act To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. Sponsor: Rep. Bilirakis, Gus M. [R-FL-12] H.R.4758 - Accelerating Kids Access to Care Act To amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines, and for other purposes. Sponsor: Rep. Trahan, Lori [D-MA-3] H.R. 4605, Healthy Moms and Babies Act To amend titles XIX and XXI of the Social Security Act to improve maternal health coverage under Medicaid and CHIP, and for other purposes. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] S.948 - Healthy Moms and Babies Act To amend titles XIX and XXI of the Social Security Act to improve maternal health coverage under Medicaid and CHIP, and for other purposes. Sponsor: Sen. Grassley, Chuck [R-IA] H.R. 6860, Restore Protections for Dialysis Patients Act To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R. 7623, Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 7996, Improving CARE for Youth Act To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Rep. Dunn, Neal P. [R-FL-2] S.2556 - Improving CARE for Youth Act To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Sen. Carper, Thomas R. [D-DE] H.R. 5380 - To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. Sarbanes, John P. [D-MD-3] H.R. 5388 - Supporting Innovation for Seniors Act To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. Sponsor: Rep. Balderson, Troy [R-OH-12] H.R. 8561 - To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification. Sponsor: Rep. Tenney, Claudia [R-NY-24]
Client expense: $1,760,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
2024 · fourth_quarter · Medicare/Medicaid
Medicare Advantage & MA Rate Notice S.1378 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care Act) To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Sen. Cortez Masto, Catherine [D-NV] H.R.5819 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care Act To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Rep. Steel, Michelle [R-CA-45] H.R. 7149, Equal Access to Specialty Care Everywhere (EASE) Act of 2024 To amend title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries. Sponsor: Rep. Steel, Michelle [R-CA-45] S.4078 - EASE Act of 2024 To amend title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries. Sponsor: Sen. Mullin, Markwayne [R-OK] H.R.5746 - Addressing Whole Health in Medicare Advantage Act To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. Sponsor: Rep. Bilirakis, Gus M. [R-FL-12] H.R. 6860, Restore Protections for Dialysis Patients Act To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R. 7623, Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 5380 - To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. Sarbanes, John P. [D-MD-3] H.R. 5388 - Supporting Innovation for Seniors Act To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. Sponsor: Rep. Balderson, Troy [R-OH-12] H.R. 8561 - To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification. Sponsor: Rep. Tenney, Claudia [R-NY-24]
Client expense: $10,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
2024 · fourth_quarter · Medicare/Medicaid
Medicare Advantage & MA Rate Notice S.1378 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care Act) To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Sen. Cortez Masto, Catherine [D-NV] H.R.5819 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care Act To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Rep. Steel, Michelle [R-CA-45] H.R. 7149, Equal Access to Specialty Care Everywhere (EASE) Act of 2024 To amend title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries. Sponsor: Rep. Steel, Michelle [R-CA-45] S.4078 - EASE Act of 2024 To amend title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries. Sponsor: Sen. Mullin, Markwayne [R-OK] H.R.5746 - Addressing Whole Health in Medicare Advantage Act To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. Sponsor: Rep. Bilirakis, Gus M. [R-FL-12] H.R. 6860, Restore Protections for Dialysis Patients Act To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R. 7623, Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 5380 - To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. Sarbanes, John P. [D-MD-3] H.R. 5388 - Supporting Innovation for Seniors Act To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. Sponsor: Rep. Balderson, Troy [R-OH-12] H.R. 8561 - To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification. Sponsor: Rep. Tenney, Claudia [R-NY-24]
2024 · fourth_quarter · Medicare/Medicaid
H.R.8561 Medicare Advantage, Medicare reimbursement and payment issues
Client expense: Not reported · Firm income: $80,000
2024 · fourth_quarter · Medicare/Medicaid
Discuss Medicare and Medicaid issues with HHS staff. Discuss with Congressional staff and HHS staff support for Medicare GME expansion and changes to GME program: 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); concerns on Rural Physician Workforce Preservation Act; Senate Finance Committee proposals to increase GME slots. Discussion with CMS on the interpretation of CAA, 2021, Sec. 131, and resetting of GME caps pertaining to Sec. 131. Discuss technical amendment to CAA, 2021, Sec. 131 pertaining to Medicare GME with Congressional staff. Discuss with Congressional staff distribution methodology for Medicare GME slots created in the CAA, 2021. Discuss expiring COVID-19 Public Health Emergency (PHE) 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 extension of Medicare Dependent Hospital and Low-Volume Adjustment programs. Support proposals to reduce payment cut in CY 2025 Physician Fee Schedule final rule. Discuss opposition to Medicare site-neutral payment policies with Congressional staff. Oppose changes to NPIs for hospital outpatient departments (H.R. 7623, H.R. 4509, H.R. 7623 as amended, H.R. 4822). Comment on FY 2024 IPPS rule to increase payment update to hospitals, Transforming Episodic Accountability Model, AHEAD Model, and CAA, 2023 Sec 4122 GME slot distribution methodology, and discuss comments with Congressional staff and CMS staff. Discuss proposals that 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. Support certain changes to Medicaid DSH payments: support two-year elimination of Medicaid DSH cut scheduled for January 1, 2025; support Save Our Safety Net Hospitals Act (H.R. 9351) to restore pre-CAA, 2021 DSH cap calculation methodology and include dual-eligible patients in state DSH cap calculation. Discuss Medicaid waiver proposal with Congressional staff and HHS. Discuss CMMI initiatives on global budgets and primary care in NYS Medicaid waiver. Discuss Medicaid IMD exclusion policies with Congressional staff. Support legislation to increase Medicaid payment rates for labor and delivery services for certain hospitals (S.5236). Discuss with Congressional staff support for CMS approval of Medicaid managed care organization tax proposed in New York State budget. Oppose CMS final rule to establish minimum nurse staffing in Medicare- and Medicaid-certified long-term care facilities (89 FR 40876) and support legislative efforts to repeal rule. Support Medicare Advantage prior authorization reforms - Improving Seniors Timely Access to Care Act (S. 4532/H.R. 8702). Meet with CMS staff and CMS Regional Administrator to discuss Medicare Advantage (MA) plans and MA utilization management practices. Discuss wage index issues with Congressional staff: H.R. 8561 to address MA local area growth under projection, FY 2025 IPPS/LTCH interim final rule, indirect medical education (IME) payments to hospitals. Meet with CMS Innovation Center to discuss CMMI models of care. Meet with CMS leadership to discuss Medicare and Medicaid issues: prior authorization and MA insurance denials, concerns on mandatory participation for AHEAD and TEAM models, Medicare support for health care workforce; support for telehealth flexibilities and Acute Hospital Care at Home waiver extension.
2024 · third_quarter · Medicare/Medicaid
H.R.8561 Medicare Advantage, Medicare reimbursement and payment issues
Client expense: Not reported · Firm income: $80,000
2024 · third_quarter · Medicare/Medicaid
Discuss Medicare and Medicaid issues with HHS staff. Discuss with Congressional staff and HHS 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; Rural Residency Planning and Development Act (H.R. 7855). Discussion with CMS on the interpretation of CAA, 2021, Sec. 131, and resetting of GME caps pertaining to Sec. 131. Discuss technical amendment to CAA, 2021, Sec. 131 pertaining to Medicare GME with Congressional staff. Discuss with Congressional staff distribution methodology for Medicare GME slots created in the CAA, 2021. Discuss expiring COVID-19 Public Health Emergency (PHE) 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). Discuss legislation to provide financial support for safety net hospitals. Discuss opposition to Medicare site-neutral payment policies with Congressional staff. Support certain changes to Medicaid DSH: support two year elimination of Medicaid DSH cut scheduled for January 1, 2025; support Save Our Safety Net Hospitals Act (H.R. 9351) to restore pre-CAA, 2021 DSH cap calculation methodology and include dual-eligible patients in state DSH cap calculation. Discuss Medicaid waiver proposal with Congressional staff and HHS. Discuss CMMI initiatives on global budgets and primary care in NYS Medicaid waiver. Discuss Medicaid IMD exclusion policies with Congressional staff. Support legislation to increase Medicaid payment rates for labor and delivery services for certain hospitals (S.5236). Discuss with Congressional staff support for CMS approval of Medicaid managed care organization tax proposed in New York State budget. Discuss comments on FY 2024 IPPS proposed rule to increase payment update to hospitals, Transforming Episodic Accountability Model, AHEAD Model, and CAA, 2023 Sec 4122 GME slot proposed distribution methodology and discuss comments with Congressional staff and CMS staff. Discuss Medicare payment for nursing and allied health with Senate Finance Committee staff. Meet with CMS Regional Administrator to discuss the behavioral health care workforce. Meet with CMS to discuss hospital price transparency regulations. Discuss proposals that 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. Oppose CMS final rule to establish minimum nurse staffing in Medicare- and Medicaid-certified long-term care facilities (89 FR 40876) and support legislative efforts to repeal rule. Meet with CMS staff to discuss behavioral health coverage for commercial insurers. Discussion with HHS Health Insurance Administrator and CMS Hospital Quality, Safety, and Oversight Group on CMS Interpretive Guidance on Informed Consent. Support Medicare Advantage prior authorization reforms. Meet with CMS staff and CMS Regional Administrator to discuss Medicare Advantage (MA) plans and MA utilization management practices. Discuss wage index issues with Congressional staff: H.R. 8561 to address MA local area growth under projection, FY 2025 IPPS/LTCH interim final rule, indirect medical education (IME) payments to hospitals. Meet with CMS Innovation Center to discuss CMMI models of care. Meet with CMS leadership to discuss Medicare and Medicaid issues: prior authorization and MA insurance denials, concerns on mandatory participation for AHEAD and TEAM models, Medicare support for health care workforce; support for telehealth flexibilities and Acute Hospital Care at Home waiver extension. Meet with CMS/Acute Care regarding the definition of new residency programs.
2024 · second_quarter · Medicare/Medicaid
Same-day billing restrictions in Medicaid; Medicare Advantage (MA) & MA Rate Notice; 340B Program/Transparency H.R.5746 - Addressing Whole Health in Medicare Advantage Act To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. Sponsor: Rep. Bilirakis, Gus M. [R-FL-12] H.R.5380 - To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. Sarbanes, John P. [D-MD-3] H.R.2880 - Protecting Patients Against PBM Abuses Act To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under part D of the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R.5385 - Medicare PBM Accountability Act To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare part D. Sponsor: Rep. Landsman, Greg [D-OH-1] H.R.5388 - Supporting Innovation for Seniors Act To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. Sponsor: Rep. Balderson, Troy [R-OH-12] H.R.4758 - Accelerating Kids Access to Care Act To amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines, and for other purposes. Sponsor: Rep. Trahan, Lori [D-MA-3] S.1378 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care Act) To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Sen. Cortez Masto, Catherine [D-NV] H.R. 4605, Healthy Moms and Babies Act To amend titles XIX and XXI of the Social Security Act to improve maternal health coverage under Medicaid and CHIP, and for other purposes. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 6860, Restore Protections for Dialysis Patients Act To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R. 7623, Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 7996, Improving CARE for Youth Act To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Rep. Dunn, Neal P. [R-FL-2] H.R. 8561, to amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification Sponsor: Rep. Tenney, Claudia [R-NY-24]
2024 · second_quarter · Medicare/Medicaid
Medicare Advantage (MA) & MA Rate Notice; 340B Program/Transparency HR 2880, Protecting Patients Against PBM Abuses Act, by Rep. Earl Carter (R-GA). To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under Part D of the Medicare program. HR 5380, by Rep. John Sarbanes (D-MD). To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. HR 5385, Medicare PBM Accountability Act, by Rep. Greg Landsman (D-OH). To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare Part D. HR 5386, Cutting Copays Act, by Rep. Morgan McGarvey (D-KY). To amend title XVIII of the Social Security Act to provide for adjustments to the Medicare Part D cost-sharing reductions for low-income individuals. HR 5388, Supporting Innovation for Seniors Act, by Rep. Troy Balderson (R-OH). To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. HR 5663, ALS Better Care Act, by Rep. Janice Schakowsky (D-IL). To amend title XVIII of the Social Security Act to provide coverage of ALS-related services under the Medicare program for individuals diagnosed with amyotrophic lateral sclerosis. HR 5746, Addressing Whole Health in Medicare Advantage Act, by Rep. Gus Bilirakis (R-FL). To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. HR 6860, Restore Protections for Dialysis Patients Act, by Rep. Mike Kelly (R-PA). To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. HR 7623, Telehealth Modernization Act, by Rep. Earl Carter (R-GA). To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. HR 7996, Improving CARE for Youth Act, by Rep. Neal Dunn (R-FL). To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. HR 8561, by Rep. Claudia Tenney (R-NY). To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification. S 1378, Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care Act), by Sen. Catherine Cortez Masto (D-NV). To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program.
