Building America’s Health Care Workforce Act

MMM [House, Senate, HHS, CMS, FDA, Administration on Aging, EOP, DOC] Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act (Public Law No: 117-169). Medicare and Medicaid Prescription Drugs. (No bill): Joined comments with 19 other organizations urging HHS to use its existing authority to license competition in order to lower consumer and taxpayer costs for semaglutide drugs treating diabetes and weight management (e.g., Ozempic and Wegovy). Medicare Prescription Drugs. The PACE Part D Choice Act (H.R. 3549 and S. 1703): Proposal to increase the affordability of the Program of All-Inclusive Care for the Elderly (PACE) for Medicare beneficiaries by lowering the cost of Part D premiums substantially for Medicare-only enrollees, thus opening up the PACE program to this population. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Trustees Report (No bill). Review of the findings on economic, legislative and other developments affecting the actuarial soundness of the Medicare Part A (Hospital Insurance) Trust Fund and the Trust Funds for Parts B and D coverage. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Help Extend Auditory Relief Act of 2024 (H.R. 8064): Proposal to expand Medicare coverage to include hearing examinations and diagnoses, fittings and hearing aids. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home and Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes. The Building Americas Health Care Workforce Act (H.R. 9067): Proposal to allow time spent working in a nursing home (prior to any formal training, and permitted during the COVID-19 pandemic) to count toward a 75-hour minimum federal training standard that is required for certified nursing assistants. Medicare, Medicaid Nursing Homes. The Ensuring Seniors Access to Quality Care Act (H.R. 3227): Proposal to repeal regulations that prohibit certified nursing assistant training and competency evaluation programs in skilled nursing facilities that have a record of health and safety deficiencies and have incurred penalties (e.g., civil monetary penalties for substandard quality of care). Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposals to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposals to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities. Oversight of Health Care Industry Owned by Private Equity Firms. (No bill): Joined with other organizations in submitting comments (April 2024) to HHS, the Federal Trade Commission and the Department of Justice urging sustained, stepped up and rigorous oversight be extended to health care industry transactions that are financed by private equity company companies and other types of private investors. Medicaid Eligibility and Beneficiary Assets. Medicaid Estate Recovery Act (H.R. 7573): Proposals to provide financial protection to the families of Medicaid beneficiaries, including ending Medicaid estate claims and Medicaid liens, except in cases when benefits had been incorrectly paid, as determined by a court.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Workforce Innovation and Opportunity Act H.R. 7887 - ACCESS Act National Defense Authorization Act of Fiscal Year 2025 (shipbuilding amendment) H.R. 8033 - Regulatory Transparency for Small Businesses Act H.R. 9030 - Regulatory Agenda Clarity Act H.R. 9032 - Enhanced Regulatory Flexibility Assessment Act H.R. 9033 - LABOR Act of 2024 H.R. 9085 - Regulatory Review Improvement Act of 2024 S. 4875 - No FAKES Act CHIPS and Science Act (implementation) H.R. 9067 - Building Americas Health Care Workforce Act H.J. Res. 139 - Congressional Review Act resolution on minimum staffing standards H.R. 5338 - No Discrimination in My Benefits Act Port Strike (urging noninterference) S. 576 - Railway Safety Act Confirmation of PBGC Executive Director Confirmation of FLRA General Counsel Confirmation of Railroad Retirement Board Nominee Confirmation of OSHA Review Commission Nominee H.R. 20 & S. 567 - Protecting the Right to Organize Act NLRB Board Member Nominations WIOA Reauthorization (H.R. 6655, Senate bill not numbered yet)

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

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

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act (Public Law No: 117-169). Medicare and Medicaid Prescription Drugs. (No bill): Joined comments with 19 other organizations urging HHS to use its existing authority to license competition in order to lower consumer and taxpayer costs for semaglutide drugs treating diabetes and weight management (e.g., Ozempic and Wegovy). Medicare Prescription Drugs. The PACE Part D Choice Act (H.R. 3549 and S. 1703): Proposal to increase the affordability of the Program of All-Inclusive Care for the Elderly (PACE) for Medicare beneficiaries by lowering the cost of Part D premiums substantially for Medicare-only enrollees, thus opening up the PACE program to this population. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Trustees Report (No bill). Review of the findings on economic, legislative and other developments affecting the actuarial soundness of the Medicare Part A (Hospital Insurance) Trust Fund and the Trust Funds for Parts B and D coverage. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Help Extend Auditory Relief Act of 2024 (H.R. 8064): Proposal to expand Medicare coverage to include hearing examinations and diagnoses, fittings and hearing aids. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home and Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes. The Building Americas Health Care Workforce Act (H.R. 9067): Proposal to allow time spent working in a nursing home (prior to any formal training, and permitted during the COVID-19 pandemic) to count toward a 75-hour minimum federal training standard that is required for certified nursing assistants. Medicare, Medicaid Nursing Homes. The Ensuring Seniors Access to Quality Care Act (H.R. 3227): Proposal to repeal regulations that prohibit certified nursing assistant training and competency evaluation programs in skilled nursing facilities that have a record of health and safety deficiencies and have incurred penalties (e.g., civil monetary penalties for substandard quality of care). Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposals to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposals to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities. Oversight of Health Care Industry Owned by Private Equity Firms. (No bill): Joined with other organizations in submitting comments (April 2024) to HHS, the Federal Trade Commission and the Department of Justice urging sustained, stepped up and rigorous oversight be extended to health care industry transactions that are financed by private equity company companies and other types of private investors.