Patient Access to Higher Quality Health Care Act of 2023

Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA)

H.R. 4942/ S.665 - "Conrad State 30 and Physician Access Reauthorization Act"; H.R. 2584/ S. 2768 - "SAVE Act"; H.R. 2255/ S. 1024 - "Healthcare Workforce Resilience Act" - Re: Healthcare Workforce Issues H.R. 977 - "The Patient Access to Higher Quality Health Care Act" - re: Physician-Owned Hospitals S. 4322 - Rural Emergency Hospital Designation Improvement Act re: Rural health S.4054 - "Health Care Cybersecurity Improvement Act of 2024" - Re: Cybersecurity requirements H.R. 9714 / S. 5194 - Health Care Affordability Act of 2024; re: ACA enhanced tax credits H.R. 10073 - Medicare Patient Access and Practice Stabilization Act re: Physician payment updates H.R. 10515 - American Relief Act - re: Hospital payment and PAYGO Discussions re: disaster relief

Client expense: $680,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitored issues regarding PPS exempt hospitals. Issues concerning reimbursement for hospital services. Issues regarding hospital transparency. Monitored H.R.2389 / S. 1302, Resident Physician Shortage Reduction Act of 2023. H.R. 977, Patient Access to Higher Quality Health Care Act of 2023. Issues regarding healthcare sector consolidation. H.R. 5378, the Lower Costs, More Transparency Act, as it relates to hospitals. Issues concerning drug shortages. Issues involving the extension of the Acute Care Hospital at Home program. H.R. 6213, National Quantum Initiative Reauthorization Act. Monitored H.R.5159 / S. 2137, the Preserving Access to Home Health Care Act of 2023. Issues related to telehealth. H.R. 4758 / S. 2372, Accelerating Kids Access to Care Act. H.R. 6094, Providing Realistic Opportunity to Equal and Comparable Treatments (PROTECT) Rare Act. Issues concerning cybersecurity. H.R. 8261, Preserving Telehealth, Hospital, and Ambulance Access Act. Issues regarding the IOTA Model final rule. H.R. 10445, Furthering Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 and H.R. 10545, The American Relief Act of 2025 and issues related to hospitals. H.R. 8702 / S.4532, Improving Seniors Timely Access to Care Act of 2024.

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

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

S.470/H.R.977, Patient Access to Higher Quality Health Care Act: To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. S.4532/H.R. 8702), Improving Seniors Timely Access to Care Act: To streamline prior authorization in the Medicare Advantage program. H.R. 9001, Physician Led and Rural Access to Quality Care Act: To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals and allow physician ownership of rural hospitals H.R.9805, Access to Claims Data Act: To require the Secretary of Health and Human Services to establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement. H.R. 10073, Medicare Patient Access and Practice Stabilization Act of 2024 (H.R.10073): To eliminate the 2.8% Medicare physician fee schedule(MPFS) cut and provide an inflationary update for calendar year 2025. No bill: Medicare payment reforms, including positive annual updates, adjustments to Medicare's budget neutrality requirements, improving alternative payment models, modifying the Merit-based Improvement Payment System and expanding relevant quality improvement measures.

Client expense: $35,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.470/H.R.977, Patient Access to Higher Quality Health Care Act: To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. S.4532/H.R. 8702), Improving Seniors Timely Access to Care Act: To streamline prior authorization in the Medicare Advantage program. H.R. 9001, Physician Led and Rural Access to Quality Care Act: To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals and allow physician ownership of rural hospitals H.R.9805, Access to Claims Data Act: To require the Secretary of Health and Human Services to establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement. H.R. 10073, Medicare Patient Access and Practice Stabilization Act of 2024 (H.R.10073): To eliminate the 2.8% Medicare physician fee schedule (MPFS) cut and provide an inflationary update for calendar year 2025. No bill: Medicare payment reforms, including positive annual updates, adjustments to Medicare's budget neutrality requirements, improving alternative payment models, modifying the Merit-based Improvement Payment System and expanding relevant quality improvement measures.

Client expense: $35,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions involving proposed legislation requiring new National Provider Identifier (NPI) policies Discussions involving GME reform proposals impacting Medicare reimbursement to teaching hospitals Discussions pertaining to CMS hospital directed payment program Discussions pertaining to reductions to the Medicaid disproportionate share hospital (DSH) program S 470 Patient Access to Higher Quality Health Care Act of 2023 (all sections of full text)(oppose) HR 977 Patient Access to Higher Quality Health Care Act of 2023 (all sections of full text) (oppose) HR 8246 Second Chances for Rural Hospitals Act (all sections of full text)(oppose) S 1869 Site-based Invoicing and Transparency Enhancement (SITE) Act (all sections of full text) Discussions relating to site neutral payment reform Discussions pertaining to prior authorization Monitored Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 Monitored Medicare Advantage reform legislation on CMS action

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.5378, Lower Costs, More Transparency Act, Issues related to site neutral payment cuts, hospital price transparency, unique health identifier, 340B Program; H.R. 3173 / S. 4532, Improving Seniors' Timely Access to Care, all provisions; S.4350 / H.R. 8260, Hospital Inpatient Services Modernization Act of 2024, all provisions; H.R. 7623, Telehealth Modernization Act, Issues pertaining to Telehealth, Hospital at Home, Unique Health Identifier; S. 1110, the Rural Hospital Support Act, all provisions; H.R. 6430, Assistance for Rural Community Hospitals (ARCH)Act, all provisions; H. Jes Res 139 / S.J. Res 91 A, joint resolution for congressional disapproval of a rule relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting", All provisions; S. 2016/ H.R. 4189, The CONNECT for Health Act of 2023, specifically telehealth waivers, geographic restrictions, originating site requirements, in person requirement behavioral health, RHCs and FQHCs access; H.R. 1110, KEEP Telehealth Option Act, All provisions; H.R. 5541, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, All provisions; HR 2389/ S. 1302, Resident Physician Shortage Reduction Act of 2023, All provisions ; H.R. 977/S. 470, Patient Access to Higher Quality Care Act, all provisions; H.R. 4946, Medicare Mental Health Inpatient Equity Act of 2023, all provisions; H.R. 6033,Supporting Patient Education and Knowledge (SPEAK) Act of 2023all provisions; H.R. 1406, Sustainable Cardiopulmonary Rehabilitation Services in the Home Act, all provisions; DRAFT, DRAFT Clarifying that Rural Emergency Hospitals are eligible for Medicaid hospital reimbursement; DRAFT, DRAFT, Expanding services Rural Emergency Hospitals (REHs) are paid at the enhanced outpatient prospective payment system rate, allow eligibility for Small Rural Hospital improvement Grants; DRAFT, DRAFT, Issues pertaining to freestanding emergency departments; H.R. 1666, Protecting Access to Ground Ambulance Medical Services Act of 2023, All provisions; H. R. 8246, Second Chances for Rural Hospitals Act, Issues pertaining to expansion of physician-owned Rural Emergency Hospitals; Draft Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; Centers for Medicare & Medicaid Services (CMS), Medicare Severity-Long Term Care-Diagnosis Related Groups (MS-LTC-DRGs) used as part of the LTCH prospective payment system (PPS), Feedback on Medicare Severity-Long Term Care-Diagnosis Related Groups (MS-LTC-DRGs) used as part of the LTCH prospective payment system (PPS); Centers for Medicare & Medicaid Services (CMS), Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026, Navigators and non-navigator assistance personnel working within hospitals and health systems to assist consumers; Centers for Medicare & Medicaid Services (CMS) Medicare Part C Utilization Management Annual Data Submission and Audit Protocol Data Request, Proposed Medicare Part C Utilization Management and data submission and audit protocol; Medicare Payment Advisory Commission (MedPAC), Physician fee schedule payments, advanced alternative payment model (A-APM) incentives and Medicare Advantage (MA) network adequacy; Centers for Medicare & Medicaid Services (CMS), Affordable drugs, Medicare $2 Drug List Model request for information; Centers for Medicare & Medicaid Services (CMS), Changes to the Fiscal Year 2025 Hospital Inpatient Prospective Payment System (IPPS) Rates Due to Court Decision, Low Wage Index Policy changes due to recent court change; Centers for Medicare & Medicaid Services (CMS), Medicare Transaction Facilitator and the Medicare drug negotiation program, Information collection request (ICR) regarding the Medicare Transaction Facilitator (MTF) and the Medicare drug negotiation program; Site Neutral Payments, Issues related to site neutral payment cuts for drug administration; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees, DSH cuts; Medicaid Disproportionate Share Hospital (DSH) program, Medicaid DSH program; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage; Physician Payments, Issues pertaining to proposed solutions to improve MACRA, alternative payment models, mental health of workforce, scheduled physician reimbursement cuts for 2025, extension of Medicare's Advanced Alternative Payment Model (AAPM) incentive payments; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, REH's; National Provider Identifier (NPI), Unique identifiers for off-campus Hospital Outpatient Departments (HOPDs); Organ Transplant Final Rule, Increasing Organ Transplant Access (IOTA) Final Rule, IOTA Model impact on hospitals.

Client expense: $6,570,000 · Firm income: Not reported

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

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

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE

Issues regarding reimbursement for hospital services. Issues related to transparency. H.R. 2389 / S. 1302, Resident Physician Shortage Reduction Act of 2023 and issues related to Medicare graduate medical education residency positions. H.R. 5378, the Lower Costs, More Transparency Act. H.R. 977, Patient Access to Higher Quality Health Care Act of 2023. Issues regarding health care sector consolidation. Issues concerning cybersecurity. The extension of Acute Care Hospital at Home program and telehealth flexibilities. H.R. 8261, Preserving Telehealth, Hospital, and Ambulance Access Act. H.R. 7623, Telehealth Modernization Act of 2024. Issues related to drug shortages. H.R. 10445, Furthering Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 and H.R. 10545, The American Relief Act of 2025 and issues related to hospitals.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program (H.R. 3290) Rural health care innovation (PA Rural Health Model) Public Health Emergency designation SAVE Act (H.R. 2584) Fairness for Rural Teaching Hospitals Act (H.R.2433) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Behavioral health PATIENT Act of 2023 (H.R.3561) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (S.1113, H.R.2530) CHGME Youth behavioral health Electronic health records Pandemic and All-Hazards Preparedness Reauthorization Act Nursing and allied health education (NAHE) program Bipartisan Primary Care and Health Workforce Act (S.2840) Transparent PRICE Act (H.R.3281) Save Americas Rural Hospitals Act (H.R.833) Supporting Safety Net Hospitals Act (H.R.2665) Patient Access to Higher Quality Care Act (H.R.977/S.470) FEMA Covid-19 reimbursement Health Care Price Transparency Act (H.R.4822) Providers and Payers Compete Act (H.R.3284) Lower Costs, More Transparency Act (H.R.5378) Health Care Prices Revealed and Information to Consumers Explained Transparency Act (S.3548) Medical and Nurse Licensure Compact Health care consolidation, mergers and acquisitions Accelerating Kids Access to Care Act (H.R. 4758, S.2372)

Client expense: $60,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR977/S470, Patient Access to Higher Quality Health Care Act of 2023; HR5378, Lower Costs, More Transparency Act; HR3561, PATIENT Act of 2023; S3394, Rural Emergency Hospital Adjustment Act;

Client expense: $700,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR977/S470, Patient Access to Higher Quality Health Care Act of 2023; HR5378, Lower Costs, More Transparency Act; HR3561, PATIENT Act of 2023; S3394, Rural Emergency Hospital Adjustment Act;

Client expense: $700,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

issues relating to hospitals and healthcare H.R.1129 To direct the Secretary of Health and Human Services to revise regulations to remove the requirement under the Medicare program that an off-campus facility or organization shall be located within a 35-mile radius of a hospital or critical access hospital; S.468 Hospital Transparency Compliance Enforcement Act; H.R.990,S 407 SAFE Hospitals Act of 2023; H.R.1565 Critical Access Hospital Relief Act of 2023; H.R.2530 & S1113 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act; H.R.977-S.470 Patient Access to Higher Quality Health Care Act of 2023; H.R.1475 Hospital Adoption Education Act of 2023; H.R.410 Health Care PRICE Transparency Act; H.R.3417 FAIR Act; HR 2859 Holding Nonprofit Hospitals Accountable Act; H.R.5007, S2657 GREEN Hospitals Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.977 - Patient Access to Higher Quality Health Care Act of 2023 To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. Michael Burgess, (R-TX) Henry Cuellar (D-TX) HR 2474: Strengthening Medicare for Patients and Providers Act Reps. Raul Ruiz, MD (D-CA); Larry Bucshon, MD (R-IN); Ami Bera, MD (D-CA); Mariannette Miller-Meeks, MD (R-IA) Provides an annual Medicare physician payment update tied to inflation as measured by the Medicare Economic Index (MEI). HR 4968, the GOLD CARD Act of 2023 Reps Michael Burgess (R-TX); Vincente Gonzalez (D-TX) Exempts physicians who in the previous year received approval for at least 90 percent of their prior authorization requests, from the prior authorization approval process under Medicare Advantage plans. HR 6683: Preserving Seniors Access to Physicians Act Reps. Greg Murphy, MD (R-NC); Brad Wenstrup, DPM (R-OH); Michael Burgess, MD (R-TX); Larry Bucshon, MD (R-IN); Danny Davis (D-IL); Jimmy Panetta (D-CA) Prevents the full 3.4% Medicare physician fee schedule cuts from being implemented on January 1, 2024. Support implementation of the No Surprises Act (NSA) according to congressional intent The NSA aimed to fix the problem of unanticipated medical bills and remove patients from the middle of out-of-network billing disputes. However, the Administration crafted rules that disregard congressional intent and insurers are not being held accountable under current policies. HR 8702 and S 4532: Improving Seniors Timely Access to Care Act: To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. HR 8702--Mike Kelly (R-PA) and Susan DelBene (D-WA). S 4532--Sen. Sinema, Kyrsten (I-AZ) Sen. Thune, John (R-SD) Sen. Brown, Sherrod (D-OH) 06/13/2024 H.R.9001 - Physician Led and Rural Access to Quality Care Act: Reps Tony Cardenas(D-CA); Morgan Griffith (R-VA); Vicente Gonzalez (D-TX) To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals.

Client expense: $518,655 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 977/S 470: Patient Access to Higher Quality Health Act of 2023 Rep. Michael Burgess, MD (R-TX); Sen. James Lankford (R-OK) This bill repeals provisions under the Stark Law (i.e., the Physician Self-Referral Law) that limit, for purposes of Medicare participation, self-referrals by newly constructed or expanded physician-owned hospitals HR 2630/S 652: Safe Step Act Reps. Brad Wenstrup, DPM (R-OH); Raul Ruiz, MD (D-CA); Mariannette Miller-Meeks, MD (R-IA) Sens. Lisa Murkowski (R-AK); Maggie Hassan (D-NH); Roger Marshall, MD (R-KS) Requires group health plans to establish a clear and transparent process to request an exception to step therapy protocols in specified cases. Support reforming prior authorization Advocate for prior authorization policies that are more seamless, automated, and transparent for physicians and their patients. HR: 6545: Physician Fee Schedule Update and Improvements Act Reps. Mariannette Miller-Meeks (R-IA); Larry Bucshon ,MD (R-IN); Kim Schrier, MD (D-WA); Robin Kelly (D-IL), Michael Burgess, MD (R-TX); Greg Murphy, MD (R-NC), Brad Wenstrup, ,DPM (R-OH), Ami Bera, MD (D-CA), Tony Cardenas (D-CA); Raul Ruiz, MD (D-CA): Increases the budget neutrality from $20 million to $53 million would allow for greater flexibility in determining pricing adjustments for services without leading to harmful payment cuts for doctors.

Client expense: $518,655 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act

Client expense: $30,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Gun Safety Issues related to gun safety - no specific bill H.R. 4283, Gun Violence Prevention and Community Safety Act Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill H.R. 9001, Physician Led and Rural Access to Quality Care Act Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R. 4942/ S. 665, the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317MAMAS First Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act H.R.10073, Medicare Patient Access and Practice Stabilization Act of 2024 H.R. 8816, the American Medical Innovation and Investment Act of 2024 H.R. 2474, the Strengthening Medicare for Patients and Providers Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill Issues related to prior authorization and administrative simplification - no specific bill Issues related to Medicare Advantage - no specific bill Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R.4189, the CONNECT for Health Act of 2023 H.R.7623, the Telehealth Modernization Act of 2024 H.R.1843, the Telehealth Expansion Act of 2023 Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Tobacco Issues related to prohibiting sale of menthol cigarettes and flavored cigars - no specific bill Issues related to increasing awareness about lung cancer screening on cigarette packages - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory FDA's proposed rule to eliminate menthol cigarettes Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth Issues related to Medicare Advantage Star Rating Health Equity Index calculation HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident

Client expense: $30,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Gun Safety Issues related to gun safety - no specific bill H.R. 4283, Gun Violence Prevention and Community Safety Act Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill H.R. 9001, Physician Led and Rural Access to Quality Care Act Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R. 4942/ S. 665, the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317MAMAS First Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act H.R.10073, Medicare Patient Access and Practice Stabilization Act of 2024 H.R. 8816, the American Medical Innovation and Investment Act of 2024 H.R. 2474, the Strengthening Medicare for Patients and Providers Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill Issues related to prior authorization and administrative simplification - no specific bill Issues related to Medicare Advantage - no specific bill Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Publications Open access to information based on publicly funded research - no specific bill Request for Information for NIH Plan to Enhance Public Access to the Results of NIH-Supported Research Issues related to scholarly and scientific publishing and public access - no specific bill H.R. 9378, Sunshine Act of 2023 Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R.4189, the CONNECT for Health Act of 2023 H.R.7623, the Telehealth Modernization Act of 2024 H.R.1843, the Telehealth Expansion Act of 2023 Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Tobacco Issues related to prohibiting sale of menthol cigarettes and flavored cigars - no specific bill Issues related to increasing awareness about lung cancer screening on cigarette packages - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory FDA's proposed rule to eliminate menthol cigarettes Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth Issues related to Medicare Advantage Star Rating Health Equity Index calculation HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident

Client expense: $30,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA)

HR2389/S1302 - Resident Physician Shortage Reduction Act S2333 - Public Health Workforce Loan Repayment Act Health Workforce Resilience Act S665/HR 4942 Conrad 30 and Physician Access Reauthorization Act CLIA Waiver CURES 2.0 To prevent across-the-board direct spending cuts Cytotechnologist labor rates Remote digital telepathology S 1000/HR 2377 SALSA HR 977 - legislation that would repeal provisions prohibiting self-referrals to new or expanded POHs. HR 1202/S 704 - REDI Act HR2761/S 705 - SPARC Act HR 2764/S1229 - Green New Deal for Health HR 3248 - Diagnostic Lab Testing Transparency Act H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023 Student loan repayment for FPs HR 4527 - HEALTH DATA Act Primary Care and Health Workforce Expansion Act S 1994 Counting Veterans Cancer Act HR 4875 Doctors in our Borders Act HR 2474 - Strengthening Medicare for Patients and Providers Act Continuing Appropriations Act, 2024 and Other Extensions Act Further Continuing Appropriations and Other Extensions Act, 2024 HR 6683 - Preserving Seniors Access to Physicians Act of 2023 Gene Therapy Precision Medicine Answers for Kids Today Act S.3018/H.R.3173 the Improving Seniors Timely Access to Care Act of 2021 Dr. Lorna Breen Health Care Provider Protection Act PREVAIL HR 6371 - budget neutrality bill EDUCATE Act - Murphy DEI Bill HR 2369 - VALID Act FDA final rule on LDTs Pandemic All-Hazards Preparedness Act H.R.9747, the Continuing Appropriations and Extensions Act, 2025 S.2140/H.R. 9474, the Patent Eligibility Restoration Act of 2023 S.1451 / H.R. 3120 - Healthy Competition for Better Care Act H.R. 9572 - Enhanced Enforcement of Health Coverage Act H.R. 6025/S. 3211 - Healthcare Workforce Resilience Act Cures 2.1 H.R. 10073, Medicare patient Access and Practice Stabilization Act of 2024 S. 4935, Physician Fee Stabilization Act H.R. 5392, The Timely Access to Coverage Decisions Act of 2023 Medical Lab Personnel Shortage Relief Act H.R. 9572 Enhanced Enforcement of Health Coverage Act Sickle Cell Disease Comprehensive Care Act

Client expense: $126,566 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Q4 Lobbying Report (Oct.1 -Dec. 31) HCR Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program Resident Physician Shortage Act of 2023 (H.R. 2389) No Surprises Act regulations Food and Drug Amendments No Surprise Bills for New Moms Act (H.R. 3387) Securing the U.S. Organ Procurement and Transplantation Network Act (H.R. 2544) Promoting Access to Treatments and Increasing Extremely Needed Transparency Act (H.R. 3561) Medicaid VBPs for Patients (MVP) Act (H.R. 2666) Providers and Payers COMPETE Act (H.R. 3284) To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program (H.R. 3290) Transparent PRICE Act (H.R. 3281/H.R. 2691)) Resident Physician Shortage Reduction (S. 1302) Medical Student Education Authorization Act (H.R. 3046) Save Americas Rural Hospitals Act (H.R. 833) Chronic Care Management Improvement Act (H.R. 2829) Safety From Violence for Healthcare Employees Act (H.R. 2584) Supporting Safety Net Hospitals Act (H.R. 2665) Patient Access to Higher Quality Health Care Act (H.R. 977/S.470) FEMA re: COVID-19 related reimbursement Public Health Guidance Transparency and Accountability Act of 2023 (H.R. 4529) Public Health Emergency Congressional Review Act (H.R. 4381) CDC Leadership Accountability Act of 2023 (H.R. 3813) Preparing for All Hazards and Pathogens Reauthorization Act (H.R. 4421) Preparedness and Response Reauthorization Act (H.R. 4420) Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887) Health Care Price Transparency Act of 2023 (H.R. 4822) Providers and Payers COMPETE Act (H.R. 3284) Lower Costs, More Transparency Act (H.R. 5378 Transparency in Coverage Act (H.R. 4507) GOLD Card Act of 2023 (H.R. 4968) No Fees for EFTs Act (H.R.6487) Rural Health Care Facilities Revitalization Act (H.R. 5989) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (H.R. 7153) To amend title XVIII of the Social Security Act to establish a definition of essential health system in statute (H.R. 7397) Substance Use Disorder Workforce Act (H.R. 7050) 340B PATIENTS Act (H.R. 7635) The 340B Affording Care for Communities and Ensuring a Strong Safety-net (ACCESS) Act (H.R. 8574) Improving Seniors Access to Timely Care Act (H.R. 8702/S.4532) The Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931) Rural Health Care Facilities Revitalization Act (H.R. 5989) MMM Accelerated and Advance Payment Program repayment flexibility Graduate Medical Education (GME) funding Telehealth flexibilities and payment Annual Prospective Payment System Rules Organ acquisition payment policies Californias Medicaid Hospital Quality Assurance Fee Program Medicare Advantage BUD FY 2025 Appropriations bills Nursing and allied health workforce funding FY 2025 budget request Further Continuing Appropriations and Other Extensions Act (H.R. 6363) Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (H.R. 5894) Tax Relief for American Families and Workers Act of 2024 (H.R. 7024) Extension of Continuing Appropriations and Other Matters Act, 2024 (H.R. 7463) Submitted Comments Regulatory Comment Letters SUBJECT: CMS-10913, Medicare Part C Utilization Management Annual Data Submission and Audit Protocol Data Request; Notice, Agency Information Collection Activities: Proposed Collection; Comment Request; Federal Register (Vol 89, No 145), September 10, 2024

Client expense: $300,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Social Security Administration (SSA)

Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program (H.R. 3290) Rural health care innovation (PA Rural Health Model) Public Health Emergency designation SAVE Act (H.R. 2584) Fairness for Rural Teaching Hospitals Act (H.R.2433) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Behavioral health PATIENT Act of 2023 (H.R.3561) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (S.1113, H.R.2530) CHGME Youth behavioral health Electronic health records Pandemic and All-Hazards Preparedness Reauthorization Act Nursing and allied health education (NAHE) program Bipartisan Primary Care and Health Workforce Act (S.2840) Transparent PRICE Act (H.R.3281) Save Americas Rural Hospitals Act (H.R.833) Supporting Safety Net Hospitals Act (H.R.2665) Patient Access to Higher Quality Care Act (H.R.977/S.470) FEMA Covid-19 reimbursement Health Care Price Transparency Act (H.R.4822) Providers and Payers Compete Act (H.R.3284) Lower Costs, More Transparency Act (H.R.5378) Health Care Prices Revealed and Information to Consumers Explained Transparency Act (S.3548) Medical and Nurse Licensure Compact Health care consolidation, mergers and acquisitions Accelerating Kids Access to Care Act (H.R. 4758, S.2372)

Client expense: $60,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4942/ S.665 - "Conrad State 30 and Physician Access Reauthorization Act"; H.R. 2584/ S. 2768 - "SAVE Act"; H.R. 2255/ S. 1024 - "Healthcare Workforce Resilience Act" - Re: Healthcare Workforce Issues H.R. 977 - "The Patient Access to Higher Quality Health Care Act" - re: Physician-Owned Hospitals S.4054 - "Health Care Cybersecurity Improvement Act of 2024" - Re: Cybersecurity requirements H.R. 9714 / S. 5194 - Health Care Affordability Act of 2024; re: ACA enhanced tax credits Discussions re: tariff on Chinese manufactured health care goods Discussions re: drug shortages Physician payment updates Discussions re: Medical debt S. 2840 Bipartisan Primary Care and Health Workforce Act; H.R. 3120 Healthy Competition for Better Care Act; H.R. 9457 - Transparent Telehealth Bills Act - re: Hospital payment and contracting practices Discussions regarding independent dispute resolution process- Re: No Surprises Act Implementation

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.5378, Lower Costs, More Transparency Act, Issues related to site neutral payment cuts, hospital price transparency, unique health identifier, 340B Program; H.R. 3173 / S. 4532, Improving Seniors' Timely Access to Care, all provisions; S.4350 / H.R. 8260, Hospital Inpatient Services Modernization Act of 2024, all provisions; Draft Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; S.4338, the Pay PCPs Act , Feedback to improve physician reimbursement and value-based primary care; S. 1110, the Rural Hospital Support Act, all provisions; H.R. 6430, Assistance for Rural Community Hospitals (ARCH)Act, all provisions; H.R. 7711, Advancing Access to Telehealth Act,all provisions; H.R. 3432, Telemental Health Care Access Act, all provisions; H.R. 3875, the Expanded Telehealth Access Act, all provisions; H.R. 5611, Helping Ensure Access to Local Telehealth (HEALTH) Act of 2023, all provisions; H.R. 6033, Supporting Patient Education and Knowledge (SPEAK) Act of 2023, all provisions; Draft Bill, To amend title XVIII of the Social Security Act to adjust long-term care hospital payment rates under the Medicare program, Issues related to LTCH payment policy reforms; S. 5236, A bill to amend titles XIX and XXI of the Social Security Act to enhance financial support for rural and safety net hospitals providing maternity, labor, and delivery services to vulnerable populations, and for other purposes, Reimbursements to rural and safety net hospitals providing maternity, labor, and delivery services; H.R. 7623, Telehealth Modernization Act, Issues pertaining to Telehealth, Hospital at Home, Unique Health Identifier; H. Jes Res 139 / S.J. Res 91, A joint resolution for congressional disapproval of a rule relating to "Medicare and Medicaid Programs, Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting", All provisions; S. 2016/ H.R. 4189, The CONNECT for Health Act of 2023, Specifically telehealth waivers, geographic restrictions, originating site requirements, in person requirement behavioral health, RHCs and FQHCs access; H.R. 1110, KEEP Telehealth Option Act, All provisions; H.R. 5541, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, All provisions; HR 2389/ S. 1302, Resident Physician Shortage Reduction Act of 2023, All provisions; H.R. 977/S. 470, Patient Access to Higher Quality Care Act, all provisions; Draft Bill, Obstetric care in Critical Access Hospitals (CAH); Centers for Medicare & Medicaid Services (CMS), Medicare Drug Price Negotiation Program Draft Guidance, Issues pertaining to the implementation of the Medicare drug price negotiation program; Centers for Medicare & Medicaid Services (CMS), Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model, Issues pertaining to Value Based Care and feedback on proposed IOTA model; Centers for Medicare & Medicaid Services (CMS), FY 2025 Inpatient Prospective Payment Systems for Acute Care Hospitals; Disproportionate Share Hospital Payments, Issues pertaining to the FY2025 Inpatient Prospective Payment Systems Rule and Disproportionate Share Hospital Payments Changes in FY25 IPPS Rule; Medicare Payment Advisory Commission (MedPAC), 2025 Priorities, Issues pertaining to 340B Drug Pricing Program, inpatient rehabilitation facility (IRF) payments, the physician fee schedule (PFS) and telehealth in the new cycle; Centers for Medicare & Medicaid Services (CMS), Calendar Year (CY) 2025 Home Health Prospective; Payment System (HH PPS) Rate Update, Issues pertaining to the CY25 Home Health Proposed Rule; Centers for Medicare & Medicaid Services (CMS), Physician fee schedule (PFS) proposed rule for calendar year (CY) 2025, Issues pertaining to physician fee schedule; Centers for Medicare & Medicaid Services (CMS), Outpatient Prospective Payment System (OPPS) Proposed rule for Calendar Year (CY2025), Issues pertaining to outpatient and ambulatory surgery center prospective payment system, conditions of participation for maternal health; Health & Human Services (HHS), Letter to HHS, Medicare Advantage Organizations' Use of Prior Authorization for Post-Acute Care; Centers for Medicare & Medicaid Services (CMS), Significant, Anomalous and Highly Suspect (SAHS) billing in Medicare Shared Savings Program (MSSP) in Calendar Year 2023, Issues pertaining to proposed rule to mitigate the impact of significant, anomalous and highly suspect (SAHS) billing activity within the Medicare Shared Savings Program (MSSP) in calendar year (CY) 2023; Site Neutral Payments, Issues related to site neutral payment cuts for drug administration; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees, DSH cuts; Medicaid Disproportionate Share Hospital (DSH) program, Medicaid DSH program; LTCH High Cost Outlier Threshold, SFC / W&M Meeting / CMS Meeting , Issues concerning High Cost Outlier in LTCH payment policy; National Provider Identifier (NPI), Included in E&C markup statement in September , Unique identifiers for off-campus Hospital Outpatient Departments (HOPDs); Access to inpatient rehabilitation care, Letter to CMS / Supported Hill Led Effort, Access to inpatient rehabilitation care for MA enrollees; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, and REHs; Physician Payments, Issues pertaining to proposed solutions to improve MACRA, alternative payment models, mental health of workforce; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage.

Client expense: $5,450,000 · Firm income: Not reported

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

S.470/H.R.977, Patient Access to Higher Quality Health Care Act: To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. S.4532/H.R. 8702), Improving Seniors Timely Access to Care Act: To streamline prior authorization in the Medicare Advantage program. H.R.2389, Resident Physician Shortage Reduction Act: To provide for the distribution of additional residency positions H.R. 2474, Strengthening Medicare for Patients and Providers Act: To provide an update to a single conversion factor under the Medicare physician fee schedule that is based on the Medicare economic index. H.R. 4968, the GOLD CARD Act of 2023: Prior authorization reform in Medicare Advantage H.R. 9001, Physician Led and Rural Access to Quality Care Act: To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals and allow physician ownership of rural hospitals H.R.9805, Access to Claims Data Act: To require the Secretary of Health and Human Services to establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement. No bill: Graduate medical education policy reform ideas. No bill: Medicare physician payment reform policy ideas, need for legislation to prevent Medicare physician payment cuts and adopt an inflation-based payment update for 2025, modifications to Medicare's budget neutrality rules, increasing surgical global codes to incorporate increased RVUs for follow-up care w/in the global period, and improvements to value-based care payment models

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.470/H.R.977, Patient Access to Higher Quality Health Care Act: To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. S.4532/H.R. 8702), Improving Seniors Timely Access to Care Act: To streamline prior authorization in the Medicare Advantage program. H.R.2389, Resident Physician Shortage Reduction Act: To provide for the distribution of additional residency positions H.R. 2474, Strengthening Medicare for Patients and Providers Act: To provide an update to a single conversion factor under the Medicare physician fee schedule that is based on the Medicare economic index. H.R. 4968, the GOLD CARD Act of 2023: Prior authorization reform in Medicare Advantage H.R. 9001, Physician Led and Rural Access to Quality Care Act: To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals and allow physician ownership of rural hospitals H.R.9805, Access to Claims Data Act: To require the Secretary of Health and Human Services to establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement. No bill: Graduate medical education policy reform ideas. No bill: Medicare physician payment reform policy ideas, need for legislation to prevent Medicare physician payment cuts and adopt an inflation-based payment update for 2025, modifications to Medicare's budget neutrality rules, increasing surgical global codes to incorporate increased RVUs for follow-up care w/in the global period, and improvements to value-based care payment models

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitored issues regarding PPS exempt hospitals. Issues concerning reimbursement for hospital services. Issues regarding hospital transparency. Monitored H.R.2389 / S. 1302, Resident Physician Shortage Reduction Act of 2023. H.R. 977, Patient Access to Higher Quality Health Care Act of 2023. Issues regarding healthcare sector consolidation. H.R. 5378, the Lower Costs, More Transparency Act, as it relates to hospitals. Issues concerning drug shortages. Issues involving the extension of the Acute Care Hospital at Home program. H.R. 6213, National Quantum Initiative Reauthorization Act. Monitored H.R.5159 / S. 2137, the Preserving Access to Home Health Care Act of 2023. Issues related to telehealth. H.R. 4758 / S. 2372, Accelerating Kids Access to Care Act. H.R. 6094, Providing Realistic Opportunity to Equal and Comparable Treatments (PROTECT) Rare Act. Issues concerning cybersecurity. H.R. 8261, Preserving Telehealth, Hospital, and Ambulance Access Act. Issues regarding the IOTA Model proposed rule.

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

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

HR977/S470, Patient Access to Higher Quality Health Care Act of 2023; HR5378, Lower Costs, More Transparency Act; HR3561, PATIENT Act of 2023; S3394, Rural Emergency Hospital Adjustment Act;

Client expense: $430,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR977/S470, Patient Access to Higher Quality Health Care Act of 2023; HR5378, Lower Costs, More Transparency Act; HR3561, PATIENT Act of 2023; S3394, Rural Emergency Hospital Adjustment Act;

Client expense: $430,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA)

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill S. 1655/H.R. 3421, Medicare for All Act of 2023 H.R. 9001, Physician Led and Rural Access to Quality Care Act Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act H.R. 2389 The Resident Physician Shortage Reduction Act H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R. 4942/ S. 665, the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign H.R. 2389 The Resident Physician Shortage Reduction Act Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317MAMAS First Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill Issues related to prior authorization and administrative simplification - no specific bill Issues related to Medicare Advantage - no specific bill Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Issues related to scholarly and scientific publishing and public access - no specific bill H.R. 9378, Sunshine Act of 2023 Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R. 4189/S.2016 the CONNECT for Health Act and H.R.7623/S.3967 the Telehealth Modernization Act Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident File Code CMS-1807-P. Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Gun Safety Issues related to gun safety - no specific bill H.R. 4283, Gun Violence Prevention and Community Safety Act Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill S. 1655/H.R. 3421, Medicare for All Act of 2023 H.R. 9001, Physician Led and Rural Access to Quality Care Act Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act H.R. 2389 The Resident Physician Shortage Reduction Act H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R. 4942/ S. 665, the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign H.R. 2389 The Resident Physician Shortage Reduction Act Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317MAMAS First Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill Issues related to prior authorization and administrative simplification - no specific bill Issues related to Medicare Advantage - no specific bill Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Publications Open access to information based on publicly funded research - no specific bill Request for Information for NIH Plan to Enhance Public Access to the Results of NIH-Supported Research Issues related to scholarly and scientific publishing and public access - no specific bill H.R. 9378, Sunshine Act of 2023 Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R. 4189/S.2016 the CONNECT for Health Act and H.R.7623/S.3967 the Telehealth Modernization Act Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Tobacco Issues related to prohibiting sale of menthol cigarettes and flavored cigars - no specific bill Issues related to increasing awareness about lung cancer screening on cigarette packages - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory FDA's proposed rule to eliminate menthol cigarettes Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident File Code CMS-1807-P. Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA)

Q3 Lobbying Report (July 1-Sept. 10) HCR Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program Resident Physician Shortage Act of 2023 (H.R. 2389) No Surprises Act regulations Food and Drug Amendments No Surprise Bills for New Moms Act (H.R. 3387) Securing the U.S. Organ Procurement and Transplantation Network Act (H.R. 2544) Promoting Access to Treatments and Increasing Extremely Needed Transparency Act (H.R. 3561) Medicaid VBPs for Patients (MVP) Act (H.R. 2666) Providers and Payers COMPETE Act (H.R. 3284) To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program (H.R. 3290) Transparent PRICE Act (H.R. 3281/H.R. 2691)) Resident Physician Shortage Reduction (S. 1302) Medical Student Education Authorization Act (H.R. 3046) Save Americas Rural Hospitals Act (H.R. 833) Chronic Care Management Improvement Act (H.R. 2829) Safety From Violence for Healthcare Employees Act (H.R. 2584) Supporting Safety Net Hospitals Act (H.R. 2665) Patient Access to Higher Quality Health Care Act (H.R. 977/S.470) FEMA re: COVID-19 related reimbursement Public Health Guidance Transparency and Accountability Act of 2023 (H.R. 4529) Public Health Emergency Congressional Review Act (H.R. 4381) CDC Leadership Accountability Act of 2023 (H.R. 3813) Preparing for All Hazards and Pathogens Reauthorization Act (H.R. 4421) Preparedness and Response Reauthorization Act (H.R. 4420) Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887) Health Care Price Transparency Act of 2023 (H.R. 4822) Providers and Payers COMPETE Act (H.R. 3284) Lower Costs, More Transparency Act (H.R. 5378 Transparency in Coverage Act (H.R. 4507) GOLD Card Act of 2023 (H.R. 4968) No Fees for EFTs Act (H.R.6487) Rural Health Care Facilities Revitalization Act (H.R. 5989) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (H.R. 7153) To amend title XVIII of the Social Security Act to establish a definition of essential health system in statute (H.R. 7397) Substance Use Disorder Workforce Act (H.R. 7050) 340B PATIENTS Act (H.R. 7635) The 340B Affording Care for Communities and Ensuring a Strong Safety-net (ACCESS) Act (H.R. 8574) Improving Seniors Access to Timely Care Act (H.R. 8702/S.4532) The Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931) Rural Health Care Facilities Revitalization Act (H.R. 5989) MMM Accelerated and Advance Payment Program repayment flexibility Graduate Medical Education (GME) funding Telehealth flexibilities and payment Annual Prospective Payment System Rules Organ acquisition payment policies Californias Medicaid Hospital Quality Assurance Fee Program Medicare Advantage BUD FY 2024 Appropriations bills Nursing and allied health workforce funding FY 2024 budget request Further Continuing Appropriations and Other Extensions Act (H.R. 6363) Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (H.R. 5894) Tax Relief for American Families and Workers Act of 2024 (H.R. 7024) Extension of Continuing Appropriations and Other Matters Act, 2024 (H.R. 7463) Submitted Comments Regulatory Comment Letters SUBJECT: CMS-1809-P, Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities, (Vol 89, No 140), July 22, 2024 SUBJECT: CMS-1803-P, Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies, Federal Register (Vol. 89, No. 128), July 3, 2024 SUBJECT: CMS-5535-P, Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model, Federal Register (Vol. 89, No. 97), May 17, 2024 Legislative Comment Letters Letter to HHS on Johnson & Johnson's Proposed Changes to 340B Drug Discount Program, Sept. 19, 2024

Client expense: $380,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Social Security Administration (SSA)

H.R.977 - Patient Access to Higher Quality Health Care Act of 2023 To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. Michael Burgess, (R-TX) Henry Cuellar (D-TX) HR 2474: Strengthening Medicare for Patients and Providers Act Reps. Raul Ruiz, MD (D-CA); Larry Bucshon, MD (R-IN); Ami Bera, MD (D-CA); Mariannette Miller-Meeks, MD (R-IA) Provides an annual Medicare physician payment update tied to inflation as measured by the Medicare Economic Index (MEI). HR 4968, the GOLD CARD Act of 2023 Reps Michael Burgess (R-TX); Vincente Gonzalez (D-TX) Exempts physicians who in the previous year received approval for at least 90 percent of their prior authorization requests, from the prior authorization approval process under Medicare Advantage plans. HR 6683: Preserving Seniors Access to Physicians Act Reps. Greg Murphy, MD (R-NC); Brad Wenstrup, DPM (R-OH); Michael Burgess, MD (R-TX); Larry Bucshon, MD (R-IN); Danny Davis (D-IL); Jimmy Panetta (D-CA) Prevents the full 3.4% Medicare physician fee schedule cuts from being implemented on January 1, 2024. Support implementation of the No Surprises Act (NSA) according to congressional intent The NSA aimed to fix the problem of unanticipated medical bills and remove patients from the middle of out-of-network billing disputes. However, the Administration crafted rules that disregard congressional intent and insurers are not being held accountable under current policies. HR 8702 and S 4532: Improving Seniors Timely Access to Care Act: To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. HR 8702--Mike Kelly (R-PA) and Susan DelBene (D-WA). S 4532--Sen. Sinema, Kyrsten (I-AZ) Sen. Thune, John (R-SD) Sen. Brown, Sherrod (D-OH) 06/13/2024 H.R.9001 - Physician Led and Rural Access to Quality Care Act: Reps Tony Cardenas(D-CA); Morgan Griffith (R-VA); Vicente Gonzalez (D-TX) To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals.

Client expense: $393,590 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 977/S 470: Patient Access to Higher Quality Health Act of 2023 Rep. Michael Burgess, MD (R-TX); Sen. James Lankford (R-OK) This bill repeals provisions under the Stark Law (i.e., the Physician Self-Referral Law) that limit, for purposes of Medicare participation, self-referrals by newly constructed or expanded physician-owned hospitals HR 2630/S 652: Safe Step Act Reps. Brad Wenstrup, DPM (R-OH); Raul Ruiz, MD (D-CA); Mariannette Miller-Meeks, MD (R-IA) Sens. Lisa Murkowski (R-AK); Maggie Hassan (D-NH); Roger Marshall, MD (R-KS) Requires group health plans to establish a clear and transparent process to request an exception to step therapy protocols in specified cases. Support reforming prior authorization Advocate for prior authorization policies that are more seamless, automated, and transparent for physicians and their patients. HR: 6545: Physician Fee Schedule Update and Improvements Act Reps. Mariannette Miller-Meeks (R-IA); Larry Bucshon ,MD (R-IN); Kim Schrier, MD (D-WA); Robin Kelly (D-IL), Michael Burgess, MD (R-TX); Greg Murphy, MD (R-NC), Brad Wenstrup, ,DPM (R-OH), Ami Bera, MD (D-CA), Tony Cardenas (D-CA); Raul Ruiz, MD (D-CA): Increases the budget neutrality from $20 million to $53 million would allow for greater flexibility in determining pricing adjustments for services without leading to harmful payment cuts for doctors.

Client expense: $393,590 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues regarding reimbursement for hospital services. Issues related to transparency. H.R. 2389 / S. 1302, Resident Physician Shortage Reduction Act of 2023 and issues related to Medicare graduate medical education residency positions. H.R. 5378, the Lower Costs, More Transparency Act. H.R. 977, Patient Access to Higher Quality Health Care Act of 2023. Issues regarding health care sector consolidation. Issues concerning cybersecurity. Issues related to remote care, including extension of Acute Care Hospital at Home program and telehealth flexibilities. H.R. 8261, Preserving Telehealth, Hospital, and Ambulance Access Act. H.R. 7623, Telehealth Modernization Act of 2024. Issues related to drug shortages.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

issues relating to hospitals and healthcare H.R.1129 To direct the Secretary of Health and Human Services to revise regulations to remove the requirement under the Medicare program that an off-campus facility or organization shall be located within a 35-mile radius of a hospital or critical access hospital; S.468 Hospital Transparency Compliance Enforcement Act; H.R.990,S 407 SAFE Hospitals Act of 2023; H.R.1565 Critical Access Hospital Relief Act of 2023; H.R.2530 & S1113 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act; H.R.977-S.470 Patient Access to Higher Quality Health Care Act of 2023; H.R.1475 Hospital Adoption Education Act of 2023; H.R.410 Health Care PRICE Transparency Act; H.R.3417 FAIR Act; HR 2859 Holding Nonprofit Hospitals Accountable Act; H.R.5007, S2657 GREEN Hospitals Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR2389/S1302 - Resident Physician Shortage Reduction Act S2333 - Public Health Workforce Loan Repayment Act Health Workforce Resilience Act S665/HR 4942 Conrad 30 and Physician Access Reauthorization Act CLIA Waiver CURES 2.0 To prevent across-the-board direct spending cuts Cytotechnologist labor rates Remote digital telepathology S 1000/HR 2377 SALSA HR 977 - legislation that would repeal provisions prohibiting self-referrals to new or expanded POHs. HR 1202/S 704 - REDI Act HR2761/S 705 - SPARC Act HR 2764/S1229 - Green New Deal for Health HR 3248 - Diagnostic Lab Testing Transparency Act H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023 Student loan repayment for FPs HR 4527 - HEALTH DATA Act Primary Care and Health Workforce Expansion Act S 1994 Counting Veterans Cancer Act HR 4875 Doctors in our Borders Act HR 2474 - Strengthening Medicare for Patients and Providers Act Continuing Appropriations Act, 2024 and Other Extensions Act Further Continuing Appropriations and Other Extensions Act, 2024 HR 6683 - Preserving Seniors Access to Physicians Act of 2023 Gene Therapy Precision Medicine Answers for Kids Today Act S.3018/H.R.3173 the Improving Seniors Timely Access to Care Act of 2021 Dr. Lorna Breen Health Care Provider Protection Act PREVAIL HR 6371 - budget neutrality bill EDUCATE Act - Murphy DEI Bill HR 2369 - VALID Act FDA final rule on LDTs Pandemic All-Hazards Preparedness Act H.R.9747, the Continuing Appropriations and Extensions Act, 2025 S.2140/H.R. 9474, the Patent Eligibility Restoration Act of 2023 S.1451 / H.R. 3120 - Healthy Competition for Better Care Act H.R. 9572 - Enhanced Enforcement of Health Coverage Act H.R. 6025/S. 3211 - Healthcare Workforce Resilience Act

Client expense: $193,594 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR2389/S1302 - Resident Physician Shortage Reduction Act S2333 - Public Health Workforce Loan Repayment Act Health Workforce Resilience Act S665/HR 4942 Conrad 30 and Physician Access Reauthorization Act CLIA Waiver PREVENT Pandemics Act CURES 2.0 To prevent across-the-board direct spending cuts Cytotechnologist labor rates Remote digital telepathology S 1000/HR 2377 SALSA S 2140 - Patient Eligibility Restoration Act HR 977 - legislation that would repeal provisions prohibiting self-referrals to new or expanded POHs. HR 1202/S 704 - REDI Act HR 2761 - SPARC act HR 2764/S1229 - Green New Deal for Health HR 3248 - Diagnostic Lab Testing Transparency Act H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023 Student loan repayment for FPs HR 4527 - HEALTH DATA Act Primary Care and Health Workforce Expansion Act S 1994 Counting Veterans Cancer Act HR 4875 Doctors in our Borders Act HR 2474 - Strengthening Medicare for Patients and Providers Act Continuing Appropriations Act, 2024 and Other Extensions Act Further Continuing Appropriations and Other Extensions Act, 2024 HR 6683 Gene Therapy Precision Medicine Answers for Kids Today Act S.3018/H.R.3173 the Improving Seniors Timely Access to Care Act of 2021 Dr. Lorna Breen Health Care Provider Protection Act PREVAIL HR 6371 - budget neutrality bill EDUCATE Act - Murphy DEI Bill

Client expense: $220,591 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 977/S470: Patient Access to Higher Quality Health Act of 2023. Rep. Michael Burgess (R-TX) Sen. James Lankford (R-OK). This bill repeals provisions under the Stark Law (i.e., the Physician Self-Referral Law) that limit, for purposes of Medicare participation, self-referrals by newly constructed or expanded physician-owned hospitals. HR 2630/S 652: Safe Step Act. Reps. Brad Wenstrup, DPM (R-OH); Raul Ruiz, MD (D-CA); Mariannette Miller-Meeks, MD (R-IA) Sens. Lisa Murkowski (R-AK); Maggie Hassan (D-NH); Roger Marshall, MD (R-KS). Requires group health plans to establish a clear and transparent process to request an exception to step therapy protocols in specified cases. Support reforming prior authorization. Advocate for prior authorization policies that are more seamless, automated, and transparent for physicians and their patients. HR: 6545: Physician Fee Schedule Update and Improvements Act. Reps. Mariannette Miller-Meeks (R-IA): Larry Bucshon, MD (R-IN); Kim Schrier, MD (D-WA); Robin Kelly (D-IL); Michael Burgess, MD (R-TX); Greg Murphy, MD (R-NC); Brad Wenstrup, DPM (R-OH); Ami Bera, MD (D-CA); Tony Cardenas (D-CA); Raul Ruiz, MD (D-CA). Increases the budget neutrality from $20 million to $53 million would allow for greater flexibility in determining pricing adjustments for services without leading to harmful payment cuts for doctors.

Client expense: $424,674 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 7513, Protecting America's Seniors Access to Care Act, all provisions; H.R. 468, Building Americas Health Care Workforce Act, all provisions; H.R. 8113, Transparency into State Directed Payments Act of 2024, all provisions; H.R. 8115, To amend title XIX of the Social Security Act to allow for the deferral or disallowance of portions of payments for certain managed care violations under Medicaid, all provisions; H.R. 1110, KEEP Telehealth Option Act, all provisions; H.R. 7711, Advancing Access to Telehealth Act, all provisions; H.R. 3432, Telemental Health Care Access Act, all provisions; H.R. 3875, the Expanded Telehealth Access Act, all provisions; H.R. 5611, Helping Ensure Access to Local Telehealth (HEALTH) Act of 2023, all provisions; H.R. 6033, Patient Education and Knowledge (SPEAK) Act of 2023, all provisions; H.R. 5541, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, all provisions; H.R. 7863, To require the Secretary of Health and Human Services to issue guidance on furnishing behavioral health services via telehealth to individuals with limited English proficiency under Medicare program, all provisions; H.R. 134, To amend title XVIII of the Social Security Act to remove geographic requirements and expand originating sites for telehealth services, all provisions; H.R. 8261, The Preserving Telehealth, Hospital, and Ambulance Access Act, Issues pertaining to Telehealth, Hospital at Home, and MDH-LVA; S.4350 / H.R. 8260, Hospital Inpatient Services, Modernization Act of 2024, all provisions; H.R. 8235, Rural Physician Workforce Preservation Act, all provisions; S. 2016/ H.R. 4189, The CONNECT for Health Act of 2023, Specifically telehealth waivers, geographic restrictions, originating site requirements, in person requirement behavioral health, RHCs and FQHCs access; S. 1110, the Rural Hospital Support Act, all provisions; S. 1673 / H.R. 1666, Protecting Access to Ground Ambulance Medical Services Act of 2023, all provisions; H.R. 6430, Assistance for Rural Community Hospitals (ARCH)Act, all provisions; S. 803, Save Rural Hospitals Act, all provisions; H.R. 4968, GOLD Card Act of 2023, all provisions; H.R. 3173 / S. 4532, Improving Seniors' Timely Access to Care, all provisions; H.R. 5013/S. 3503, Value in Health Care Act, all provisions; HR 2389/ S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions; Draft Bill, Graduate Medical Education Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; H.J.Res. 139 / S.J. Res 91, A joint resolution for congressional disapproval of a rule relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting", all provisions; HR 1565, Critical Access Hospital Relief Act of 2023, all provisions; H.R. 7623, Telehealth Modernization Act, Issues pertaining to Telehealth, Hospital at Home, Unique Health Identifier; H.R.1128, Rural Health Care Access Act of 2023, all provisions; S.1571, Rural Hospital Closure Relief Act of 2023, all provisions; S. 470 / H.R. 977, The Patient Access to Higher Quality Health Care Act, all provisions; Draft Bill, Keeping Obstetrics Local Act, all provisions;H.R.5378, Lower Costs, More Transparency Act, Issues related to site neutral payment cuts, hospital price transparency, unique health identifier, 340B Program; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for the inpatient psychiatric facility (IPF) prospective payment system (PPS), Issues pertaining to payment policy proposals for inpatient psychiatric facilities (IPFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for skilled nursing facility prospective payment system , Issues pertaining to payment policy proposals for skilled nursing facilities (SNFs); Centers for Medicare & Medicaid Services (CMS)FY25 proposed rule for inpatient rehabilitation facility prospective payment system, Issues pertaining to payment policy proposals for inpatient rehabilitation facilities (IRFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Hospital Inpatient Prospective Payment Systems , Issues pertaining to payment policy proposals for acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Long-Term Care Hospital Prospective Payment System, Issues pertaining to payment policy proposals for long term acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), Transforming Episode Accountability Model (TEAM), Deadline expansion and proposed mandatory alternative payment model; Centers for Medicare & Medicaid Services (CMS), Medicare Advantage Data RFI, Issues pertaining to enforcement and accountability of MA plans, prompt payment, gold carding, Standarization, penalties, and plan oversight; Centers for Medicare & Medicaid Services (CMS); Anomalous DME Spending in MSSP, accountable care models; Centers for Medicare & Medicaid Services (CMS), Accrediting Organizations (AO's), Feedback to strengthen accrediting organizations oversight; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees; Site Neutral Payments, for Q2 2024, Issues related to site neutral payment cuts for drug administration; Valued Based Care, for Q2 2024, Specifically on alternative payment models, MACRA reform, feedback on proposed TEAM model; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, and REHs; Physician Payments, Issues pertaining to proposed solutions to improve MACRA, alternative payment models, mental health of workforce; LTCH High Cost Outlier Threshold, Issues concerning High Cost Outlier in LTCH payment policy; Organ Transplant Model, Issues pertaining to Value Based Care; Rural Health Clinic Payments, Issues related to increasing payments for rural health clinics; Chronic Care Management, Issues pertaining to chronic care management for Medicare beneficiaries.

Client expense: $6,080,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Natl Drug Control Policy (NDCP), SENATE, White House Office