2024 · second_quarter · Medicare/Medicaid
Issues Same-day billing restrictions in Medicaid; Medicare Advantage (MA) & MA Rate Notice; 340B Program/Transparency Bills H.R.5746 - Addressing Whole Health in Medicare Advantage Act To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. Sponsor: Rep. Bilirakis, Gus M. [R-FL-12] H.R.5380 - To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. Sarbanes, John P. [D-MD-3] H.R.5388 - Supporting Innovation for Seniors Act To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. Sponsor: Rep. Balderson, Troy [R-OH-12] H.R. 4605, Healthy Moms and Babies Act To amend titles XIX and XXI of the Social Security Act to improve maternal health coverage under Medicaid and CHIP, and for other purposes. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 6860, Restore Protections for Dialysis Patients Act To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R. 7623, Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 7996, Improving CARE for Youth Act To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Rep. Dunn, Neal P. [R-FL-2] H.R. 8561, to amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification Sponsor: Rep. Tenney, Claudia [R-NY-24]
2024 · second_quarter · Medicare/Medicaid
Medicare Advantage (MA) & MA Rate Notice; 340B Program/Transparency HR 2880, Protecting Patients Against PBM Abuses Act, by Rep. Earl Carter (R-GA). To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under Part D of the Medicare program. HR 5380, by Rep. John Sarbanes (D-MD). To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. HR 5385, Medicare PBM Accountability Act, by Rep. Greg Landsman (D-OH). To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare Part D. HR 5386, Cutting Copays Act, by Rep. Morgan McGarvey (D-KY). To amend title XVIII of the Social Security Act to provide for adjustments to the Medicare Part D cost-sharing reductions for low-income individuals. HR 5388, Supporting Innovation for Seniors Act, by Rep. Troy Balderson (R-OH). To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. HR 5663, ALS Better Care Act, by Rep. Janice Schakowsky (D-IL). To amend title XVIII of the Social Security Act to provide coverage of ALS-related services under the Medicare program for individuals diagnosed with amyotrophic lateral sclerosis. HR 5746, Addressing Whole Health in Medicare Advantage Act, by Rep. Gus Bilirakis (R-FL). To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. HR 6860, Restore Protections for Dialysis Patients Act, by Rep. Mike Kelly (R-PA). To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. HR 7623, Telehealth Modernization Act, by Rep. Earl Carter (R-GA). To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. HR 7996, Improving CARE for Youth Act, by Rep. Neal Dunn (R-FL). To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. HR 8561, by Rep. Claudia Tenney (R-NY). To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification. S 1378, Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care Act), by Sen. Catherine Cortez Masto (D-NV). To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program.
2024 · second_quarter · Medicare/Medicaid
Discuss Medicare and Medicaid issues with HHS staff. Meet with Congressional staff and discuss support for Medicare graduate medical education (GME) funding, including support for the Resident Physician Shortage Reduction Act, the Opioid Workforce Act, Substance Use Disorder Workforce Act, the Pathway to Practice program proposal, and the Presidents FY 2025 budget request. Discussion with CMS on the interpretation of CAA, 2021, Sec. 131, and resetting of GME caps pertaining to Sec. 131. Discuss technical amendment to CAA, 2021, Sec. 131 pertaining to Medicare GME with Congressional staff. Meet with Congressional staff to discuss distribution methodology for Medicare GME slots created in the CAA, 2021. Discuss telehealth issues with Congressional staff and support for the permanent extension of COVID-19 PHE telehealth flexibilities. Discuss Acute Hospital Care at Home waiver and support for extension. Discuss legislation to provide financial support for safety net hospitals. Discuss opposition to site-neutral payment policies with Congressional staff. Advocate for two-year elimination of Medicaid DSH cut. Support elimination of Medicaid DSH cut in CAA, 2024 (H.R. 4366). Support revisions to Medicaid DSH policy to include dual-eligible patients in state DSH cap calculation. Discuss Medicaid waiver proposal with Congressional staff and HHS. Discuss CMMI initiatives on global budgets and primary care in NYS Medicaid waiver. Discuss Medicaid IMD exclusion policies with Congressional staff. Discuss legislative proposals for Medicaid support for rural and safety net hospitals providing maternity, labor, and delivery services to vulnerable populations. Discuss with Congressional staff support for CMS approval of Medicaid managed care organization tax proposed in New York State budget. Comment on FY 2024 IPPS proposed rule to increase payment update to hospitals, Transforming Episodic Accountability Model, and CAA, 2023 Sec 4122 GME slot proposed distribution methodology and discuss comments with Congressional staff and CMS staff. Discuss Medicare payment for nursing and allied health with Senate Finance Committee staff. Discussion with congressional staff regarding Medicare Disproportionate Share Hospital (DSH) rulemaking. Discuss CMS requirement to report telehealth provider home addresses with HHS staff. Meet with CMS Regional Administrator to discuss the behavioral health care workforce. Meet with CMS to discuss hospital price transparency regulations. Discuss proposals that 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. Oppose CMS final rule to establish minimum nurse staffing in Medicare- and Medicaid-certified long-term care facilities (89 FR 40876) and support legislative efforts to repeal rule. Meet with CMS staff to discuss behavioral health coverage for commercial insurers. Discussion with HHS Health Insurance Administrator and CMS Hospital Quality, Safety, and Oversight Group on CMS Interpretive Guidance on Informed Consent. Support Medicare Advantage prior authorization reforms. Meet with CMS staff and CMS Regional Administrator to discuss Medicare Advantage (MA) plans and MA utilization management practices. Discuss with Congressional staff H.R.8561, to amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification. Meet with CMS Innovation Center to discuss CMMI models of care. Discuss Making Care Primary model with CMMI staff.
| Republican |
| NY |
| Michael Lawler | Republican | NY |
| Nicholas A. Langworthy | Republican | NY |
| Paul Tonko | Democratic | NY |
Client expense: $140,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $350,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $830,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE
Client expense: $1,430,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
Client expense: $10,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
Client expense: $269,075 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Client expense: $240,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
Client expense: $370,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE