SPARC Act

Medicare Physician Payment Reform; in general; Mitigating cuts for Medicare Part B cuts; in general; Concerns regarding Expansion of Prior Authorization in Medicare FFS; H.R. 879/S. 1640, the Medicare Patient Access and Practice Stabilization Act; H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act; H.R. 3514/S.1816, the Improving Seniors Timely Access to Care Act; H.R. 539/S. 106, the Chiropractic Medicare Coverage Modernization Act; H.R. 4731/S. 2439, Resident Physician Shortage Reduction Act; H.R. 4681/S. 1380, the Specialty Physicians Advancing Rural Care (SPARC) Act; H.R. 7520, the Efficiency Adjustment Delay Act; H.R. 1616/S. 1805, the Promoting Access to Diabetic Shoes Act; H.R. 8163, the Provider Reimbursement Stability Act of 2026 Expansion of Physician Workforce/surgical workforce shortages; in general H.R. 9963, the Patients First Act H.R. 8500/S. 5475, the Timely Access to Coverage Decisions Act Issues relating to the CY2027 Medicare Physician Fee Schedule Proposed Rule

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

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

Preserving Federal Loan Access for Physicians and Other Health Professionals Under OBBBA Implementation; S. 942/H.R. 2028, the Resident Education Deferred Interest (REDI) Act; H.R. 4681/S. 1380, the Specialty Physicians Advancing Rural Care (SPARC) Act Expansion of Physician Workforce/surgical workforce shortages; in general

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

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

H.R.1 - An act to provide for reconciliation pursuant to title II of H. Con. Res. 14 (PL 119-21), provisions related to student loans H.R.2028 - REDI Act, all provisions H.R.2314 - FAIR Act, all provisions H.R.3890 - Resident Physician Shortage Reduction Act of 2025, all provisions H.R.4681 - SPARC Act, all provisions H.R.4731 - Resident Physician Shortage Reduction Act of 2025, all provisions H.R.6468 - Rural Residency Planning and Development Act of 2025, all provisions S.1380 - SPARC Act, all provisions S.2439 - Resident Physician Shortage Reduction Act of 2025, all provisions S.2715 - FAIR Act of 2025, all provisions S.942 - REDI Act, all provisions Comment Letter: [ED-2025-OPE-1042-0002] Accreditation, Innovation, and Modernization: Secretary's Recognition of Accrediting Agencies: Institutional Eligibility under the Higher Education Act, as Amended, Student Assistance General Provisions Matters related to GME funding/teaching health centers Matters related to the National Health Service Corps (NHSC)/loan repayment programs Matters related to the National Resident Matching Program (MATCH) and foreign international medical graduates Matters related to the NHSC Scholarship program Matters related to Student Loans Matters related to caps on GME Matters related to J-1 visa sponsorship of international medical graduates

Client expense: $4,540,000 · Firm income: Not reported

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

H.R.2028/S.942, Resident Education Deferred Interest (REDI) Act. H.R.4681/S.1380, Specialty Physicians Advancing Rural Care (SPARC) Act. H.R.4731/S.2439, Resident Physician Shortage Reduction Act of 2025. Commented to Office of Management and Budget Director Russell Vought on July 13, 2026, regarding regulation for Federal Financial Assistance [OMB-2026-0034].

Client expense: $388,538 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

Issues related to Medicare physician payment, specifically proposed changes by CMS to reimbursement for services provided on the same day using Modifier 25. H.R.539/S.106, Chiropractic Medicare Coverage Modernization Act of 2025. H.R.879/S.1640, Medicare Patient Access and Practice Stabilization Act of 2025. H.R.929/S.266, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act. H.R.2028/S.942, Resident Education Deferred Interest (REDI) Act. H.R.2191/S.1390, Physician Led and Rural Access to Quality Care Act. H.R.2433, Reducing Medically Unnecessary Delays in Care Act of 2025. H.R.2757/S.1996, Medicare Audiology Access Improvement Act of 2025. H.R.3006/S.1776, Medicare Beneficiary Co-Pay Fairness Act. H.R.3164/S.2426, Ensuring Community Access to Pharmacist Services (ECAPS) Act. H.R.3170/S.3296, Improving Access to Workers' Compensation for Injured Federal Workers Act. H.R.3277/S.1677, Ensuring Lasting Smiles Act. H.R.3514/S.1816, Improving Seniors' Timely Access to Care Act of 2025. H.R.4002, Patient Access to Higher Quality Health Care Act of 2025. H.R.4206/S.1261, CONNECT for Health Act of 2025. H.R.4331, Access to Claims Data Act. H.R.4606/S.3400, Allys Act. H.R.4681/S.1380, Specialty Physicians Advancing Rural Care (SPARC) Act. H.R.4710/S.2420, No Surprises Act Enforcement Act. H.R.4731/S.2439, Resident Physician Shortage Reduction Act of 2025. H.R.5435/S.2842, Stop CMV Act of 2025. H.R.5509/S.2903, Safe Step Act. H.R. 5736, Penicillin Allergy Verification and Evaluation (PAVE) Act. H.R.6160, Strengthening Medicare for Patients and Providers Act. H.R. 7520, Efficiency Adjustment Delay Act. H.R.8163/S.5180, Provider Reimbursement Stability Act of 2026. H.R.9237, Take Care of Americas Veterans Act. H.R.9260, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2027. H.R.9693, Patients First Act of 2026. S.1105, No UPCODE Act. Commented to Office of Management and Budget Director Russell Vought on July 13, 2026, regarding regulation for Federal Financial Assistance [OMB-2026-0034]. Commented to Centers for Medicare & Medicaid Services Administrator Mehmet Oz on August 21, 2026, regarding CY 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Extended HH Value-Based Purchasing Model; Medicare Provider Enrollment, Durable Medical Equipment (DME), and DME, Prosthetics, Orthotics, and Supplies (DMEPOS) Policies [CMS-1844-P]. Commented to Centers for Medicare & Medicaid Services Administrator Mehmet Oz on September 11, 2026, regarding CY 2027 Medicare Physician Fee Schedule and Quality Payment Program proposed rule [CMS-1848-P]. Submitted statement for the record supporting H.R. 4331, the "Access to Claims Data Act," on September 15, 2026, at the House Energy and Commerce Health Subcommittee hearing: "Examining Legislative Proposals to Reform Medicare Provider Payment and Bolster Health Care Cybersecurity."

Client expense: $388,538 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

The One Big Beautiful Bill Act, H.R. 1; Medicare physician payment including, the Medicare Patient Access and Practice Stabilization Act (H.R. 879); the Strengthening Medicare for Patients and Providers Act (H.R. 6160), the Provider Reimbursement Stability Act (S. 4935); the Provider Reimbursement Stability Act (H.R. 8163/S. 5180); and the Efficiency Adjustment Delay Act (H.R. 7520); new/alternative payment models; Medicare coverage, hospital payment of cardiovascular services; access to Medicare claims data; physician and hospital quality; Quality Payment Program; clinical data registries; health care quality; medical imaging and prior authorization; the Stark Law and the in-office ancillary services exception; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; graduate medical education policy including the Resident Physician Shortage Reduction Act (H.R. 3890/S. 2439); provide a specialty physician loan repayment program with the SPARC Act (H.R 4681/S. 1380); provide deferred interest payments for residents on student loans with the Resident Education Deferred Interest (REDI) Act (H.R. 2028/S. 942); oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; physician-owned hospital policy including the Physician Led Rural Access to Quality Care Act (H.R. 2191/S. 1390) and the Patient Access to Higher Quality Health Care Act (H.R. 4002); COVID-19 public health emergency and the implementation of the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security Act; implementation of the Protecting Medicare and American Farmers from Sequester Cuts Act; Increasing Access to Quality Cardiac Rehabilitation Care Act; the expansion of telehealth services, including the CONNECT for Health Act (H.R. 41894206/S. 1261), the Sustainable Cardiopulmonary Rehabilitation Services in the Home At (H.R. 783/S. 248), and the Telehealth Modernization Act (H.R. 5081/S. 2709); Improving maternal health, including Connected Maternal Online Monitoring Act (Connected MOM Act) (H.R. 4977/S. 141), Preventing Maternal Deaths Reauthorization Act of 2025 (H.R. 1909), and Rural Obstetrics Readiness Act (H.R. 1254/S. 380), and the Womens Heart Health Expansion Act (H.R. 7417/S. 3944) ; prior authorization reform, including the Improving Seniors Timely Access to Care Act (H.R. 3514/S. 1816), the Reducing Medically Unnecessary Delays in Care Act (H.R. 2433), and the Safe Step Act (H.R. 5509/S. 2903); clinician-led registry access to federal claims data, including the Access to Claims Data Act (H.R. 4331); and expanding in home prescribing coverage provided in the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2025 (H.R. 6894/S. 717), Centers for Medicare and Medicaid Innovation payment models, including the Ambulatory Specialty Model for Heart Failure.

Client expense: $600,000 · 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), SENATE

Graduate Medical Education Certified Anesthesiologist Assistants Anesthesia workforce shortages HR 3890, Resident Physician Shortage Reduction Act of 2025: residency positions S.709, Conrad State 30 and Physician Access Reauthorization Act: Foreign physician immigration status S. 1380, Specialty Physicians Advancing Rural Care (SPARC) Act: physician shortages in rural areas HR 2028; Resident Education Deferred Interest Act (REDI Act): Student loan relief Anesthesia Research Funding Scope of Practice Merit-based Incentive Payment System, MIPS, MIPS Value Pathway Quality Payment Program, QPP Alternative Payment Model, APM QCDR - Qualified Clinical Data Registry Evaluation and Monitoring codes & cuts Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Brain health CMS Interpretive Guidelines: Hospital Conditions of Participation Related to Anesthesia Services Conditions of Participation - Anesthesia services, opt-outs, supervision CMS: Federal Independent Dispute Resolution (IDR) Process, Batching H.R.27, HALT Fentanyl Act: fentanyl scheduling and registration requirements H.R. 1227/S.475, Alternatives to PAIN Act of 2025: access to non-opioid pain management options Pain Medicine Prescription Drug Abuse CDC Opioid Prescribing Guideline H.R. 3595, Safe Prescribing Through Reporting Act of 2025: disclosure of certain records relating to substance use disorder medications to State prescription drug monitoring programs Drug shortages DEA Scheduling Propofol FDA Safe Use Initiative FDA Operating Room Fires FDA Opioids FDA Network of Experts FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) USP - US Pharmacopeia Compounding NIH Interagency Pain Research Coordinating Committee NIH: Funding, Indirect Costs, Indirect Grants, Overhead Agency for Healthcare Research and Quality (AHRQ) funding Long COVID research 21st Century Cures Initiative Out of Network/Out of Network Payment Network Adequacy Pre-authorization; prior authorization Insurance reform, shared savings, insurer accountability Affordable Care Act reform efforts Provider Nondiscrimination Change Healthcare, Change Healthcare data breach HR 292 Lorna Breen Reauthorization H.R. 3178, SAVE Healthcare Workers Act: To protect hospital personnel from violence, and for other purposes Maternal Mortality/Maternal Care Deserts Blood management 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care S. 2759/H.R. 5283, the Healthcare Workforce Resilience Act, Exemption for Physicians from New H-1B Visa Policy and $100,000 Fee Medical journal fees No Surprises Act (NSA) - H.R.4710 / S. 2420, the No Surprises Enforcement Act H.R. 3164, the Ensuring Community Access to Pharmacist Services Act Advance Premium Tax Credits (APTCs) Federal regulation of commercial health insurance companies One Big Beautiful Bill (OBBB) Commercial payer/payment H.R.7961: H-1Bs for Physicians and the Healthcare Workforce Act S.3822: Breaking Up Big Medicine Act H.R. 4681: Specialty Physicians Advancing Rural Care (SPARC) Act Low-carbon anesthesia OMB Proposed Rule on federal funding / grants U.S. Departments of State and Homeland Security Visa delays Venezuelan patients Pain management in C-sections DEA Regulations Controlled Substances Act Amendments

Client expense: $270,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Medicare physician reimbursement and the importance of long-term structural reform to the reimbursement system, including the Provider Reimbursement Stability Act (H.R. 8163), the Strengthening Medicare for Patients and Providers Act (H.R. 6160) and the Efficiency Adjustment Delay Act (H.R. 7520) The Safe Step Act (H.R. 5509/S. 2903) requires group health plans regulated by the Employee Retirement Income Security Act (ERISA) to provide a clear exception process for any medication step therapy protocol. The Specialty Physicians Advancing Rural Care (SPARC) Act (S. 1380; H.R. 4681), a bill designed to increase access to specialty care services in rural areas. Expanding the definition of a preventive service to surveillance colonoscopy. Efforts to secure appropriations language that guides action at the U.S. Department of Health and Human Services. Opposing National Institutes of Health (NIH) research cuts.

Client expense: $218,460 · Firm income: Not reported

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act (HR 929 / S 266) Medicare Patient Access and Practice Stabilization Act (HR 879/ S.1640) Reducing Medically Unnecessary Delays in Care Act (HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resident Physician Shortage Reduction Act (HR.3890/S. 2439) Improving Seniors Timely Access to Care Act (S. 1816/HR. 3514) One Big Beautiful Bill Act (HR. 1) Safe Step Act (HR 5509/S. 668) Patient Access to Autoimmune Treatment, PAAT, Act (HR. 5467) Protecting Patient Access to Cancer and Complex Therapies Act (HR 4299) PBM Reform Act of 2025 (HR 4317) Workforce Mobility Act (S.2031) Specialty Physicians Advancing Rural Care, SPARC, Act (H.R 4681/S. 1380) Connect for Health Act of 2025 (HR 2406/S. 1261) Telehealth Modernization Act (HR 5081/S 2709) House Concurrent Res. 14 establishing congressional budget for FY2025 Department of Labor, HHS, and Education Appropriations Act (S. 2587) Department of Defense Appropriations Act (HR 4016/S. 2572) Seniors Deserve SMARTER Care Act (HR 5940) A bill to require private plans to provide for e-prior auth for drugs (S. 4349) Patient Access to Higher Quality Health Care Act (HR 4002) Biosimilar Red Tape Elimination Act (HR 5526/S. 1954) Medical Foods and Formulas Access Act (HR 5684) Physician Led and Rural Access to Quality Care Act (HR 2191/S. 1390) Claims Data Act, H.R. 4331 Rural Residency Planning and development Act of 2025, H.R. 6468 To exempt H-1B health care workers from the restriction under the Presidential Proclamation entitled "Restriction on Entry of Certain Nonimmigrant Workers", and for other purposes, H.R. 7961 Provider Reimbursement Stability Act, H.R. 8163 PBM Fiduciary Accountability, Integrity, and Reform (FAIR) Act, S.3549 Chronic Care Management Act of 2026ﾠHR 8261 Prior Authorization Reform for Autoimmune & Blood Disorders ActﾠHR 9192 Patient Access to Autoimmune Treatments ActﾠHR 5467

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act (HR 929 / S 266) Medicare Patient Access and Practice Stabilization Act (HR 879/ S.1640) Reducing Medically Unnecessary Delays in Care Act (HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resident Physician Shortage Reduction Act (HR.3890/S. 2439) Improving Seniors Timely Access to Care Act (S. 1816/HR. 3514) One Big Beautiful Bill Act (HR. 1) Safe Step Act (HR 5509/S. 668) Patient Access to Autoimmune Treatment, PAAT, Act (HR. 5467) Protecting Patient Access to Cancer and Complex Therapies Act (HR 4299) PBM Reform Act of 2025 (HR 4317) Workforce Mobility Act (S.2031) Specialty Physicians Advancing Rural Care, SPARC, Act (H.R 4681/S. 1380) Connect for Health Act of 2025 (HR 2406/S. 1261) Telehealth Modernization Act (HR 5081/S 2709) House Concurrent Res. 14 establishing congressional budget for FY2025 Department of Labor, HHS, and Education Appropriations Act (S. 2587) Department of Defense Appropriations Act (HR 4016/S. 2572) Seniors Deserve SMARTER Care Act (HR 5940) A bill to require private plans to provide for e-prior auth for drugs (S. 4349) Patient Access to Higher Quality Health Care Act (HR 4002) Biosimilar Red Tape Elimination Act (HR 5526/S. 1954) Medical Foods and Formulas Access Act (HR 5684) Physician Led and Rural Access to Quality Care Act (HR 2191/S. 1390) Claims Data Act, H.R. 4331 Rural Residency Planning and development Act of 2025, H.R. 6468 To exempt H-1B health care workers from the restriction under the Presidential Proclamation entitled "Restriction on Entry of Certain Nonimmigrant Workers", and for other purposes, H.R. 7961 Provider Reimbursement Stability Act, H.R. 8163 PBM Fiduciary Accountability, Integrity, and Reform (FAIR) Act, S.3549 Chronic Care Management Act of 2026ﾠHR 8261 Prior Authorization Reform for Autoimmune & Blood Disorders ActﾠHR 9192 Patient Access to Autoimmune Treatments ActﾠHR 5467

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act (HR 929 / S 266) Medicare Patient Access and Practice Stabilization Act (HR 879/ S.1640) Reducing Medically Unnecessary Delays in Care Act (HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resident Physician Shortage Reduction Act (HR.3890/S. 2439) Improving Seniors Timely Access to Care Act (S. 1816/HR. 3514) One Big Beautiful Bill Act (HR. 1) Safe Step Act (HR 5509/S. 668) Patient Access to Autoimmune Treatment, PAAT, Act (HR. 5467) Protecting Patient Access to Cancer and Complex Therapies Act (HR 4299) PBM Reform Act of 2025 (HR 4317) Workforce Mobility Act (S.2031) Specialty Physicians Advancing Rural Care, SPARC, Act (H.R 4681/S. 1380) Connect for Health Act of 2025 (HR 2406/S. 1261) Telehealth Modernization Act (HR 5081/S 2709) House Concurrent Res. 14 establishing congressional budget for FY2025 Department of Labor, HHS, and Education Appropriations Act (S. 2587) Department of Defense Appropriations Act (HR 4016/S. 2572) Seniors Deserve SMARTER Care Act (HR 5940) A bill to require private plans to provide for e-prior auth for drugs (S. 4349) Patient Access to Higher Quality Health Care Act (HR 4002) Biosimilar Red Tape Elimination Act (HR 5526/S. 1954) Medical Foods and Formulas Access Act (HR 5684) Physician Led and Rural Access to Quality Care Act (HR 2191/S. 1390) Claims Data Act, H.R. 4331 Rural Residency Planning and development Act of 2025, H.R. 6468 To exempt H-1B health care workers from the restriction under the Presidential Proclamation entitled "Restriction on Entry of Certain Nonimmigrant Workers", and for other purposes, H.R. 7961 Provider Reimbursement Stability Act, H.R. 8163 PBM Fiduciary Accountability, Integrity, and Reform (FAIR) Act, S.3549 Chronic Care Management Act of 2026ﾠHR 8261 Prior Authorization Reform for Autoimmune & Blood Disorders ActﾠHR 9192 Patient Access to Autoimmune Treatments ActﾠHR 5467

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

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

The One Big Beautiful Bill Act, H.R. 1; Medicare physician payment including, the Medicare Patient Access and Practice Stabilization Act (H.R. 879); the Strengthening Medicare for Patients and Providers Act (H.R. 6160), the Provider Reimbursement Stability Act (S. 4935); the Provider Reimbursement Stability Act (H.R. 8163); and the Efficiency Adjustment Delay Act (H.R. 7520); new/alternative payment models; Medicare coverage, hospital payment of cardiovascular services; access to Medicare claims data; physician and hospital quality; Quality Payment Program; clinical data registries; health care quality; medical imaging and prior authorization; the Stark Law and the in-office ancillary services exception; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; graduate medical education policy including the Resident Physician Shortage Reduction Act (H.R. 3890/S. 2439); provide a specialty physician loan repayment program with the SPARC Act (H.R 4681/S. 1380); provide deferred interest payments for residents on student loans with the Resident Education Deferred Interest (REDI) Act (H.R. 2028/S. 942); oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; physician-owned hospital policy including the Physician Led Rural Access to Quality Care Act (H.R. 2191/S. 1390) and the Patient Access to Higher Quality Health Care Act (H.R. 4002); COVID-19 public health emergency and the implementation of the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security Act; implementation of the Protecting Medicare and American Farmers from Sequester Cuts Act; Increasing Access to Quality Cardiac Rehabilitation Care Act; the expansion of telehealth services, including the CONNECT for Health Act (H.R. 41894206/S. 1261), the Sustainable Cardiopulmonary Rehabilitation Services in the Home At (H.R. 783/S. 248), and the Telehealth Modernization Act (H.R. 5081/S. 2709); Improving maternal health, including Connected Maternal Online Monitoring Act (Connected MOM Act) (H.R. 4977/S. 141), Preventing Maternal Deaths Reauthorization Act of 2025 (H.R. 1909), and Rural Obstetrics Readiness Act (H.R. 1254/S. 380), and the Womens Heart Health Expansion Act (H.R. 7417/S. 3944) ; prior authorization reform, including the Improving Seniors Timely Access to Care Act (H.R. 3514/S. 1816), the Reducing Medically Unnecessary Delays in Care Act (H.R. 2433), and the Safe Step Act (H.R. 5509/S. 2903); clinician-led registry access to federal claims data, including the Access to Claims Data Act (H.R. 4331); and expanding in home prescribing coverage provided in the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2025 (H.R. 6894/S. 717), Centers for Medicare and Medicaid Innovation payment models.

Client expense: $680,000 · 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), SENATE

H.R. 929/S.266 - Lorna Breen Health Care Provider Protection Reauthorization H.R. 593 - Strengthening Pathways to Health Professions Act H.R. 879/S.1640 - Medicare Patient Access and Practice Stabilization Act H.R. 1153 - Rural America Health Corps Act H.R. 1227/S.475 - Alternatives to Prevent Addiction in the Nation (Alternatives to PAIN) Act H.R. 1735/S.779 - EARLY Minds Act H.R. 1448 - PEER for Mental Health Act H.R. 1585/S.709 - Conrad State 30 and Physician Access Reauthorization Act H.R. 1909/S.2621 - Preventing Maternal Deaths Reauthorization Act of 2025 H.R. 957 - Parity Enforcement Act H.R. 2509/S.931 - COMPLETE Care Act H.R. 4206/S.1261 - CONNECT for Health Act H.R. 1305 - Improving Measurements for Loneliness and Isolation Act H.R. 1902 - Helping Emergency Responders Overcome (HERO) Act H.R. 2223 - Building Capacity for Care Act H.R. 2586 - Reentry Act of 2025 H.R. 3884/S.2011 - Telemental Health Care Access Act of 2025 H.R. 3266/S.1673 - Mental Health Infrastructure Improvement Act of 2025 H.R. 4619 - Medicare Mental Health Inpatient Equity Act S. 1062 - Suicide Prevention Act H.R. 912 - 9-8-8 Lifeline Cybersecurity Act H.R. 2587 - Youth Mental Health Research Act H.R. 2483/S.2121 - SUPPORT for Patients and Communities Reauthorization Act of 2025 H.R. 2630 - Youth Suicide Prevention Research Act H.R. 3655 - STAR Plus Scholarship Act H.R. 3890/S. 2439 - Resident Physician Shortage Reduction Act of 2025 H.R. 3885/S.3989 - Community TEAMS Act H.R. 1867 - To amend title XVIII of the Social Security Act to remove in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology H.R. 3164 - Ensuring Community Access to Pharmacist Services (ECAPS) Act H.R. 4681/S. 1379 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 4723/S. 2446 - Mental Health for Latinos Act Conversations with Congressional offices on Teaching Health Center Graduate Medical Education (THCGME) H.R.3505 - Barriers to Suicide Act H.R.6249 - Addressing Addiction After Disasters Act H.R.7394/S.3783 - Mental Health Career Promotion Act H.R. 5074 - Protecting Young Minds Online Act H.R. 5434/S. 2826 - 988 LGBTQ+ Youth Access Act H.R.5509 /S.2903 - Safe Step Act H.R. 5557 - Mental Health Services for Students Act H.R.1197 - PREEMIE Reauthorization Act of 2025 H.R. 3514/S.1816 - Improving Seniors Timely Access to Care Act H.Res.792 - Youth Mental Health Day and Suicide Prevention Day Resolution H.R.5725 - Mental Health Crisis Response Act of 2025 H.R.5706 - Mental Health Emergency Responder Act S. 3064 - Relief of Chronic Pain Act H.R. 6226 - Latino Youth Mental Health Empowerment Act H.R. 5482 - Prevent Youth Suicide Act H.R.6672 - Mental Health Professionals Workforce Shortage Loan Repayment Act Letter to Letter to Department of Labor, Department of Health and Human Services, and Department of Treasury regarding mental health parity enforcement H.R. 3492 - Protect Children's Innocence Act H.R. 498 - Do No Harm in Medicaid Act H.R. 6817/ S. 1056 - Home-Based Telemental Health Care Act Communication with Congressional offices on SAMHSA grant terminations Input on Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) modernization Communication with Congressional offices on ghost networks S. 3486 - Expand the Behavioral Health Workforce Now Act H.R.7324/S. 683 - More Behavioral Health Providers Act H.R. 786/S. 1460 - Preserving Patient Access to Accountable Care Act H.R. 4331 - Access to Claims Data Act H.R.5281 - REAL Health Providers Act H.R.7875 - Providing Opportunities for Individuals in Need of Treatment and Support (POINTS) Act Letter to Congress on Agency for Healthcare Research and Quality (AHRQ) funding H.R. 6396 - Kid PROOF Act H.R. 6468 - Rural Residency Planning and Development Act of 2025 H.R. 8234 - Save Money, Save Lives Act H.R.7092 - RAYS Act H.R.7787 - Mental Health Workforce Act Letter in support of funding for gun violence prevention research at CDC, NIH and NIJ. S.4076 - Removing Medicare Mental Health Inpatient Limitations Act of 2026 Letter supporting funding for Maternal Mental Health and Substance Use Disorder Programs (MMHSUD) and National Maternal Mental Health Hotline. H.R. 5629 - To provide that the final rule of the Department of Health and Human Services titled Medications for the Treatment of Opioid Use Disorder except for the portion of the final rule relating to accreditation of opioid treatment programs, shall have no force or effect H.R. 7994 - The HERO Act H.R. 8124 - STOP Suicide Act S.1924 / H.R.3624 - Improving Mental Health Access for Students Act H.R.8261 - Chronic Care Management Act Letter in support of funding for the Pediatric Mental Health Care Access program H.R. 8201 - Expanding Community Access to Health Services Act Letter supporting increased funding for Childrens Hospital Graduate Medical Education Letter expressing concerns over H.R. 5629 and H.R. 5630 S. 1874 - Title VIII Nursing Workforce Reauthorization Act of 2025 S. 4110 - EMPOWER for Health Act H.R. 9044 - Minority Fellowship Program Reauthorization Act of 2026 H.R. 8163 - Provider Reimbursement Stability Act H.R.8961 - Student Suicide Prevention Awareness Act H.Res.1329 - Expressing support for the designation of May 2026 as Mental Health Awareness Month H.R.8989 - Evidence-Based Youth Suicide Prevention Act of 2026 H.R.8122/ S.4640 - 9-8-8 Connect Act H.R.8811/S.4552 - Moms Matter Act H.R.9257 - Primary and Behavioral Health Care Access Act H.R.8487/S.3401 - Ensuring Excellence in Mental Health Act Joint letter to SAMHSA regarding the planned removal of SAMHSAs buprenorphine practitioner locator and pharmacy locator.

Client expense: $137,391 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of

H.R.2028 - REDI Act, all provisions H.R.2314 - FAIR Act, all provisions H.R.3890 - Resident Physician Shortage Reduction Act of 2025, all provisions H.R.4681 - SPARC Act, all provisions H.R.4731 - Resident Physician Shortage Reduction Act of 2025, all provisions H.R.6468 - Rural Residency Planning and Development Act of 2025, all provisions S.1380 - SPARC Act, all provisions S.2439 - Resident Physician Shortage Reduction Act of 2025, all provisions S.2715 - FAIR Act of 2025, all provisions S.942 - REDI Act, all provisions GME funding/teaching health centers National Health Service Corps (NHSC)/loan repayment programs National Resident Matching Program (MATCH) and foreign international medical graduates NHSC Scholarship program Student Loans

Client expense: $5,130,000 · Firm income: Not reported

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

H.R.2028 - REDI Act, all provisions H.R.2314 - FAIR Act, all provisions H.R.3890 - Resident Physician Shortage Reduction Act of 2025, all provisions H.R.4681 - SPARC Act, all provisions H.R.4731 - Resident Physician Shortage Reduction Act of 2025, all provisions H.R.6468 - Rural Residency Planning and Development Act of 2025, all provisions S.1380 - SPARC Act, all provisions S.2439 - Resident Physician Shortage Reduction Act of 2025, all provisions S.2715 - FAIR Act of 2025, all provisions S.942 - REDI Act, all provisions GME funding/teaching health centers National Health Service Corps (NHSC)/loan repayment programs National Resident Matching Program (MATCH) and foreign international medical graduates NHSC Scholarship program Student Loans

Client expense: $513,000 · Firm income: Not reported

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

Graduate Medical Education Certified Anesthesiologist Assistants Anesthesia workforce shortages HR 3890, Resident Physician Shortage Reduction Act of 2025: residency positions S.709, Conrad State 30 and Physician Access Reauthorization Act: Foreign physician immigration status S. 1380, Specialty Physicians Advancing Rural Care (SPARC) Act: physician shortages in rural areas HR 2028; Resident Education Deferred Interest Act (REDI Act): Student loan relief Anesthesia Research Funding Scope of Practice Merit-based Incentive Payment System, MIPS, MIPS Value Pathway Quality Payment Program, QPP Alternative Payment Model, APM QCDR - Qualified Clinical Data Registry Evaluation and Monitoring codes & cuts Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Brain health CMS Interpretive Guidelines: Hospital Conditions of Participation Related to Anesthesia Services Conditions of Participation - Anesthesia services, opt-outs, supervision CMS: Federal Independent Dispute Resolution (IDR) Process, Batching H.R.27, HALT Fentanyl Act: fentanyl scheduling and registration requirements H.R. 1227/S.475, Alternatives to PAIN Act of 2025: access to non-opioid pain management options Pain Medicine Prescription Drug Abuse CDC Opioid Prescribing Guideline H.R. 3595, Safe Prescribing Through Reporting Act of 2025: disclosure of certain records relating to substance use disorder medications to State prescription drug monitoring programs Drug shortages DEA Scheduling Propofol FDA Safe Use Initiative FDA Operating Room Fires FDA Opioids FDA Network of Experts FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) USP - US Pharmacopeia Compounding NIH Interagency Pain Research Coordinating Committee NIH: Funding, Indirect Costs, Indirect Grants, Overhead Agency for Healthcare Research and Quality (AHRQ) funding Long COVID research 21st Century Cures Initiative Out of Network/Out of Network Payment Network Adequacy Pre-authorization; prior authorization Insurance reform, shared savings, insurer accountability Affordable Care Act reform efforts Provider Nondiscrimination Change Healthcare, Change Healthcare data breach HR 292 Lorna Breen Reauthorization H.R. 3178, SAVE Healthcare Workers Act: To protect hospital personnel from violence, and for other purposes Maternal Mortality/Maternal Care Deserts Blood management 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care S. 2759/H.R. 5283, the Healthcare Workforce Resilience Act, Exemption for Physicians from New H-1B Visa Policy and $100,000 Fee Medical journal fees No Surprises Act (NSA) - H.R.4710 / S. 2420, the No Surprises Enforcement Act H.R. 3164, the Ensuring Community Access to Pharmacist Services Act Advance Premium Tax Credits (APTCs) Federal regulation of commercial health insurance companies One Big Beautiful Bill (OBBB) Commercial payer/payment H.R.7961: H-1Bs for Physicians and the Healthcare Workforce Act S.3822: Breaking Up Big Medicine Act H.R. 4681: Specialty Physicians Advancing Rural Care (SPARC) Act Low-carbon anesthesia OMB Proposed Rule on federal funding / grants U.S. Departments of State and Homeland Security Visa delays Venezuelan patients Pain management in C-sections

Client expense: $270,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Issues related to Medicare physician payment. H.R.539/S.106, Chiropractic Medicare Coverage Modernization Act of 2025. H.R.879/S.1640, Medicare Patient Access and Practice Stabilization Act of 2025. H.R.929/S.266, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act. H.R.2028/S.942, Resident Education Deferred Interest (REDI) Act. H.R.2191/S.1390, Physician Led and Rural Access to Quality Care Act. H.R.2433, Reducing Medically Unnecessary Delays in Care Act of 2025. H.R.2757/S.1996, Medicare Audiology Access Improvement Act of 2025. H.R.3006/S.1776, Medicare Beneficiary Co-Pay Fairness Act. H.R.3164, Ensuring Community Access to Pharmacist Services (ECAPS) Act. H.R.3170, Improving Access to Workers' Compensation for Injured Federal Workers Act. H.R.3277/S.1677, Ensuring Lasting Smiles Act. H.R.3514/S.1816, Improving Seniors' Timely Access to Care Act of 2025. H.R.4002, Patient Access to Higher Quality Health Care Act of 2025. H.R.4206/S.1261, CONNECT for Health Act of 2025. H.R.4331, Access to Claims Data Act. H.R.4606/S.3400, Ally's Act. H.R.4681/S.1380, Specialty Physicians Advancing Rural Care (SPARC) Act. H.R.4710/S.2420, No Surprises Act Enforcement Act. H.R.4731/S.2439, Resident Physician Shortage Reduction Act of 2025. H.R.5435/S.2842, Stop CMV Act of 2025. H.R.5509/S.2903, Safe Step Act. H.R.5736, Penicillin Allergy Verification and Evaluation (PAVE) Act. H.R.6160, Strengthening Medicare for Patients and Providers Act. H.R.7520, Efficiency Adjustment Delay Act. H.R.8163, Provider Reimbursement Stability Act of 2026. H.R.9237, Take Care of America's Veterans Act. H.R.9260, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2027. S.1105, No UPCODE Act. Commented on May 20, 2026, House Energy and Commerce Health Subcommittee hearing regarding Medicare Physician Fee Schedule, MACRA, and opportunities for payment reforms. Provided comments to Representatives Greg Murphy, MD; John Joyce, MD; and Kim Schrier, MD; regarding their April 23 discussion draft of legislation to modernize the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Provided comments to Representatives Greg Murphy, MD; John Joyce, MD; and Kim Schrier, MD; urging them to include provisions in their physician payment reform legislation that would address the impending cut to the Medicare Physician Fee Schedule scheduled to take effect in 2027 and address the efficiency adjustment cuts expected to continue on an indefinite three-year cycle.

Client expense: $286,331 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.2028/S.942, Resident Education Deferred Interest (REDI) Act. H.R.4681/S.1380, Specialty Physicians Advancing Rural Care (SPARC) Act. H.R.4731/S.2439, Resident Physician Shortage Reduction Act of 2025.

Client expense: $286,331 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Preserving Federal Loan Access for Physicians and Other Health Professionals Under OBBBA Implementation; S. 942/H.R. 2028, the Resident Education Deferred Interest (REDI) Act; H.R. 4681/S. 1380, the Specialty Physicians Advancing Rural Care (SPARC) Act Expansion of Physician Workforce/surgical workforce shortages; in general

Client expense: $70,000 · Firm income: Not reported

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

Medicare Physician Payment Reform; in general; Mitigating cuts for Medicare Part B cuts; in general; Concerns regarding Expansion of Prior Authorization in Medicare FFS; H.R. 879/S. 1640, the Medicare Patient Access and Practice Stabilization Act; H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act; H.R. 3514/S.1816, the Improving Seniors Timely Access to Care Act; H.R. 539/S. 106, the Chiropractic Medicare Coverage Modernization Act; H.R. 4731/S. 2439, Resident Physician Shortage Reduction Act; H.R. 4681/S. 1380, the Specialty Physicians Advancing Rural Care (SPARC) Act; H.R. 7520, the Efficiency Adjustment Delay Act; H.R. 1616/S. 1805, the Promoting Access to Diabetic Shoes Act; H.R. 8163, the Provider Reimbursement Stability Act of 2026 Expansion of Physician Workforce/surgical workforce shortages; in general

Client expense: $70,000 · Firm income: Not reported

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

Medicare physician reimbursement and the importance of long-term structural reform to the reimbursement system, including the Provider Reimbursement Stability Act (H.R. 8163), the Strengthening Medicare for Patients and Providers Act (H.R. 6160) and the Efficiency Adjustment Delay Act (H.R. 7520) The Safe Step Act (H.R. 5509/S. 2903) requires group health plans regulated by the Employee Retirement Income Security Act (ERISA) to provide a clear exception process for any medication step therapy protocol. The Specialty Physicians Advancing Rural Care (SPARC) Act (S. 1380; H.R. 4681), a bill designed to increase access to specialty care services in rural areas. Expanding the definition of a preventive service to surveillance colonoscopy. Efforts to secure appropriations language that guides action at the U.S. Department of Health and Human Services. Opposing National Institutes of Health (NIH) research cuts.

Client expense: $67,545 · Firm income: Not reported

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act (HR 929 / S 266) Medicare Patient Access and Practice Stabilization Act (HR 879/ S.1640) Reducing Medically Unnecessary Delays in Care Act (HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resident Physician Shortage Reduction Act (HR.3890/S. 2439) Improving Seniors Timely Access to Care Act (S. 1816/HR. 3514) One Big Beautiful Bill Act (HR. 1) Safe Step Act (HR 5509/S. 668) Patient Access to Autoimmune Treatment, PAAT, Act (HR. 5467) Protecting Patient Access to Cancer and Complex Therapies Act (HR 4299) PBM Reform Act of 2025 (HR 4317) Workforce Mobility Act (S.2031) Specialty Physicians Advancing Rural Care, SPARC, Act (H.R 4681/S. 1380) Connect for Health Act of 2025 (HR 2406/S. 1261) Telehealth Modernization Act (HR 5081/S 2709) House Concurrent Res. 14 establishing congressional budget for FY2025 Department of Labor, HHS, and Education Appropriations Act (S. 2587) Department of Defense Appropriations Act (HR 4016/S. 2572) Seniors Deserve SMARTER Care Act (HR 5940) A bill to require private plans to provide for e-prior auth for drugs (S. 4349) Patient Access to Higher Quality Health Care Act (HR 4002) Biosimilar Red Tape Elimination Act (HR 5526/S. 1954) Medical Foods and Formulas Access Act (HR 5684) Physician Led and Rural Access to Quality Care Act (HR 2191/S. 1390) Claims Data Act, H.R. 4331 Rural Residency Planning and development Act of 2025, H.R. 6468 To exempt H-1B health care workers from the restriction under the Presidential Proclamation entitled "Restriction on Entry of Certain Nonimmigrant Workers", and for other purposes, H.R. 7961 Provider Reimbursement Stability Act, H.R. 8163 PBM Fiduciary Accountability, Integrity, and Reform (FAIR) Act, S.3549

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act (HR 929 / S 266) Medicare Patient Access and Practice Stabilization Act (HR 879/ S.1640) Reducing Medically Unnecessary Delays in Care Act (HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resident Physician Shortage Reduction Act (HR.3890/S. 2439) Improving Seniors Timely Access to Care Act (S. 1816/HR. 3514) One Big Beautiful Bill Act (HR. 1) Safe Step Act (HR 5509/S. 668) Patient Access to Autoimmune Treatment, PAAT, Act (HR. 5467) Protecting Patient Access to Cancer and Complex Therapies Act (HR 4299) PBM Reform Act of 2025 (HR 4317) Workforce Mobility Act (S.2031) Specialty Physicians Advancing Rural Care, SPARC, Act (H.R 4681/S. 1380) Connect for Health Act of 2025 (HR 2406/S. 1261) Telehealth Modernization Act (HR 5081/S 2709) House Concurrent Res. 14 establishing congressional budget for FY2025 Department of Labor, HHS, and Education Appropriations Act (S. 2587) Department of Defense Appropriations Act (HR 4016/S. 2572) Seniors Deserve SMARTER Care Act (HR 5940) A bill to require private plans to provide for e-prior auth for drugs (S. 4349) Patient Access to Higher Quality Health Care Act (HR 4002) Biosimilar Red Tape Elimination Act (HR 5526/S. 1954) Medical Foods and Formulas Access Act (HR 5684) Physician Led and Rural Access to Quality Care Act (HR 2191/S. 1390) Claims Data Act, H.R. 4331 Rural Residency Planning and development Act of 2025, H.R. 6468 To exempt H-1B health care workers from the restriction under the Presidential Proclamation entitled "Restriction on Entry of Certain Nonimmigrant Workers", and for other purposes, H.R. 7961 Provider Reimbursement Stability Act, H.R. 8163 PBM Fiduciary Accountability, Integrity, and Reform (FAIR) Act, S.3549

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act (HR 929 / S 266) Medicare Patient Access and Practice Stabilization Act (HR 879/ S.1640) Reducing Medically Unnecessary Delays in Care Act (HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resident Physician Shortage Reduction Act (HR.3890/S. 2439) Improving Seniors Timely Access to Care Act (S. 1816/HR. 3514) One Big Beautiful Bill Act (HR. 1) Safe Step Act (HR 5509/S. 668) Patient Access to Autoimmune Treatment, PAAT, Act (HR. 5467) Protecting Patient Access to Cancer and Complex Therapies Act (HR 4299) PBM Reform Act of 2025 (HR 4317) Workforce Mobility Act (S.2031) Specialty Physicians Advancing Rural Care, SPARC, Act (H.R 4681/S. 1380) Connect for Health Act of 2025 (HR 2406/S. 1261) Telehealth Modernization Act (HR 5081/S 2709) House Concurrent Res. 14 establishing congressional budget for FY2025 Department of Labor, HHS, and Education Appropriations Act (S. 2587) Department of Defense Appropriations Act (HR 4016/S. 2572) Seniors Deserve SMARTER Care Act (HR 5940) A bill to require private plans to provide for e-prior auth for drugs (S. 4349) Patient Access to Higher Quality Health Care Act (HR 4002) Biosimilar Red Tape Elimination Act (HR 5526/S. 1954) Medical Foods and Formulas Access Act (HR 5684) Physician Led and Rural Access to Quality Care Act (HR 2191/S. 1390) Claims Data Act, H.R. 4331 Rural Residency Planning and development Act of 2025, H.R. 6468 To exempt H-1B health care workers from the restriction under the Presidential Proclamation entitled "Restriction on Entry of Certain Nonimmigrant Workers", and for other purposes, H.R. 7961 Provider Reimbursement Stability Act, H.R. 8163 PBM Fiduciary Accountability, Integrity, and Reform (FAIR) Act, S.3549

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

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

The One Big Beautiful Bill Act, H.R. 1; Medicare physician payment including, the Medicare Patient Access and Practice Stabilization Act (H.R. 879); the Strengthening Medicare for Patients and Providers Act (H.R. 6160), the Provider Reimbursement Stability Act (S. 4935); the Provider Reimbursement Stability Act (H.R. 8163); and the Efficiency Adjustment Delay Act (H.R. 7520); new/alternative payment models; Medicare coverage, hospital payment of cardiovascular services; access to Medicare claims data; physician and hospital quality; Quality Payment Program; clinical data registries; health care quality; medical imaging and prior authorization; the Stark Law and the in-office ancillary services exception; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; graduate medical education policy including the Resident Physician Shortage Reduction Act (H.R. 3890/S. 2439); provide a specialty physician loan repayment program with the SPARC Act (H.R 4681/S. 1380); provide deferred interest payments for residents on student loans with the Resident Education Deferred Interest (REDI) Act (H.R. 2028/S. 942); oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; physician-owned hospital policy including the Physician Led Rural Access to Quality Care Act (H.R. 2191/S. 1390) and the Patient Access to Higher Quality Health Care Act (H.R. 4002); COVID-19 public health emergency and the implementation of the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security Act; implementation of the Protecting Medicare and American Farmers from Sequester Cuts Act; Increasing Access to Quality Cardiac Rehabilitation Care Act; the expansion of telehealth services, including the CONNECT for Health Act (H.R. 41894206/S. 1261), the Sustainable Cardiopulmonary Rehabilitation Services in the Home At (H.R. 783/S. 248), and the Telehealth Modernization Act (H.R. 5081/S. 2709); Improving maternal health, including Connected Maternal Online Monitoring Act (Connected MOM Act) (H.R. 4977/S. 141), Preventing Maternal Deaths Reauthorization Act of 2025 (H.R. 1909), and Rural Obstetrics Readiness Act (H.R. 1254/S. 380), and the Womens Heart Health Expansion Act (H.R. 7417/S. 3944) ; prior authorization reform, including the Improving Seniors Timely Access to Care Act (H.R. 3514/S. 1816), the Reducing Medically Unnecessary Delays in Care Act (H.R. 2433), and the Safe Step Act (H.R. 5509/S. 2903); clinician-led registry access to federal claims data, including the Access to Claims Data Act (H.R. 4331); and expanding in home prescribing coverage provided in the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2025 (H.R. 6894/S. 717), Centers for Medicare and Medicaid Innovation payment models.

Client expense: $600,000 · 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), SENATE

H.R. 2028, Resident Education Deferred Interest (REDI) Act, all provisions S. 942, Resident Education Deferred Interest (REDI) Act, all provisions H.R. 2314, Fair Access In Residency (FAIR) Act, provisions to the MATCH, and foreign medical graduates S. 2715, Fair Access In Residency (FAIR) Act, provisions to the MATCH, and foreign medical graduates S. 632, IHS Workforce Parity Act of 2025, all provisions H.R. 1, One Big Beautiful Bill Act, provisions relating to Graduate Medical Education, and student loans H.R. 3890, Resident Physician Shortage Reduction Act of 2025, all provisions S. 2439, Resident Physician Shortage Reduction Act of 2025, all provisions H.R. 4731, Resident Physician Shortage Reduction Act of 2025, all provisions H.R. 4681, Specialty Physicians Advancing Rural Care (SPARC) Act, all provisions S. 1380, Specialty Physicians Advancing Rural Care (SPARC) Act, all provisions H.R. 6468, Rural Residency Planning and Development Act of 2025, all provisions H.R. 3885, Community Training, Education, and Access for Medical Students (Community TEAMS) Act of 2025, all provisions S. 632, IHS Workforce Parity Act of 2025, all provisions GME funding/teaching health centers National Health Service Corps (NHSC)/loan repayment programs NHSC Scholarship program

Client expense: $7,970,000 · Firm income: Not reported

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, SENATE

H.R. 2028, Resident Education Deferred Interest (REDI) Act, all provisions S. 942, Resident Education Deferred Interest (REDI) Act, all provisions H.R. 2314, Fair Access In Residency (FAIR) Act, provisions to the MATCH, and foreign medical graduates S. 2715, Fair Access In Residency (FAIR) Act, provisions to the MATCH, and foreign medical graduates S. 632, IHS Workforce Parity Act of 2025, all provisions H.R. 1, One Big Beautiful Bill Act, provisions relating to Graduate Medical Education, and student loans H.R. 3890, Resident Physician Shortage Reduction Act of 2025, all provisions S. 2439, Resident Physician Shortage Reduction Act of 2025, all provisions H.R. 4731, Resident Physician Shortage Reduction Act of 2025, all provisions H.R. 4681, Specialty Physicians Advancing Rural Care (SPARC) Act, all provisions S. 1380, Specialty Physicians Advancing Rural Care (SPARC) Act, all provisions H.R. 6468, Rural Residency Planning and Development Act of 2025, all provisions H.R. 3885, Community Training, Education, and Access for Medical Students (Community TEAMS) Act of 2025, all provisions S. 632, IHS Workforce Parity Act of 2025, all provisions GME funding/teaching health centers National Health Service Corps (NHSC)/loan repayment programs NHSC Scholarship program

Client expense: $7,970,000 · Firm income: Not reported

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, SENATE

Medicare Physician Payment Reform; in general; Mitigating cuts for Medicare Part B cuts; in general; Concerns regarding Expansion of Prior Authorization in Medicare FFS; H.R. 879/S. 1640, the Medicare Patient Access and Practice Stabilization Act; H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act of 2025; H.R. 3514/S.1816, the Improving Seniors Timely Access to Care Act of 2025; H.R. 539/S. 106, the Chiropractic Medicare Coverage Modernization Act; H.R. 4731/S. 2439, Resident Physician Shortage Reduction Act of 2025; H.R. 4681/S. 1380, the Specialty Physicians Advancing Rural Care (SPARC) Act; H.R. 7520, the Efficiency Adjustment Delay Act; H.R. 1616/S. 1805, the Promoting Access to Diabetic Shoes Act; H.R. 8163, the Provider Reimbursement Stability Act of 2026

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

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

Preserving Federal Loan Access for Physicians and Other Health Professionals Under OBBBA Implementation; S. 942/H.R. 2028, the Resident Education Deferred Interest (REDI) Act; H.R. 4681/S. 1380, the Specialty Physicians Advancing Rural Care (SPARC) Act

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

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

H.R.1096 - HOPE and Mental Wellbeing Act of 2025 H.R. 929/S. 266 - Lorna Breen Health Care Provider Protection Reauthorization H.R. 593 - Strengthening Pathways to Health Professions Act H.R. 879/S. 1640 - Medicare Patient Access and Practice Stabilization Act H.R. 1153 - Rural America Health Corps Act H.R. 1227/S. 475 - Alternatives to Prevent Addiction in the Nation (Alternatives to PAIN) Act H.R. 1735/S. 779 - EARLY Minds Act H.R. 1448 - PEER for Mental Health Act H.R. 1585/S. 709 - Conrad State 30 and Physician Access Reauthorization Act H.R. 1909/S. 2621 - Preventing Maternal Deaths Reauthorization Act of 2025 H.R. 957 - Parity Enforcement Act H.R. 2509/S. 931 - COMPLETE Care Act H.R. 4206/S. 1261 - CONNECT for Health Act H.R. 1305 - Improving Measurements for Loneliness and Isolation Act H.R. 1902 - Helping Emergency Responders Overcome (HERO) Act H.R. 2223 - Building Capacity for Care Act H.R. 2586 - Reentry Act of 2025 H.R. 3884/S.2011 - Telemental Health Care Access Act of 2025 H.R. 3266/S.1673 - Mental Health Infrastructure Improvement Act of 2025 Mental Health Matters Act H.R. 4619 - Medicare Mental Health Inpatient Equity Act S. 1062 - Suicide Prevention Act H.R. 912 - 9-8-8 Lifeline Cybersecurity Act H.R. 2587 - Youth Mental Health Research Act H.R. 2483/S. 2121 - SUPPORT for Patients and Communities Reauthorization Act of 2025 H.R. 2630 - Youth Suicide Prevention Research Act H.R. 3655 - STAR Plus Scholarship Act H.R. 3890/S. 2439 - Resident Physician Shortage Reduction Act of 2025 H.R. 3885/S.3989 - Community TEAMS Act H.R. 1867 - To amend title XVIII of the Social Security Act to remove in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology H.R. 3164 - Ensuring Community Access to Pharmacist Services (ECAPS) Act H.R. 4681/S. 1379 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 4723/S. 2446 - Mental Health for Latinos Act Conversations with Congressional offices on Teaching Health Center Graduate Medical Education (THCGME) H.R.3505 - Barriers to Suicide Act Letters to Congress to extend the enhanced premium tax credits H.R.6249 - Addressing Addiction After Disasters Act H.R.7394/S.3783 - Mental Health Career Promotion Act H.R. 5074 - Protecting Young Minds Online Act H.R. 5434/S. 2826 - 988 LGBTQ+ Youth Access Act H.R.5509 /S.2903 - Safe Step Act H.R. 5557 - Mental Health Services for Students Act H.R.1197 - PREEMIE Reauthorization Act of 2025 H.R. 3514/S.1816 - Improving Seniors Timely Access to Care Act H.Res.792 - Youth Mental Health Day and Suicide Prevention Day Resolution H.R.5725 - Mental Health Crisis Response Act of 2025 H.R.5706 - Mental Health Emergency Responder Act S. 3064 - Relief of Chronic Pain Act H.R. 6226 - Latino Youth Mental Health Empowerment Act H.R. 5482 - Prevent Youth Suicide Act H.R.6672 - Mental Health Professionals Workforce Shortage Loan Repayment Act Letter to Letter to Department of Labor, Department of Health and Human Services, and Department of Treasury regarding mental health parity enforcement H.R. 3492 - Protect Children's Innocence Act H.R. 498 - Do No Harm in Medicaid Act H.R. 6817/ S. 1056 - Home-Based Telemental Health Care Act Communication with Congressional offices on SAMHSA grant terminations Input on Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) modernization Communication with Congressional offices on ghost networks S. 3486 - Expand the Behavioral Health Workforce Now Act H.R.7324/S. 683 - More Behavioral Health Providers Act H.R. 786/S. 1460 - Preserving Patient Access to Accountable Care Act H.R. 4331 - Access to Claims Data Act H.R.5281 - REAL Health Providers Act H.R.7875 - Providing Opportunities for Individuals in Need of Treatment and Support (POINTS) Act Response to HHS proposed rule on nondiscrimination on the basis of disability Letter to Congress on Agency for Healthcare Research and Quality (AHRQ) funding H.R. 6396 - Kid PROOF Act H.R. 6468 - Rural Residency Planning and Development Act of 2025 H.R. 8234 - Save Money, Save Lives Act H.R.7092 - RAYS Act H.R.7787 - Mental Health Workforce Act Letter in support of funding for gun violence prevention research at CDC, NIH and NIJ. S.4076 - Removing Medicare Mental Health Inpatient Limitations Act of 2026 Letter supporting funding for Maternal Mental Health and Substance Use Disorder Programs (MMHSUD) and National Maternal Mental Health Hotline. H.R. 5629 - To provide that the final rule of the Department of Health and Human Services titled Medications for the Treatment of Opioid Use Disorder except for the portion of the final rule relating to accreditation of opioid treatment programs, shall have no force or effect H.R. 7994 - The HERO Act

Client expense: $205,809 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of

H.R.2028/S.942, Resident Education Deferred Interest (REDI) Act. H.R.4681/S.1380, Specialty Physicians Advancing Rural Care (SPARC) Act. H.R.4731/S.2439, Resident Physician Shortage Reduction Act of 2025.

Client expense: $319,200 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to Medicare physician payment. H.R.539/S.106, Chiropractic Medicare Coverage Modernization Act of 2025. H.R.879/S.1640, Medicare Patient Access and Practice Stabilization Act of 2025. H.R.929/S.266, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act. H.R.2028/S.942, Resident Education Deferred Interest (REDI) Act. H.R.2191/S.1390, Physician Led and Rural Access to Quality Care Act. H.R.2433, Reducing Medically Unnecessary Delays in Care Act of 2025. H.R.2757/S.1996, Medicare Audiology Access Improvement Act of 2025. H.R.3006/S.1776, Medicare Beneficiary Co-Pay Fairness Act. H.R.3164, Ensuring Community Access to Pharmacist Services (ECAPS) Act. H.R.3170, Improving Access to Workers' Compensation for Injured Federal Workers Act. H.R.3277/S.1677, Ensuring Lasting Smiles Act. H.R.3514/S.1816, Improving Seniors' Timely Access to Care Act of 2025. H.R.4002, Patient Access to Higher Quality Health Care Act of 2025. H.R.4206/S.1261, CONNECT for Health Act of 2025. H.R.4331, Access to Claims Data Act. H.R.4606/S.3400, Ally's Act. H.R.4681/S.1380, Specialty Physicians Advancing Rural Care (SPARC) Act. H.R.4710/S.2420, No Surprises Act Enforcement Act. H.R.4731/S.2439, Resident Physician Shortage Reduction Act of 2025. H.R.5304/S.2587, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2026. H.R.5435/S.2842, Stop CMV Act of 2025. H.R.5509/S.2903, Safe Step Act. H.R.5736, Penicillin Allergy Verification and Evaluation (PAVE) Act. H.R.6160, Strengthening Medicare for Patients and Providers Act. H.R. 7520, Efficiency Adjustment Delay Act. S.1105, No UPCODE Act. Commented on policies to modernize the Medicare Access and CHIP Reauthorization Act of 2015. Commented on the Department of Homeland Security proclamation Restriction on Entry of Certain Nonimmigrant Workers. Submitted an Appropriations request of $310 million for smoking cessation programs in the Centers for Disease Control Submitted comments to CMS on CY 2027 Medicare Advantage and Part D Advance Notice Submitted response to CMS RFI on Comprehensive Regulations to Uncover Suspicious Healthcare Activity (CRUSH) Regulation RFI

Client expense: $319,200 · Firm income: Not reported

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

H.R.2028/S.942, Resident Education Deferred Interest (REDI) Act. H.R.4681/S.1380, Specialty Physicians Advancing Rural Care (SPARC) Act. H.R.4731/S.2439, Resident Physician Shortage Reduction Act of 2025.

Client expense: $260,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to Medicare physician payment. H.R.539/S.106, Chiropractic Medicare Coverage Modernization Act of 2025. H.R.879/S.1640, Medicare Patient Access and Practice Stabilization Act of 2025. H.R.929/S.266, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act. H.R.2028/S.942, Resident Education Deferred Interest (REDI) Act. H.R.2191/S.1390, Physician Led and Rural Access to Quality Care Act. H.R.2433, Reducing Medically Unnecessary Delays in Care Act of 2025. H.R.2757/S.1996, Medicare Audiology Access Improvement Act of 2025. H.R.3006/S.1776, Medicare Beneficiary Co-Pay Fairness Act. H.R.3164, Ensuring Community Access to Pharmacist Services (ECAPS) Act. H.R.3170, Improving Access to Workers' Compensation for Injured Federal Workers Act. H.R.3277/S.1677, Ensuring Lasting Smiles Act. H.R.3514/S.1816, Improving Seniors' Timely Access to Care Act of 2025. H.R.4002, Patient Access to Higher Quality Health Care Act of 2025. H.R.4206/S.1261, CONNECT for Health Act of 2025. H.R.4331, Access to Claims Data Act. H.R.4606/S.3400, Ally's Act. H.R.4681/S.1380, Specialty Physicians Advancing Rural Care (SPARC) Act. H.R.4710/S.2420, No Surprises Act Enforcement Act. H.R.4731/S.2439, Resident Physician Shortage Reduction Act of 2025. H.R.5304/S.2587, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2026. H.R.5435/S.2842, Stop CMV Act of 2025. H.R.5509/S.2903, Safe Step Act. H.R.5736, Penicillin Allergy Verification and Evaluation (PAVE) Act. H.R.6160, Strengthening Medicare for Patients and Providers Act. S.1105, No UPCODE Act. Commented to House and Senate leadership opposing provision in CY2026 Medicare Physician Fee Schedule final rule that reduces the work Relative Value Units (RVUs) and intra-service time for all non-time-based codes by 2.5 percent in 2026, with additional reductions expected every three years indefinitely. Commented to House Appropriations Committee commending them for adopting an amendment to the FY2026 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act that would halt funding to implement the Medicare Wasteful and Inappropriate Service Reduction (WISeR) Model.

Client expense: $260,000 · Firm income: Not reported

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act (HR 929 / S 266) Medicare Patient Access and Practice Stabilization Act (HR 879/ S.1640) Reducing Medically Unnecessary Delays in Care Act (HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resident Physician Shortage Reduction Act (HR.3890/S. 2439) Improving Seniors Timely Access to Care Act (S. 1816/HR. 3514) One Big Beautiful Bill Act (HR. 1) Safe Step Act (HR 5509/S. 668) Patient Access to Autoimmune Treatment, PAAT, Act (HR. 5467) Protecting Patient Access to Cancer and Complex Therapies Act (HR 4299) PBM Reform Act of 2025 (HR 4317) Workforce Mobility Act (S.2031) Specialty Physicians Advancing Rural Care, SPARC, Act (H.R 4681/S. 1380) Connect for Health Act of 2025 (HR 2406/S. 1261) Telehealth Modernization Act (HR 5081/S 2709) House Concurrent Res. 14 establishing congressional budget for FY2025 Department of Labor, HHS, and Education Appropriations Act (S. 2587) Department of Defense Appropriations Act (HR 4016/S. 2572) Seniors Deserve SMARTER Care Act (HR 5940) A bill to require private plans to provide for e-prior auth for drugs (S. 4349) Patient Access to Higher Quality Health Care Act (HR 4002) Biosimilar Red Tape Elimination Act (HR 5526/S. 1954) Medical Foods and Formulas Access Act (HR 5684) Physician Led and Rural Access to Quality Care Act (HR 2191/S. 1390)

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act (HR 929 / S 266) Medicare Patient Access and Practice Stabilization Act (HR 879/ S.1640) Reducing Medically Unnecessary Delays in Care Act (HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resident Physician Shortage Reduction Act (HR.3890/S. 2439) Improving Seniors Timely Access to Care Act (S. 1816/HR. 3514) One Big Beautiful Bill Act (HR. 1) Safe Step Act (HR 5509/S. 668) Patient Access to Autoimmune Treatment, PAAT, Act (HR. 5467) Protecting Patient Access to Cancer and Complex Therapies Act (HR 4299) PBM Reform Act of 2025 (HR 4317) Workforce Mobility Act (S.2031) Specialty Physicians Advancing Rural Care, SPARC, Act (H.R 4681/S. 1380) Connect for Health Act of 2025 (HR 2406/S. 1261) Telehealth Modernization Act (HR 5081/S 2709) House Concurrent Res. 14 establishing congressional budget for FY2025 Department of Labor, HHS, and Education Appropriations Act (S. 2587) Department of Defense Appropriations Act (HR 4016/S. 2572) Seniors Deserve SMARTER Care Act (HR 5940) A bill to require private plans to provide for e-prior auth for drugs (S. 4349) Patient Access to Higher Quality Health Care Act (HR 4002) Biosimilar Red Tape Elimination Act (HR 5526/S. 1954) Medical Foods and Formulas Access Act (HR 5684) Physician Led and Rural Access to Quality Care Act (HR 2191/S. 1390)

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act (HR 929 / S 266) Medicare Patient Access and Practice Stabilization Act (HR 879/ S.1640) Reducing Medically Unnecessary Delays in Care Act (HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resident Physician Shortage Reduction Act (HR.3890/S. 2439) Improving Seniors Timely Access to Care Act (S. 1816/HR. 3514) One Big Beautiful Bill Act (HR. 1) Safe Step Act (HR 5509/S. 668) Patient Access to Autoimmune Treatment, PAAT, Act (HR. 5467) Protecting Patient Access to Cancer and Complex Therapies Act (HR 4299) PBM Reform Act of 2025 (HR 4317) Workforce Mobility Act (S.2031) Specialty Physicians Advancing Rural Care, SPARC, Act (H.R 4681/S. 1380) Connect for Health Act of 2025 (HR 2406/S. 1261) Telehealth Modernization Act (HR 5081/S 2709) House Concurrent Res. 14 establishing congressional budget for FY2025 Department of Labor, HHS, and Education Appropriations Act (S. 2587) Department of Defense Appropriations Act (HR 4016/S. 2572) Seniors Deserve SMARTER Care Act (HR 5940) A bill to require private plans to provide for e-prior auth for drugs (S. 4349) Patient Access to Higher Quality Health Care Act (HR 4002) Biosimilar Red Tape Elimination Act (HR 5526/S. 1954) Medical Foods and Formulas Access Act (HR 5684) Physician Led and Rural Access to Quality Care Act (HR 2191/S. 1390)

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

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

The One Big Beautiful Bill Act, H.R. 1; Medicare physician payment including H.R. 879, the Medicare Patient Access and Practice Stabilization Act of 2025; the Strengthening Medicare for Patients and Providers Act (H.R. 6160), and; the Provider Reimbursement Stability Act (S. 4935); new/alternative payment models; Medicare coverage, hospital payment of cardiovascular services; access to Medicare claims data; physician and hospital quality; Quality Payment Program; clinical data registries; health care quality; medical imaging and prior authorization; the Stark Law and the in-office ancillary services exception; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; graduate medical education policy including the Resident Physician Shortage Reduction Act (H.R. 3890/S. 2439); provide a specialty physician loan repayment program with the SPARC Act (H.R 4681/S. 1380); provide deferred interest payments for residents on student loans with the Resident Education Deferred Interest (REDI) Act (H.R. 2028/S. 942); oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; physician-owned hospital policy including the Physician Led Rural Access to Quality Care Act (H.R. 2191/S. 1390) and the Patient Access to Higher Quality Health Care Act (H.R. 4002); COVID-19 public health emergency and the implementation of the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security Act; implementation of the Protecting Medicare and American Farmers from Sequester Cuts Act; Increasing Access to Quality Cardiac Rehabilitation Care Act; the expansion of telehealth services, including the CONNECT for Health Act (H.R. 41894206/S. 1261), the Sustainable Cardiopulmonary Rehabilitation Services in the Home At (H.R. 783/S. 248), and the Telehealth Modernization Act (H.R. 5081/S. 2709); Improving maternal health, including Connected Maternal Online Monitoring Act (Connected MOM Act) (H.R. 4977/S. 141), Preventing Maternal Deaths Reauthorization Act of 2025 (H.R. 1909), and Rural Obstetrics Readiness Act (H.R. 1254/S. 380); prior authorization reform, including the Improving Seniors Timely Access to Care Act (H.R. 3514/S. 1816) and the Reducing Medically Unnecessary Delays in Care Act (H.R. 2433); clinician-led registry access to federal claims data, including the Access to Claims Data Act (H.R. 4331); and expanding in home prescribing coverage provided in the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2025 (H.R. 6894/S. 717), Centers for Medicare and Medicaid Innovation payment models

Client expense: $480,000 · 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), SENATE

H.R. 21/S. 6 - Born-Alive Abortion Survivors Protection Act H.R.1096 - HOPE and Mental Wellbeing Act of 2025 H.R. 929/S. 266 - Lorna Breen Health Care Provider Protection Reauthorization H.R. 593 - Strengthening Pathways to Health Professions Act H.R. 879/S. 1640 - Medicare Patient Access and Practice Stabilization Act H.R. 1153 - Rural America Health Corps Act H.R. 1227/S. 475 - Alternatives to Prevent Addiction in the Nation (Alternatives to PAIN) Act H.R. 1735/S. 779 - EARLY Minds Act H.R. 1448 - PEER for Mental Health Act H.R. 1585/S. 709 - Conrad State 30 and Physician Access Reauthorization Act H.R. 1909/S. 2621 - Preventing Maternal Deaths Reauthorization Act of 2025 H.R. 957 - Parity Enforcement Act H.R. 2509/S. 931 - COMPLETE Care Act H.R. 4206/S. 1261 - CONNECT for Health Act H.R. 1305 - Improving Measurements for Loneliness and Isolation Act H.R. 1902 - Helping Emergency Responders Overcome (HERO) Act H.R. 2223 - Building Capacity for Care Act H.R. 2586 - Reentry Act of 2025 H.R. 3884/S.2011 - Telemental Health Care Access Act of 2025 H.R. 3266/S.1673 - Mental Health Infrastructure Improvement Act of 2025 Mental Health Matters Act H.R. 4619 - Medicare Mental Health Inpatient Equity Act Letter to Congress in support of the Prevention and Public Health Fund Letter to Congress to extend telehealth flexibilities Letter to Congress for funding for public health research into firearm morbidity and mortality prevention at CDC, NIH and NIJ. Letter to Congress on Agency for Healthcare Research and Quality (AHRQ) funding Letter to Congress on funding for FDAs Neurology Drug Program in FY26 Letter to Congress on funding for the BRAIN Initiative in FY26 Letter to Congress regarding school-based Medicaid programs Letters to Congress in support of Medicaid Letter to NIH regarding indirect cost caps for NIH grants Letter to HHS in response to the draft Make American Healthy Again Commission Assessment. S. 1062 - Suicide Prevention Act H.R. 912 - 9-8-8 Lifeline Cybersecurity Act H.R. 2587 - Youth Mental Health Research Act H.R. 2483/S. 2121 - SUPPORT for Patients and Communities Reauthorization Act of 2025 H.R. 539/S. 106 - Chiropractic Medicare Coverage Modernization Act of 2025 H.R. 2630 - Youth Suicide Prevention Research Act H.R. 3655 - STAR Plus Scholarship Act Letter to Congress in support of NIH neuroscience research Letter to Congress to protect federal funding of maternal health programs Letter to Congress supporting the Pediatric Mental Health Care Access (PMHCA) program Letter to Congress in support of funding for the Children's Hospital Graduate Medical Education (CHGME) program Letter to Congress in support of school mental health workforce grants Communication with Congressional offices on CCBHC funding Letter to Congress to include report language in FY26 appropriations for the 988 Suicide and Crisis Lifeline and Garrett Lee Smith Youth Suicide Prevention Campus Grants Letter to Congress concerning funding for 988 lifeline LGBTQ+ youth specialized services H.R. 3890/S. 2439 - Resident Physician Shortage Reduction Act of 2025 H.R. 3885 - Community TEAMS Act H.R. 3658 - 911 Community Crisis Responders Act H.R. 4745/S. 2410 - Medicaid Bump Act H.R. 3758 - Workers' Disability Benefits Parity Act H.R. 4744/S. 2445 - Community Mental Wellness and Resilience Act H.R. 1867 - To amend title XVIII of the Social Security Act to remove in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology H.R 4641 - Keep Kids Covered Act Letter opposing H.R. 3164 - Ensuring Community Access to Pharmacist Services (ECAPS) Act Letter to Congress to support the integrity of the United States Preventive Services Task Force (USPSTF) Letter in response to FDA panel review of SSRIs and pregnancy Letter to HHS in response to proposed change to its interpretation of federal public benefit to include 13 additional programs as restricted Federal public benefits Letter to SAMHSA regarding reports on the redirection of FY25 funds H.R. 4681/S. 1379 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 4723/S. 2446 - Mental Health for Latinos Act Conversations with Congressional offices on Teaching Health Center Graduate Medical Education (THCGME) H.R.3505 - Barriers to Suicide Act H.R. 5454/S.2879 - Medicare Advantage Prompt Pay Act Letters to Congress to extend the enhanced premium tax credits H.R.6249 - Addressing Addiction After Disasters Act Mental Health Emergency Needs in Disasters (MEND) Act Mental Health Career Promotion Act H.R. 5074 - Protecting Young Minds Online Act H.R. 5434/S. 2826 - 988 LGBTQ+ Youth Access Act H.R.5509 /S.2903 - Safe Step Act H.R.5553 - CTE Student Mental Health and Wellness Act H.R. 5557 - Mental Health Services for Students Act H.R.1197 - PREEMIE Reauthorization Act of 2025 H.R. 3514/S.1816 - Improving Seniors Timely Access to Care Act Draft legislation on expedited FDA approval pathways for addiction therapeutics Mental Health Emergency Package: Youth Mental Health Day and Suicide Prevention Day Resolution, Mental Health Crisis Response Act, and Mental Health Emergency Responder Act S. 3064 - Relief of Chronic Pain Act H.R. 6226 - Latino Youth Mental Health Empowerment Act H.R. 5482 - Prevent Youth Suicide Act H.R.6672 - Mental Health Professionals Workforce Shortage Loan Repayment Act Letter to Letter to Department of Labor, Department of Health and Human Services, and Department of Treasury regarding mental health parity enforcement. H.R. 3492 - Protect Children's Innocence Act H.R. 498 - Do No Harm in Medicaid Act H.R. 6817/ S. 1056 - Home-Based Telemental Health Care Act Letters and a presentation to the FDA digital health advisory panel regarding generative AI enabled mental health medical devices

Client expense: $391,974 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of

Mitigating cuts for Medicare Part B cuts; in general. H.R. 879/S. 1640, the Medicare Patient Access and Practice Stabilization Act. Inclusion of physician payment provisions in the Full-Year Continuing Appropriations and Extensions Act, 2025 H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act of 2025 H.R. 3514/S.1816, the Improving Seniors Timely Access to Care Act of 2025 H.R. 1, One Big Beautiful Bill, Medicare payment provisions, reduction in Medicaid benefits H.R. 539/S. 106, the Chiropractic Medicare Coverage Modernization Act Concerns regarding Expansion of Prior Authorization in Medicare FFS Comments relating to File Code CMS-1832-P; Medicare Program; 2026 Payment Policies under the Physician Payment Schedule and Other Changes to Part B Payment and Coverage Policies; (July 16, 2025) H.R. 4331, the Access to Claims Data Act H.R. 4731/S. 2439, Resident Physician Shortage Reduction Act of 2025 H.R. 4681/S. 1380, the Specialty Physicians Advancing Rural Care (SPARC) Act Medicare Physician Payment Reform; in general. Extending ACA subsidies; in general Issues relating to the "efficiency adjustment" policy re: CY26 MPFS

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

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

S. 266/H.R. 929, the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act. S. 942/H.R. 2028, the Resident Education Deferred Interest (REDI) Act. Re: Preserving Federal Loan Access for Physicians and Other Health Professionals Under OBBBA Implementation H.R. 4681/S. 1380, the Specialty Physicians Advancing Rural Care (SPARC) Act

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

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

Abortion access (general); Access to mifepristone (general); Contraception (general); Maternal mortality and morbidity (general); H.R. _____/S. _____, Advancing Safe Medications for Moms and Babies Act;;Obstetric and gynecologic care in rural and underserved areas (general); impact of closures of labor and delivery units in rural hospitals on patient access to care and maternal morbidity and mortality; abortion training in obstetrics and gynecology residency programs (general); Teaching Health Center Graduate Medication Education program (general); P.L. 119-21, One Big, Beautiful Bill Act; H.R. 1909/S. 2621, Preventing Maternal Deaths Reauthorization Act of 2025; Telemedicine (general); S. 380/H.R. 1254, Rural Obstetrics Readiness Act; S. 1834/H.R. 3762, Supporting Healthy Moms and Babies Act; H.R. 6242/S. 3274, Healthy MOM Act; H.R. 6096, NEST Act; H.R. 3670, IHS Provider Expansion Act; S. 1380/H.R. 4681, Specialty Physicians Advancing Rural Care (SPARC) Act; H.R. _____/S. _____, Black Maternal Health Momnibus Act; H.R. 5536, HEADACHE Act; H.R. 3633, Prevent HPV Cancers Act; maternal mortality review committees (general); Patient-physician relationship (general); Obstetrician-gynecologist workforce (general); Substance use disorder during pregnancy (general); Maternal mental health (general); Insurance coverage for infertility (general); Protections for in vitro fertilization (general); Vaccination (general); Task Force on Research Specific to Pregnant Women and Lactating Women (PRGLAC) recommendations (general); NIH/NICHD womens health research (general); access to fertility services and treatments (general); Restorative Reproductive Medicine (general); funding for providers of reproductive health care (general); prepregnancy health (general); Affordable Care Act (general); Advisory Committee on Immunization Practices (ACIP); COVID vaccine during pregnancy (general); S.____, Maternal Health Pandemic Response Act; United States Preventive Services Taskforce (general); hormone therapy for menopause symptoms (general acetaminophen use during pregnancy (general); SSRI use during pregnancy (general); Pregnancy Risk Assessment Monitoring System (PRAMS);; biomarker testing for preeclampsia (general); reproductive coercion (general);Richardson Waiver (general);

Client expense: $230,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Specialty Physicians Advancing Rural Care Act (H.R. 4681 / S. 1380); PSA screening for HIM Act (H.R. 1300 / S. 297); Medicare physician payment issues; Telehealth policy issues; Price authorization issues; Medicine Patient Access & Practice Stabilization Act (H.R. 879); Public questions for the record on Senate U.S. Department of Health and Human Services confirmation hearings.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for the Specialty Physicians Advancing Rural Care (SPARC) Act. (S. 1380/ H.R. 4681) which would establish a new loan repayment program to incentivize specialty physicians to practice in rural communities. Support the efforts of House Republican leadership to expand an innovative and practical solution to the healthcare access, affordability, and consolidation crisis facing America: provider-owned hospitals (POHs). Support H.R.5509/S.903, the Safe Step Act, which would provide patients and providers with a clear and transparent appeals process when subject to step therapy protocols instituted by insurers.

Client expense: $121,531 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2028, Resident Education Deferred Interest (REDI) Act, all provisions S. 942, Resident Education Deferred Interest (REDI) Act, all provisions H.R. 2314, Fair Access In Residency (FAIR) Act, all provisions S. 2715, Fair Access In Residency (FAIR) Act of 2025, all provisions S. 632, IHS Workforce Parity Act of 2025, all provisions H.R. 1, One Big Beautiful Bill Act, provisions relating to Graduate Medical Education, student loans H.R. 3890, Resident Physician Shortage Reduction Act of 2025, all provisions H.R. 4731, Resident Physician Shortage Reduction Act of 2025, all provisions S. 2439, Resident Physician Shortage Reduction Act of 2025, all provisions H.R. 4681, Specialty Physicians Advancing Rural Care (SPARC) Act, all provisions S. 1380, Specialty Physicians Advancing Rural Care (SPARC) Act, all provisions H.R. 3885, Community TEAMS Act of 2025, all provisions H.R. 5428, Medical Student Education Authorization Act of 2025, all provisions Health Resources and Services Administration (HRSA) Title VII and Title VIII Programs/reauthorization

Client expense: $4,620,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE