Save our Safety-Net Hospitals Act of 2024

H.R.9351 - Save our Safety-Net Hospitals Act of 2024; increased federal funding for public safety-net hospitals; prevent Disproportionate Share Hospital (DSH) cuts; prevent Medicaid and Medicare cuts; and increased funding for Graduate Medical Education (GME)including the Resident Physician Shortage Reduction Act (HR 2389); Medicaid and Medicare provisions of H.R.1 - One Big Beautiful Bill Act.

Client expense: $180,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.9351 - Save our Safety-Net Hospitals Act of 2024; increased federal funding for public safety-net hospitals; prevent Disproportionate Share Hospital (DSH) cuts; prevent Medicaid and Medicare cuts; and increased funding for Graduate Medical Education (GME)including the Resident Physician Shortage Reduction Act (HR 2389).

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

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

Issues: Medicaid/Medicare: - Medicaid Disproportionate Share Hospital (DSH) Cuts: Advocated for the elimination of cuts. - Public Health Emergency (PHE) Waivers: Supported extension of waivers, including telehealth flexibilities and the hospital-at-home program. - Medicare Site-Neutral Payments: Opposed proposed cuts to site-neutral payments. Healthcare Workforce: - Graduate Medical Education (GME): Supported increasing the number of GME slots. Administrative Reforms: - National Provider Identifier (NPI): Opposed burdensome policies that would impact NPI requirements under H.R. 5378. - Prior Authorization Improvements: Advocated for measures to improve access to care and reduce administrative delays. Healthcare Programs: - Community Health Center Funding: Advocated for the extension of federal funding for community health centers. - Urged members of Congress to sign the bipartisan Dear Colleague letter on Medicaid DSH, led by Representatives Clarke, Crenshaw, DeGette, and Bilirakis. Legislation Monitored and Supported/Opposed: - H.R. 8260 / S. 4350 - Hospital Inpatient Services Modernization Act - H.R. 5378 - Lower Costs, More Transparency Act - H.R. 2389 - Resident Physician Shortage Reduction Act of 2023 - H.R. 9351 - Save Our Safety-Net Hospitals Act of 2024 - H.R. 8702 / S. 4532 - Improving Seniors Timely Access to Care Act of 2024

Client expense: $40,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Specific Lobbying Issues: Medicaid/Medicare: - Medicaid Disproportionate Share Hospital (DSH) Cuts: Advocated for elimination of cuts. Medicare Site-Neutral Payments: - Opposed proposed cuts to site-neutral payments. Extension of Public Health Emergency (PHE) Waivers: - Supported continuation of waivers for Hospital-at-Home (H@H) programs and telehealth services. Healthcare Workforce: - Graduate Medical Education (GME): Advocated for increased GME slots. Improving Medicaid and CHIP Provider Enrollment Processes: - Supported proposals to streamline enrollment. Healthcare Programs: - 340B Drug Pricing Program: Supported the program and opposed efforts to impose restrictive policies. - Community Health Center Funding: Advocated for extension of funding. Administrative Reforms: - Prior Authorization Improvements: Supported measures to improve access to timely care. - National Provider Identifier (NPI): Opposed proposals included in H.R. 5378 that would impact the NPI process. Legislation Monitored and Supported/Opposed: H.R. 7635 / S. 5021 - 340B PATIENTS Act of 2024 H.R. 8260 / S. 4350 - Hospital Inpatient Services Modernization Act H.R. 5378 - Lower Costs, More Transparency Act H.R. 2389 - Resident Physician Shortage Reduction Act of 2023 H.R. 9351 - Save Our Safety-Net Hospitals Act of 2024 H.R. 8702 / S. 4532 - Improving Seniors Timely Access to Care Act of 2024 H.R. 4758 - Accelerating Kids Access to Care Act H.R. 2407 - Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act Meetings/letters with Congressional offices to discuss the above issues and legislative priorities. Advocacy for specific funding levels, policy changes, and program extensions.

Client expense: $40,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 2840, Bipartisan Primary Care and Health Workforce Act H.R. 3305 - Black Maternal Health Momnibus Act H.R. 4420, the Preparedness and Response Reauthorization Act H.R. 4531, the Support for Patients and Communities Reauthorization Act H.R. 2534, PROTECT 340B Act of 2023 H.R. 5013, the Value in Health Care Act of 2023 H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. H.R. 7050 - Substance Use Disorder Workforce Act S.4101/ H.R.7931 - the Preserving Emergency Access in Key Sites Act Keeping Obstetrics Local Act S.4088, Welcome Back to the Health Care Workforce Act Issues related to essential hospital designation Issues related to health equity Issues related to the 340B Drug Pricing program Issues related to contact pharmacies Issues related to the health care workforce Issues related to Community Paramedicine Issues related to Artificial Intelligence and Health Care Issues related to hospital digital infrastructure Issues related to cybersecurity H.R. 9351 Save our Safety-Net Hospitals Act of 2024 Issues related to Opioid overdose reduction

Client expense: $630,000 · Firm income: Not reported

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

Opposing potential cuts to Medicaid Draft Care for All Agenda resolution Healthcare workforce issues H.R.9351, Save our Safety-Net Hospitals Act S.1113, Nurse Staffing Standards for Hospital Patent Safety and Quality Care Act Funding for SUNY Downstate hospital S.1409, Kids Online Safety Act (KOSA), Entirety S.2660, Get Toxic Substances Out of Schools Act, Entirety Monitor the following: S.4503, the Corporate Crimes Against Health Care H.R.5434/S.3138, Stabilize Medicaid and CHIP Coverage Act 12-month continuous eligibility for adults in Medicaid and CHIP HVAC and Schools (draft bill) Funding for Department of Justice Antitrust Division Fiscal Year 2025 Strengthening Pathways to Health Professions Act (Draft) S.4445, The right to IVF Act, Reproductive healthcare and technology H.R.8526, the Trauma-Informed Schools Act Cognitive behavioral therapy and schools (draft bill) Impact of private equity on healthcare H.R.9131, Indoor Air Quality and Healthy Schools Act of 2024 Indoor Air Quality and Outdoor pesticide school and environmental related issues Securing Continued Healthcare for Our Operations and Logistics Professionals Act S.4278, the Physician and Patient Safety Act H.R.8444, the Mental Health in Schools Act S.4286, the Comprehensive Addiction Resources Emergency Act H.R.8524, the Elementary and Secondary School Counseling Act H.R.7153/S.3679, the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act H.R.468, the Building Americas Health Care Workforce Act H.R.3227, the Ensuring Seniors Access to Quality Care Act S.1999 the Right to Contraception Act H.R.7513/S.3410/H.J Res 139, legislation related to the administrations nursing home staffing regulation Health over Wealth Act IAQ and Healthy Schools Act (draft bill) Rural healthcare and hospital workforce challenges and related issues Mental Health Service Professional Demonstration Grant and the School-Based Mental Health Services Grant in FY2025 Supporting investments in school-based mental health professionals H.R.7546/S.3860, the Nurse Overtime and Patient Safety Act S.3770, the Future Advancement of Academic Nursing Act S.3701, the FACTS Act Healthcare high school apprenticeships Safe staffing levels Safe staffing levels at nursing homes Artificial Intelligence, Healthcare related issues Public Law 118-31, National Defense Authorization Act for Fiscal Year 2024, Teacher healthcare coverage H.R.485, the Protecting Health Care for All Patients Act Proposed regulation: File Code 1210-AC11, Requirements Related to the Mental Health Parity and Addiction Equity Act H.R.4771, the Childrens Health Insurance Program Permanency Act S.2530, the Mental Health of Educators and Staff Act Primary Care and Health Workforce Expansion Act (draft bill) Medicare drug negotiation program PMB reform H.R.5378, the Lower Costs, More Transparency Act Reauthorization of healthcare workforce programs S.2333, Pandemic and All-Hazards Preparedness and Response Act S.1113, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act Appropriations regarding but not limited to community violence intervention, School-Based Mental Health Services Professional Demonstration Grants/ School-Based Mental Health Services Grant Program, gun violence prevent and removing abortion prohibition language from future appropriations bills. H.R.3727 Teacher Health and Wellness Act S.1446, Nurse Corps Tax Parity Act H.R.3761/S.1774, Advancing Student Services in Schools Today Act H.R.3726, Student Mental Health Rights Act H.R.3682, Cady Housh and Gemesha Thomas Student Suicide Prevention Act of 2023, Entirety Public Law 117-169, Inflation Reduction Act, Prescription drug reform Public Law 117-159, Bipartisan Safer Communities Act Medicaid DSH Payments, Hospital funding formula Abortion Access related issues Supporting Trauma Informed Education Practices Act Restoring Hope for Mental Health and Well‐Being Act Health Force and Resilience Force Act Student Loan Forgiveness for Frontline Health Workers Affordability of pharmaceuticals, generally Treating gun violence as a public health epidemic related issues The National Nurse Act, Entirety Telehealth issues Mental health supports for educators Closing Health Coverage Gaps for Public Servants Act Workplace Violence Prevention for Health Care and Social Service Worker Act Visas for international healthcare professionals Workplace violence related issues Green New Deal for Health, Entirety H.R.1485/S.727, Insulin for All Act H.R.1692, Health Care Affordability Act S.1139, A bill to apply prescription drug inflation rebates to drugs furnished in the commercial market Minimum staffing levels in skilled nursing facilities related issues Health Worker Shortage/Staffing Crisis ACCESS in Mental Health Act (draft bill) Mental Health CARE Act (draft bill) Supporting All Students Act (draft bill) Epi-pen Price Cap legislation, (draft bill) Funding for Medicare low-income outreach and enrollment efforts H.R.4771, the Childrens Health Insurance Program Permanency Act S.3090/H.R.6004, the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act Prevention and Public Health Fund related issues H.R.6204, the See the Board Act Requirements Related to the Mental Health Parity and Addiction Equity Act, File Code 1210-AC11 The Employee Retirement Income Security Act and related issues Rights and access to reproductive healthcare Healthcare cybersecurity related issues

Client expense: $400,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

H.R. 1770, The Equitable Community Access to Pharmacist Services Act H.R. 2389, The Resident Physician Shortage Reduction Act of 2023 H.R. 5378, The Lower Costs, More Transparency Act; hospital outpatient department funding H.R. 7635, The 340B PATIENTS Act of 2024 H.R. 9351, The Save Our Safety-Net Hospitals Act of 2024 H.R. 9669/S.5091, The Basic Assistance for Students In College (BASIC) Act S. 4667, The Risky Research Review Act S. 5397/H.R. 10225, Rebuild Americas Health Care Schools Act of 2024 Hospital Inpatient Prospective Payment System (IPPS); funding for Graduate Medical Education (GME) resident physician slots H.R. 9029/S. 4942, FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations Act; funding for the Children's Hospital Graduate Medical Education (GME) Program Medicaid Disproportionate Share Hospital (DSH) funding cut repeal related issues; extension of Medicare telehealth program related issues; issues related to Medicare Physician Fee Schedule related payment issues; Hospital Outpatient Prospective Payment System related issues Medicaid related issues

Client expense: $440,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

S. 2840, Bipartisan Primary Care and Health Workforce Act H.R. 3305 - Black Maternal Health Momnibus Act H.R. 4420, the Preparedness and Response Reauthorization Act H.R. 4531, the Support for Patients and Communities Reauthorization Act H.R. 2534, PROTECT 340B Act of 2023 H.R. 5013, the Value in Health Care Act of 2023 H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. H.R. 7050 - Substance Use Disorder Workforce Act S.4101/ H.R.7931 - the Preserving Emergency Access in Key Sites Act Keeping Obstetrics Local Act S.4088, Welcome Back to the Health Care Workforce Act Issues related to essential hospital designation Issues related to health equity Issues related to the 340B Drug Pricing program Issues related to contact pharmacies Issues related to the health care workforce Issues related to Community Paramedicine Issues related to Artificial Intelligence and Health Care Issues related to hospital digital infrastructure Issues related to cybersecurity H.R. 9351 Save our Safety-Net Hospitals Act of 2024 Issues related to Opioid overdose reduction

Client expense: $870,000 · Firm income: Not reported

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

Support for elimination of Medicaid Disproportionate Share Hospital cuts Support for bolstering Medicare Graduate Medical Education program including the Resident Physician Shortage Reduction Act of 2023 (H.R.2389) Support for continuing key flexibilities beyond COVID-19 pandemic including telehealth policies and the hospitals at home program, and Substance Use Disorder Workforce Act (H.R. 7050) Support for Improving Seniors Timely Access to Care Act Support for bolstering healthcare workforce including the Healthcare Workforce Resilience Act Support for H.R. 9351 Opposition to proposals to cut providers including Medicare site-neutral payment reductions and policies to restrict the 340B drug pricing program Opposition to site-neutral cuts included in Lower Cost More Transparency Act and Bipartisan Primary Care and Health Workforce Act Opposition to Sec. 404 in Telehealth Modernization Act as marked up by Energy and Commerce Opposition to H.R. 2530, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act Support for H.R. 2534: Preserving Rules Ordered for the Entities Covered Through (PROTECT) 340B Act Support for: H.R. 7635: 340B Pharmaceutical Access to Invest in Essential, Needed Treatments and Support (PATIENTS) Act Opposition to H.R. 8574: 340B Affording Care for Communities and Ensuring a Strong Safety-Net Act (340B Access Act) Support for Healthcare in Your Language Bill Support for Nadler, Beatty, Williams Urge CMS to Issue Guidance on Informed Consent Requirements for Drug Testing of Pregnant Patients Opposition to proposals to implement National Provider Identifiers at Hospital Outpatient Departments

Client expense: $100,000 · Firm income: Not reported

Government targets: Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Specific Lobbying Issues: Medicaid/Medicare: - Medicaid Disproportionate Share Hospital (DSH) Cuts: Advocated for elimination of cuts. Medicare Site-Neutral Payments: - Opposed proposed cuts to site-neutral payments. Extension of Public Health Emergency (PHE) Waivers: - Supported continuation of waivers for Hospital-at-Home (H@H) programs and telehealth services. Healthcare Workforce: - Graduate Medical Education (GME): Advocated for increased GME slots. Improving Medicaid and CHIP Provider Enrollment Processes: - Supported proposals to streamline enrollment. Healthcare Programs: - 340B Drug Pricing Program: Supported the program and opposed efforts to impose restrictive policies. - Community Health Center Funding: Advocated for extension of funding. Administrative Reforms: - Prior Authorization Improvements: Supported measures to improve access to timely care. - National Provider Identifier (NPI): Opposed proposals included in H.R. 5378 that would impact the NPI process. Legislation Monitored and Supported/Opposed: H.R. 7635 / S. 5021 - 340B PATIENTS Act of 2024 H.R. 8260 / S. 4350 - Hospital Inpatient Services Modernization Act H.R. 5378 - Lower Costs, More Transparency Act H.R. 2389 - Resident Physician Shortage Reduction Act of 2023 H.R. 9351 - Save Our Safety-Net Hospitals Act of 2024 H.R. 8702 / S. 4532 - Improving Seniors Timely Access to Care Act of 2024 H.R. 4758 - Accelerating Kids Access to Care Act H.R. 2407 - Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act Meetings/letters with Congressional offices to discuss the above issues and legislative priorities. Advocacy for specific funding levels, policy changes, and program extensions.

Client expense: $20,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues: Medicaid/Medicare: - Medicaid Disproportionate Share Hospital (DSH) Cuts: Advocated for the elimination of cuts. - Public Health Emergency (PHE) Waivers: Supported extension of waivers, including telehealth flexibilities and the hospital-at-home program. - Medicare Site-Neutral Payments: Opposed proposed cuts to site-neutral payments. Healthcare Workforce: - Graduate Medical Education (GME): Supported increasing the number of GME slots. Administrative Reforms: - National Provider Identifier (NPI): Opposed burdensome policies that would impact NPI requirements under H.R. 5378. - Prior Authorization Improvements: Advocated for measures to improve access to care and reduce administrative delays. Healthcare Programs: - Community Health Center Funding: Advocated for the extension of federal funding for community health centers. - Urged members of Congress to sign the bipartisan Dear Colleague letter on Medicaid DSH, led by Representatives Clarke, Crenshaw, DeGette, and Bilirakis. Legislation Monitored and Supported/Opposed: - H.R. 8260 / S. 4350 - Hospital Inpatient Services Modernization Act - H.R. 5378 - Lower Costs, More Transparency Act - H.R. 2389 - Resident Physician Shortage Reduction Act of 2023 - H.R. 9351 - Save Our Safety-Net Hospitals Act of 2024 - H.R. 8702 / S. 4532 - Improving Seniors Timely Access to Care Act of 2024

Client expense: $20,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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.

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

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

Client expense: $632,324 · Firm income: Not reported

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

Support for elimination of Medicaid Disproportionate Share Hospital cuts Support for bolstering Medicare Graduate Medical Education program including the Resident Physician Shortage Reduction Act of 2023 (H.R.2389) Support for continuing key flexibilities beyond COVID-19 pandemic including telehealth policies and the hospitals at home program, and SubstanceUse Disorder Workforce Act (H.R. 7050) Support for Improving Seniors Timely Access to Care Act Support for bolstering healthcare workforce including the Healthcare Workforce Resilience Act Support for H.R. 9351 Opposition to proposals to cut providers including Medicare site-neutral payment reductions and policies to restrict the 340B drug pricing program Opposition to site-neutral cuts included in Lower Cost More Transparency Act and Bipartisan Primary Care and Health Workforce Act Opposition to Sec. 404 in Telehealth Modernization Act as marked up by Energy and Commerce Opposition to H.R. 2530, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act Support for H.R. 2534: Preserving Rules Ordered for the Entities Covered Through (PROTECT) 340B Act Support for: H.R. 7635: 340B Pharmaceutical Access to Invest in Essential, Needed Treatments and Support (PATIENTS) Act Opposition to H.R. 8574: 340B Affording Care for Communities and Ensuring a Strong Safety-Net Act (340B Access Act)

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

Government targets: Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

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

Client expense: $617,103 · Firm income: Not reported

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

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

Client expense: $617,103 · Firm income: Not reported

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

- Eliminate Medicaid DSH cuts - Extend expiring PHE waivers and flexibilities: (Telehealth flexibilities and hospital-at-home waiver) - Prevent Medicare site-neutral cuts to hospitals - Increased GME slots - Oppose burdensome New National Provider Identifier (NPI) Policies - Support Prior Authorization improvements - Extend Community Health Center funding H.R.8260/S.4350 - Hospital Inpatient Services Modernization Act H.R.5378 - Lower Costs, More Transparency Act H.R.2389 - Resident Physician Shortage Reduction Act of 2023 H.R. 9351 - Save our Safety-Net Hospitals Act of 2024 H.R.8702/S.4532 - Improving Seniors Timely Access to Care Act of 2024

Client expense: $20,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid DSH cuts (Eliminate) GME (Increased slots) Medicare site-neutral payments (Eliminate Cuts) NPI issue (Oppose proposals in HR 5378) 340B (Support of the program) Extend expiring PHE waivers (H@H, telehealth) Extension of community health center funding Prior Authorization Improvements H.R.7635/S.5021 - The 340B PATIENTS Act of 2024 H.R.8260/S.4350 - Hospital Inpatient Services Modernization Act H.R.5378 - Lower Costs, More Transparency Act H.R.2389 - Resident Physician Shortage Reduction Act of 2023 H.R. 9351 - Save our Safety-Net Hospitals Act of 2024 H.R.8702/S.4532 - Improving Seniors Timely Access to Care Act of 2024

Client expense: $20,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 2840, Bipartisan Primary Care and Health Workforce Act H.R. 3305 - Black Maternal Health Momnibus Act H.R. 4420, the Preparedness and Response Reauthorization Act H.R. 4531, the Support for Patients and Communities Reauthorization Act H.R. 2534, PROTECT 340B Act of 2023 H.R. 5013, the Value in Health Care Act of 2023 H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program. H.R. 7050 - Substance Use Disorder Workforce Act S.4101/ H.R.7931 - the Preserving Emergency Access in Key Sites Act Keeping Obstetrics Local Act S.4088, Welcome Back to the Health Care Workforce Act Issues related to essential hospital designation Issues related to health equity Issues related to the 340B Drug Pricing program Issues related to contact pharmacies Issues related to the health care workforce Issues related to Community Paramedicine Issues related to Artificial Intelligence and Health Care Issues related to hospital digital infrastructure Issues related to cybersecurity H.R. 9351 Save our Safety-Net Hospitals Act of 2024 Issues related to Opioid overdose reduction

Client expense: $460,000 · Firm income: Not reported

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

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.

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

FY25 Payment Policies under the Physician Fee Schedule; Medicare and Medicaid OPPS; 340B sign-on letter; Medicaid DSH cuts; HR 9351

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

FY25 Payment Policies under the Physician Fee Schedule; Medicare and Medicaid OPPS; 340B sign-on letter; Medicaid DSH cuts; HR 9351

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

Letter in support of HR 9351 (LaLota, Lawlor) Letter in support of Spanberger/Johnson 340B Dear Colleague Letter to HHS Secretary Becerra (LaLota, Garbarino, Suozzi, D'Esposito, Meeks, Bowman, Molinaro)

Client expense: $10,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS)