Medicare Advantage Prompt Pay Act

Q3 Lobbying Report (July 1-September 30) HCR FEMA re: COVID-19 related reimbursement Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Expanding Medical Education Act (H.R. 2106) Preserving Emergency Access in Key Sites Act (H.R. 3778/S.1860) Improving Seniors Timely Access to Care Act (H.R. 3514/S.1816) Prompt and Fair Pay Act (H.R. 4559) Medicare Advantage Prompt Pay Act (H.R.5454) Apples to Apples Comparison Act of 2025 (H.R. 4093) Protect Our Hospitals Act (H.R. 4807) Resident Physician Shortage Reduction Act of 2025 (H.R. 4731/S.2439) H-1Bs for Physicians and the Healthcare Workforce Act (H.R. 7961) Tax Exempt Hospital Transparency Act (H.R. 9504) MMM Graduate Medical Education (GME) funding Telehealth flexibilities and payment Californias Medicaid Hospital Quality Assurance Fee Program Medicaid 340B Restoring Rural Health Act (S. 3047) Rural Hospital Fairness Act (H.R. 5821) Defend Rural Health Act of 2026 (H.R.7409) BUD FY 2026 budget FY 2026 appropriations One Big Beautiful Bill Act (H.R. 1) Submitted Comment Letters Regulatory Comment Letter Re: Medicaid Program; Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes (CMS-2452-P) Re: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; Including the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Program; Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency (HPT) Data; Prior Authorization; Accrediting Organization (AO) Deeming for Emergency Medical Treatment and Labor Act (EMTALA); and Notices of Closure of Teaching Hospitals and Opportunities To Apply for Available Slots (CMS-1850-P)

Client expense: $370,000 · Firm income: Not reported

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

Medicare Advantage (MA) Policy and Reimbursement Medicare Part D Issues Medicaid Policy Issues Including Dual Eligibles Pharmacy Benefit Managers (PBM) and Pharmacy Policy and Reimbursement Issues Home Health Policy and Reimbursement Issues Implementation of Inflation Reduction Act of 2022 Public Law No. 117-169 H.R. 3514/S.1816, Improving Seniors' Timely Access to Care Act of 2025 (119th Congress) Prior Authorization Policy and Regulatory Issues CMS-4185-F2 Medicare Advantage Risk Adjustment Data Validation Final Rule Primary Care and Value-Based Care Policy and Reimbursement Clinical Policy Issues Including Workforce and Mental Health Hospital Outpatient Prospective Payment System (OPPS): Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 Final Rule (CMS 1793-F) Implementation of CMS Interoperability and Prior Authorization final rule (CMS-0057-F) Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F) Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies Final Calendar Year (CY) 2025 Part D Redesign Program Instructions PL 119-21, One Big Beautiful Bill Act S.1105, No Unreasonable Payments, Coding, or Diagnoses for the Elderly Act H.R. 3467, Medicare Advantage Reform Act Policy issues related to VA-eligible Medicare beneficiaries Final Calendar Year (CY) 2026 Part D Redesign Program Instructions Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4208-F) Final Guidance for Medicare Drug Price Negotiation Program guidance for initial price applicability year 2028 CMS Health Tech Ecosystem initiative H.R. 1732, GUARD VA Benefits Act H.R. 5454/S. 2789, Medicare Advantage Prompt Pay Act Contract Year 2027 Medicare Advantage and Part D Final Rule (CMS-4208-F3/CMS-4212-F) Calendar Year (CY) 2027 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the CY 2027 Rate Announcement) 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P) Medicare Drug Price Negotiation Program Proposed Rule (CMS-4215-P) Healthcare cybersecurity and Artificial Intelligence (AI) policy issues Request for Information (RFI): Pharmacy Benefit Manager Compensation and Data Collection (CMS-4218-NC) Consolidated Appropriations Act of 2026 Fiscal Year 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1851-F) Fiscal Year 2027 Skilled Nursing Facility Prospective Payment System Final Rule (CMS 1843-F) Manufacturer Effectuation of MFP Draft Guidance for 2028 Medicare Drug Price Negotiation Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule (CMS-1848-P) Calendar Year (CY) 2027 Home Health Prospective Payment System Proposed Rule (CMS-1844-P) Request for Information (RFI): Medicare Part D Reasonable and Relevant Pharmacy Contracting Standards (CMS-4217-NC)

Client expense: $1,520,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office

Care Across Generations Act (H.R. 1812) Seeking additional support for funding of multigenerational programs in Long-Term Care. Protecting Rural Seniors' Access to Care Act (S. 750/H.R. 1683) - Establishing an advisory panel to support the nursing home workforce. Train More Nurses Act (S. 547/H.R. 2151) - Requiring the Secretary of HHS and Secretary of Labor to conduct a study and issue a report on grant programs to support the nursing workforce. One Big Beautiful Bill Act (H.R. 1) - Medicaid reductions impact on Senior Care. The Medicare Advantage Prompt Pay Act (S. 2879/H.R. 5454) Entire Legislation. Improving Seniors' Timely Access to Care Act (S. 1816/H.R. 3514) - transparency requirements for MA plans. General discussions on legislative proposals related to tariffs. Health Tech Investment Act (H.R. 6197) - technology investment in senior care communities (USHR). Protecting Medicare Choice Act (H.R. 6114) - automatic enrollment prohibition for beneficiaries in Medicare Advantage Plans (USHR). Geriatrics Workforce Improvement Act (S. 2699) - training and workforce support for caregivers (USS). Medicare Advantage Improvement Act of 2026 (H.R. 8375/S. 4384) - prior authorization normalization and prompt pay. Improving Access to Medicare Coverage Act (H.R. 3954/S. 4641) - 3 day stay requirement updates.

Client expense: $170,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support Medicare GME expansion proposals: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act, additional GME slots in CAA, 2021 and CAA, 2023; Rural Residency Planning and Development Act. Discuss rural reclassification for Medicare wage index and Medicare GME purposes. Support legislative proposals to permanently extend PHE telehealth flexibilities and further extend Medicare Acute Hospital Care at Home Waiver. Oppose Medicare site-neutral payment policies. Oppose unique national provider identifier (NPI) requirement for hospital outpatient departments and discuss implementation - H.R. 7148-Sec. 6225. Support Medicare Advantage reforms - Improving Seniors Timely Access to Care Act (H.R. 3514/S. 1816), MA Prompt Pay Act (H.R. 5454/S.2879). Discuss proposals that stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges, make permanent three-day hospital stay waiver, extend COVID-19 regulatory flexibilities, address Medicare Advantage issues, support health care workforce investments. Oppose Medicaid program and financing changes in H.R. 1: work requirements as a condition of coverage, changes to state-directed payments, reductions to Federal matching funds, reductions to the safe harbor threshold for provider taxes, sunset of broad-based and uniform provider tax waivers, rescission of Medicaid Eligibility rule and Medicaid/CHIP Access rule, reductions to retroactive coverage. Discuss Medicaid Section 1115 waiver. Discuss Calendar Year 2027 Medicare Outpatient Prospective Payment Rule; oppose site-neutral proposals and proposed reductions to 340B reimbursement. Oppose CMS pricing methodology for proton therapy centers. Support creation of new reimbursement pathway for mobile stroke units.

Client expense: $550,000 · Firm income: Not reported

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

Medicaid funding, issues related to implementation of PL 119-21, Medicare Advantage Prompt Pay Act (H.R. 5454/S. 2879), Medicare Advantage Improvement Act (H.R. 8375/S.4384), Improving Seniors Timely Access to Care Act (S.1816/H.R.3514), site-neutral payment policies, Hospital Outpatient Prospective Payment System proposed rule, Physician Fee Schedule proposed rule, Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments proposed rule, WISeR model

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

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

H.R. 879, Medicare Patient Access and Practice Stabilization Act of 2025: payment rates H.R. 1317 (2025-2026), I CAN Act: provision of service under Medicare Medicare sequester, PAYGO Medicare Advantage Upcoding Medicare for All/Public Option Historical Medicare payment undervaluation for anesthesiology services (33% problem) Anesthesia Conversion Factor Medicare Physician Fee Schedule Rule Budget neutrality Medicare Economic Index: Medicare inflationary increase Medicaid Bundled payments H.R. 5454/S. 2879 Medicare Advantage Prompt Pay Act WISeR Model Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCD) Practice Expense (PE) Opioid sparing Labor, Health and Human Services (LHHS) Appropriation S.586 - NOPAIN Act: Non-Opioids Prevent Addiction In the Nation Act or the NOPAIN Act Medicare Supervision Rule H.R. 9693: Patients First Act of 2026 H.R. 8163: Medicare Reimbursement Stabilization Act ((Provider Reimbursement Stability Act of 2026)

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Transparency FEMA COVID Assistance Funds Save Healthcare Workers Act, H.R.3178 Behavioral health CHGME Health care consolidation, mergers and acquisition H1-B Visas H.R. 9393, Lower Costs, More Transparency Act of 2026 H.R. 9390, Prices on the Wall Act Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Medicare Advantage Prompt Pay Act (H.R.5454) Protect Our Hospitals Act (H.R. 4807) Resident Physician Shortage Reduction Act of 2025 (H.R. 4731/S.2439) H-1Bs for Physicians and the Healthcare Workforce Act (H.R. 7961) Tax Exempt Hospital Transparency Act (H.R. 9504)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.5269/S.2761, the RESULTS Act. H.R.2005, the DMEPOS Relief Act. H.R.2902, the SOAR Act. H.R.5454/S.2879, Medicare Advantage Prompt Pay Act. H.R.6280/S.3607, the Access to Genetic Counselor Services Act. H.R.3514/S.1816, Improving Seniors Timely Access to Care Act. Issues related to implementation of healthcare provisions in H.R.1. Issues related to CMS telehealth policies. Issues related to hospital outpatient reimbursement. Issues related to the Medicare area wage index. Issues related to Medicare Advantage. Issues related to Medicare GME. Issues related to Medicaid.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage - S.1816/H.R. 3514 Improving Seniors Timely Access to Care Act; H.R. 8375/S. 4384 - Medicare Advantage Improvement Act re: prior authorization reform H.R. 5454 / S. 2879 - Medicare Advantage Prompt Pay Act re: MA payment policy Inpatient Prospective Payment System (IPPS) CJR-X re: mandatory episode-based payment models Rural Health Transformation Fund - re: implementation of the fund Medicaid - re: implementation of state directed payment and provider tax programs and policies H.R. 8375/S. 4384 - Medicare Advantage Improvement Act re: network adequacy Discussions on proposed expansions of site-neutral payment policies

Client expense: $710,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 2761 / H.R. 5269, the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, all provisions; H.R. 5142, The Home Health Stabilization Act, all provisions; S. 1261 / H.R. 4206, CONNECT for Health Act of 2025, all provisions; H.R. 1805, Assistance for Rural Community Hospitals (ARCH) Act, all provisions; H.R. 2191, Physician Led and Rural Access to Quality Care Act, all provisions; S. 335, Rural Hospital Support Act, all provisions; S.1816 / H.R.3514, Improving Seniors Timely Access to Care Act, all provisions; S. 502, Rural Hospital Closure Relief Act, all provisions; S. 2439 / H.R. 4731, Resident Physician Shortage Reduction Act of 2025, all provisions; H.R. 4002, Patient Access to Higher Quality Health Care Act, all provisions; H.R. 5454/S. 2879, the Medicare Advantage Prompt Pay Act, all provisions; H.R. 6240, Rural Hospital Closure Relief Act of 2025, all provisions; DRAFT, Rural Teaching Hospital Relief, all provisions; S. 2793, Ensuring Access to Essential Providers, all provisions; H.R. 8375/ S. 4384, Medicare Advantage Improvement Act, all provisions; H.R. 8967 / S. 4460, Rural Community Hospital Demonstration Program Reauthorization, all provisions; H.R. 9468, Saving Today's Acute Care Resources (STAR) Act, all provisions; H.R. 8261, Chronic Care Management Improvement Act, all provisions; DRAFT, HCA Mission Act, all provisions; DRAFT, To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage Encounter Data, all provisions; DRAFT, To amend title XVIII of the Social Security Act to limit the compensation that may be paid to agents and brokers by Medicare Advantage (MA) organizations, all provisions; DRAFT, Preserving Patient Access Act, all provisions; H.R. 8891, Rural Maternity Options for Medial Support (Rural MOMS) Act, all provisions; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to Medicare Part C & D Reporting Requirements; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the FY2027 proposed rule for the hospital inpatient prospective payment system; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the proposed Comprehensive Care for Joint Replacement Expanded Model (CJR-X); Centers for Medicare & Medicaid Services (CMS) & Department of Health & Human Services (HHS), Issues pertaining to the interoperability standards and prior authorization for drugs; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the FY2027 proposed rule for the long-term care hospital prospective payment system; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to hospital food and nutrition; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the FY2027 proposed rule for skilled nursing facilities (SNFs); Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the FY2027 proposed rule for inpatient rehabilitation facilities (IRFs); Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the FY2027 proposed rule for inpatient psychiatric facilities (IPFs); Medicaid Program, Issues pertaining to Medicaid program and how states finance programs, reimburse providers, and determine beneficiary eligibility, and implementation and mitigation of H.R. 1 provisions related to state directed payments, provider taxes and community engagement requirements; Site Neutral Payments, Issues related to site neutral payment cuts and facility fees; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, REH's, implementation of Rural Health Transformation Program, rural reclassification policy; Physician Payments, Issues pertaining to alternative payment models, mental health of workforce, physician reimbursement cuts, Medicare Access & CHIP Reauthorization (MACRA) Reforms; 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, Wasteful and Inappropriate Services Reduction (WISeR) model, transparency in plan denial signatures, inappropriate downcoding, reducing administrative burdens; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees; Post Acute Care, Issues pertaining to expanding patients' access to crucial services provided by long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, hospital at home, and home health agencies.

Client expense: $4,470,000 · Firm income: Not reported

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

S.1105--No Unreasonable Payments, Coding, or Diagnoses for the Elderly (No UPCODE) Act--An act to improve the way Medicare Advantage plans assess patients health risks and reduce overpayments for care. H.R 4093--Apples to Apples--An act to require the Secretary of Health and Human Services to publish information on expenditures under the Medicare program, and for other purposes. S. 2625--Independent BROKERS TIME Act of 2025--An Act to carry out certain activities relating to the regulation of independent agents and brokers and third-party marketing organizations under parts C and D of the Medicare program, and for other purposes. H.R. 5243--Increase data transparency for supplemental benefits under Medicare Advantage--An Act to increase data transparency around Medicare Advantage supplemental benefits for seniors. S. 2793--Require Medicare Advantage plans to cover items and services furnished by certain essential community providers within a service area--An act to add an Essential Community Provider (ECP) requirement to Medicare Advantage networks. H.R. 5454--Medicare Advantage Prompt Pay Act--An act to improve Medicare Advantages (MA) billing practices, offer certainty health care providers who contract with MA plans, and ensure that seniors arent stuck with unfair, confusing, or delayed bills after receiving critical care. H.R. 5746--Addressing Whole Health in Medicare Advantage Act--Supplemental Benefits for chronically ill enrollees S. 3573--Medicare Advantage Supplemental Benefits Transparency Act--Improving Supplemental Benefits for MA beneficiaries H.R. 3514--To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans--Prior Authorization in Medicare Advantage S 1816--A bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans--Prior Authorization in Medicare Advantage H.R. 9393--Lower Costs, More Transparency Act of 2026--Promotes price transparency across hospitals, Ambulatory Surgical Centers (ASCs), and the broader health care sector H.R. 9392--Medicare Advantage Cost Transparency Act--An act to require MA plans and commercial plans to publicly post PA approval/denial rates, appeal outcomes, and average determination timelines H.R. 9395--Broker Compensation Bill--Statutory caps on compensation paid by MA organizations to agents and brokers H.R. 9544--Saving MEDICARE Act of 2026--To amend title XVIII of the Social Security Act to ensure appropriate payments under Medicare Advantage, and for other purposes. H.R. 8163--Provider Reimbursement Stability Act of 2026--Medicare physician payment reform and APM incentives H.R. 8375--Medicare Advantage Improvement Act--Prior authorization reform, plan transparency, prompt pay, and coverage standards alignment Issues related to data collection and sharing among health plans, providers, and community-based organizations issues Issues related to mental and behavioral health issues in Medicare Advantage Rural Network Adequacy Issues

Client expense: $410,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage (MA) Policy and Reimbursement Medicare Part D Issues Medicaid Policy Issues Including Dual Eligibles Pharmacy Benefit Managers (PBM) and Pharmacy Policy and Reimbursement Issues Home Health Policy and Reimbursement Issues Implementation of Inflation Reduction Act of 2022 Public Law No. 117-169 H.R. 3514/S.1816, Improving Seniors' Timely Access to Care Act of 2025 (119th Congress) Prior Authorization Policy and Regulatory Issues CMS-4185-F2 Medicare Advantage Risk Adjustment Data Validation Final Rule Primary Care and Value-Based Care Policy and Reimbursement Clinical Policy Issues Including Workforce and Mental Health Hospital Outpatient Prospective Payment System (OPPS): Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 Final Rule (CMS 1793-F) Implementation of CMS Interoperability and Prior Authorization final rule (CMS-0057-F) Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F) Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies Final Calendar Year (CY) 2025 Part D Redesign Program Instructions PL 119-21, One Big Beautiful Bill Act S.1105, No Unreasonable Payments, Coding, or Diagnoses for the Elderly Act H.R. 3467, Medicare Advantage Reform Act Policy issues related to VA-eligible Medicare beneficiaries Final Calendar Year (CY) 2026 Part D Redesign Program Instructions Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4208-F) Final Guidance for Medicare Drug Price Negotiation Program guidance for initial price applicability year 2028 CMS Health Tech Ecosystem initiative H.R. 1732, GUARD VA Benefits Act H.R. 5454/S. 2789, Medicare Advantage Prompt Pay Act Calendar Year (CY) 2026 Home Health Prospective Payment System Final Rule (CMS-1828-F) Contract Year 2027 Medicare Advantage and Part D Final Rule (CMS-4208-F3/CMS-4212-F) Calendar Year (CY) 2027 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the CY 2027 Rate Announcement) Fiscal Year (FY) 2027 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS 1843-P) Fiscal Year (FY) 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Proposed Rule (CMS-1851-P) 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P) Medicare Drug Price Negotiation Program Proposed Rule (CMS-4215-P) Healthcare cybersecurity and Artificial Intelligence (AI) policy issues Pharmacy Benefit Manager Compensation and Data Collection (CMS-4218-NC)

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office

Discuss with Congressional staff and HHS staff support for Medicare GME expansion and changes to GME program: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act, additional GME slots in CAA, 2021 and CAA, 2023; Rural Residency Planning and Development Act. Discuss with Congressional staff distribution methodology for Medicare GME slots created in the CAA, 2021. Discuss rural reclassification for Medicare wage index and Medicare GME purposes with Congressional staff. Discuss COVID-19 Public Health Emergency (PHE) Medicare flexibilities with Congressional staff and HHS staff and support legislative proposals to permanently extend PHE telehealth flexibilities and two-year extension of Acute Hospital Care at Home Waiver. Oppose Medicare site-neutral payment policies. Oppose unique national provider identifier (NPI) requirement for hospital outpatient departments and discuss implementation - H.R. 7148-Sec. 6225. Support Medicare Advantage reforms - Improving Seniors Timely Access to Care Act (H.R. 3514/S. 1816), MA Prompt Pay Act (H.R. 5454/S.2879). Discuss Medicare wage index issues with CMS. Discuss proposals that stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support), make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Oppose Medicaid program and financing changes in H.R.1: work requirements as a condition of coverage, changes to state-directed payments, reductions to Federal matching funds, reductions to the safe harbor threshold for provider taxes, sunset of broad-based and uniform provider tax waivers, rescission of Medicaid Eligibility rule and Medicaid/CHIP Access rule, reductions to retroactive coverage. Discuss Medicaid Section 1115 waiver with Congressional staff and HHS. Oppose proposed rule - Medicare and Medicaid Conditions of Participation: Limiting Participation Based on the Performance of Sex Trait Modification Procedures on Children with Congressional staff.

Client expense: $580,000 · Firm income: Not reported

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

Care Across Generations Act (H.R. 1812) Seeking additional support for funding of multigenerational programs in Long-Term Care. Protecting Rural Seniors' Access to Care Act (S. 750/H.R. 1683) - Establishing an advisory panel to support the nursing home workforce. Train More Nurses Act (S. 547/H.R. 2151) - Requiring the Secretary of HHS and Secretary of Labor to conduct a study and issue a report on grant programs to support the nursing workforce. One Big Beautiful Bill Act (H.R. 1) - Medicaid reductions impact on Senior Care. The Medicare Advantage Prompt Pay Act (S. 2879/H.R. 5454) Entire Legislation. Improving Seniors' Timely Access to Care Act (S. 1816/H.R. 3514) - transparency requirements for MA plans. General discussions on legislative proposals related to tariffs. Health Tech Investment Act (H.R. 6197) - technology investment in senior care communities (USHR). Protecting Medicare Choice Act (H.R. 6114) - automatic enrollment prohibition for beneficiaries in Medicare Advantage Plans (USHR). Geriatrics Workforce Improvement Act (S. 2699) - training and workforce support for caregivers (USS). Medicare Advantage Improvement Act of 2026 (H.R. 8375/S. 4384) - prior authorization normalization and prompt pay. Improving Access to Medicare Coverage Act (H.R. 3954/S. 4641) - 3 day stay requirement updates.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided comments on CMS Request for Information: Comprehensive Regulations to Uncover Suspicious Healthcare (CMS-6098-NC) regarding hospital efforts to prevent waste, fraud, and abuse. Provided comments on CMS-1827-P - SNF PPS, CMS-1845-P - IRF PPS, and CMS-1847-P - IPF PPS about proposed revisions to the prospective payment systems for skilled nursing facilities and inpatient rehab facilities. Urged support for H.R. 5454/S.2879, the Medicare Advantage Prompt Pay Act, which would put payment timelines in place for Medicare Advantage claims. Opposed H.R. 9504 (Tax-Exempt Hospital Transparency Act) that would implement onerous reporting requirements for non-for-profit and other hospitals.

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

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

Q2 Lobbying Report (April 1-June 30) HCR FEMA re: COVID-19 related reimbursement Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Expanding Medical Education Act (H.R. 2106) Preserving Emergency Access in Key Sites Act (H.R. 3778/S.1860) Improving Seniors Timely Access to Care Act (H.R. 3514/S.1816) Prompt and Fair Pay Act (H.R. 4559) Medicare Advantage Prompt Pay Act (H.R.5454) Apples to Apples Comparison Act of 2025 (H.R. 4093) Protect Our Hospitals Act (H.R. 4807) Resident Physician Shortage Reduction Act of 2025 (H.R. 4731/S.2439) H-1Bs for Physicians and the Healthcare Workforce Act (H.R. 7961) Tax Exempt Hospital Transparency Act (H.R. 9504) MMM Graduate Medical Education (GME) funding Telehealth flexibilities and payment Californias Medicaid Hospital Quality Assurance Fee Program Medicaid 340B Restoring Rural Health Act (S. 3047) Rural Hospital Fairness Act (H.R. 5821) Defend Rural Health Act of 2026 (H.R.7409) BUD FY 2025 budget FY 2026 appropriations One Big Beautiful Bill Act (H.R. 1)

Client expense: $410,000 · 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. 5454, Medicare Advantage Prompt Pay Act, including provisions related to medical claims payment requirements for Medicare Advantage organizations. H.R. 9393, Lower Costs, More Transparency Act of 2026, including provisions related to the current Transparency in Coverage requirements. Issues related to healthcare quality (Medicare Advantage) and MA Stars policy reform. Issues related to Medicare Advantage supplemental benefits, specifically impact of access to healthy foods on health outcomes.

Client expense: $1,460,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PBM Reform; Medicare Advantage payment issues; Medicaid Reform; One Big Beautiful Bill Act (H.R. 1, P.L. 119-21); S.1105, No UPCODE Act; HR 5454, Medicare Advantage Prompt Pay Act

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

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

PBM Reform; Medicare Advantage payment issues; Medicaid Reform; One Big Beautiful Bill Act (H.R. 1, P.L. 119-21); enhanced premium tax credits; S.1105, No UPCODE Act; HR 5454, Medicare Advantage Prompt Pay Act

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

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

Issues related to Medicare uncompensated care payments Issues related to Medicare Advantage Issues related to Medicaid financing Issues related to Medicaid eligibility Issues related to Medicaid state directed payments Issues related to Medicaid provider taxes Issues related to essential hospital designation Issues related to Maternal health equity S.1261 - CONNECT for Health Act of 2025 HR 4150 - Advancing Maternal Health Equity Under Medicaid Act of 2025 S2879/HR5454 - Medicare Advantage Prompt Pay Act Issues related to Medicare Issues related to Medicare Prior Authorization Issues related to Medicare Payment Cuts Issues related to Medicare Bad Debt Issues related to tax-exempt status of non-profit hospitals Issues related to intergovernmental transfers Issues related to price transparency Issues related to children's hospitals GME HR 5064- the Save Our Safety Net Hospitals Act HR 7145 - the Reinforcing Essential Health Systems for Communities Act

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

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

H.R. 879, Medicare Patient Access and Practice Stabilization Act of 2025: payment rates H.R. 1317 (2025-2026), I CAN Act: provision of service under Medicare Medicare sequester, PAYGO Medicare Advantage Upcoding Medicare for All/Public Option Historical Medicare payment undervaluation for anesthesiology services (33% problem) Anesthesia Conversion Factor Medicare Physician Fee Schedule Rule Budget neutrality Medicare Economic Index: Medicare inflationary increase Medicaid Bundled payments H.R. 5454/S. 2879 Medicare Advantage Prompt Pay Act WISeR Model Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCD) Practice Expense (PE) Opioid sparing Labor, Health and Human Services (LHHS) Appropriation S.586 - NOPAIN Act: Non-Opioids Prevent Addiction In the Nation Act or the NOPAIN Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicaid funding, issues related to implementation of PL 119-21, Medicare Advantage Prompt Pay Act (H.R. 5454/S. 2879), Medicare Advantage Improvement Act (H.R. 8375/S.4384) site-neutral payment policies, FY 2027 Inpatient Prospective Payment Systems (IPPS) proposed rule, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program, WISeR model

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

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

Medicaid funding, issues related to implementation of PL 119-21, Medicare Advantage (H.R. 5454/S. 2879 Medicare Advantage Prompt Pay Act), site-neutral payment policies, FY 2027 Inpatient Prospective Payment Systems (IPPS) proposed rule, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program, WISeR model

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

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

Medicaid funding, issues related to implementation of PL 119-21, Medicare Advantage (H.R. 5454/S. 2879 Medicare Advantage Prompt Pay Act), site-neutral payment policies, FY 2027 Inpatient Prospective Payment Systems (IPPS) proposed rule, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program

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

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

H.R.5269, the RESULTS Act. H.R.2005, the DMEPOS Relief Act. H.R.2902, the SOAR Act. H.R.5454/S.2879, Medicare Advantage Prompt Pay Act. H.R.6280/S.3607, the Access to Genetic Counselor Services Act. H.R.3514/S.1816, Improving Seniors Timely Access to Care Act. Issues related to implementation of healthcare provisions in H.R.1. Issues related to CMS telehealth policies. Issues related to hospital outpatient reimbursement. Issues related to the Medicare area wage index. Issues related to Medicare Advantage. Issues related to Medicare GME. Issues related to Medicaid.

Client expense: $120,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 2761 / H.R. 5269, the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act , all provisions; H.R. 5142, The Home Health Stabilization Act, all provisions; H.R. 4313 / S. 2237, Hospital Inpatient Services Modernization Act of 2025, all provisions; S. 1261 / H.R. 4206, CONNECT for Health Act of 2025, all provisions; H.R. 1805, Assistance for Rural Community Hospitals (ARCH) Act, all provisions; H.R. 2191, Physician Led and Rural Access to Quality Care Act, all provisions; S. 335, Rural Hospital Support Act, all provisions; S.1816 / H.R.3514 , Improving Seniors Timely Access to Care Act, all provisions; S. 502 / H.R. 6240 , Rural Hospital Closure Relief Act, all provisions; S. 2439 / H.R. 4731, Resident Physician Shortage Reduction Act of 2025, all provisions; H.R. 4002, Patient Access to Higher Quality Health Care Act, all provisions; DRAFT, Blood Pressure MATTERS Act, all provisions; H.R. 5454/S. 2879, the Medicare Advantage Prompt Pay Act, all provisions; DRAFT, Rural Teaching Hospital Relief, all provisions; S. 2793, Ensuring Access to Essential Providers, all provisions; H.R. 10136, Promoting Fairness for Medicare Providers Act, all provisions; H.R. 7409, Defend Rural Health Act, all provisions; H.R. 7830, Women Expansion of Learning and Labor Safety (WELLS) Act, all provisions; Centers for Medicare and Medicaid Services (CMS), Issues pertaining completing the CMS Outpatient Prospective Payment System Drug Acquisition Cost Survey; Centers for Medicare and Medicaid Services (CMS), Issues pertaining to written guidance on acceptable signage and other materials that hospitals can use in their emergency departments to discourage violent behavior; Centers for Medicare and Medicaid Services (CMS), Issue pertaining to the proposed rule on the Increasing Organ Transplant Access Model; Centers for Medicare and Medicaid Services (CMS), Comments pertaining to proposed rule on the Global Benchmark for Efficient Drug Pricing model; The Medicare Payment Advisory Commission (MedPAC), Issues related to proposed payment updates and Medicare Advantage program; Centers for Medicare and Medicaid Services (CMS), Medicare Program Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Issue pertaining to proposed rule for policy and technical changes to the Medicare Advantage and Part D programs in contract year 2027; Centers for Medicare and Medicaid Services (CMS), Issue pertaining to the upcoming rulemaking implementing requirements related to hospital off-campus provider-based departments; Centers for Medicare and Medicaid Services (CMS), Issue pertaining to the Comprehensive Regulations To Uncover Suspicious Healthcare (CRUSH), which includes efforts to combat fraud waste and abuse in federal health care programs; Centers for Medicare and Medicaid Services (CMS), Issue pertaining to the proposed rulemaking on potential options to foster a more resilient supply chain for American-made personal protective equipment and essential medicines; Centers for Medicare and Medicaid Services (CMS), Issue pertaining to expanding the use of Medicare Conditions of Participation (CoP); Centers for Medicare and Medicaid Services (CMS), Issues pertaining to the proposed Notice of Benefit and Payment Parameters for 2027; Centers for Medicare and Medicaid Services (CMS), Issues pertaining to implementation of unique national provider (NPI) for hospital off-campus provider-based departments as outlined in Consolidated Appropriations Act of 2026; Medicaid Program, Issues pertaining to Medicaid program and how states finance programs, reimburse providers, and determine beneficiary eligibility, and implementation of H.R. 1 provisions related to state directed payments and provider taxes; Site Neutral Payments, Issues related to site neutral payment cuts; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, REH's, implementation of Rural Health Transformation Program, rural reclassification policy; Physician Payments, Issues pertaining to alternative payment models, mental health of workforce, physician reimbursement cuts, Medicare Access & CHIP Reauthorization (MACRA) Reforms; 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, Wasteful and Inappropriate Services Reduction (WISeR) model, transparency in plan denial signatures, inappropriate downcoding; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees, DSH cuts, oversight; Expiring Health Care Provisions, Issues pertaining to Telehealth, Hospital at Home, MDH/LVA, Medicaid DSH Program; Post Acute Care, Issues pertaining to expanding and protecting patients access to services provided by long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies; Rural Community Hospital Demonstration Project, Issues related to ending the Rural Community Hospital Demonstration Project.

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

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

Medicare Advantage - S.1816/H.R. 3514 Improving Seniors Timely Access to Care Act and similar legislative efforts re: prior authorization reform Medicare Advantage - payment delays, denials, downcoding, and network adequacy for post-acute care H.R. 5454 / S. 2879 - Medicare Advantage Prompt Pay Act re: MA payment policy H.R. 1805 - "The Assistance for Rural Community Hospitals (ARCH) Act" - re: Discussions on Medicare rural extenders (LVH/MDH)   Medicaid Disproportionate Share Hospital (DSH) Cuts - re: reductions in Medicaid DSH funding Telehealth - re: extension of telehealth flexibilities Rural Health Transformation Fund - re: implementation of the fund Medicaid - re: implementation of state directed payment and provider tax programs and policies Post-Acute Care - discussions re: network adequacy, reimbursement updates for IRF, LTCH H.R. 3890 - Resident Physician Shortage Reduction Act of 2025 - re: GME funding Discussions on proposed expansions of site-neutral payment policies H.R. 7145 - Reinforcing Essential Health Systems for Communities Act - re: eligibility

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.1105--No Unreasonable Payments, Coding, or Diagnoses for the Elderly (No UPCODE) Act--An act to improve the way Medicare Advantage plans assess patients health risks and reduce overpayments for care. H.R 4093--Apples to Apples--An act to require the Secretary of Health and Human Services to publish information on expenditures under the Medicare program, and for other purposes. S. 2625--Independent BROKERS TIME Act of 2025--An Act to carry out certain activities relating to the regulation of independent agents and brokers and third-party marketing organizations under parts C and D of the Medicare program, and for other purposes. H.R 5243--Increase data transparency for supplemental benefits under Medicare Advantage--An Act to increase data transparency around Medicare Advantage supplemental benefits for seniors. S. 2793--Require Medicare Advantage plans to cover items and services furnished by certain essential community providers within a service area--An act to add an Essential Community Provider (ECP) requirement to Medicare Advantage networks. H.R. 5454--Medicare Advantage Prompt Pay Act--An act to improve Medicare Advantages (MA) billing practices, offer certainty health care providers who contract with MA plans, and ensure that seniors arent stuck with unfair, confusing, or delayed bills after receiving critical care. HR 5746--Addressing Whole Health in Medicare Advantage Act--Supplemental Benefits for chronically Ill enrollees S. 3573--Medicare Advantage Supplemental Benefits Transparency Act--Improving Supplemental Benefits for MA beneficiaries HR 3514--To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans--Prior Authorization in Medicare Advantage S 1816--A bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans--Prior Authorization in Medicare Advantage Issues related to data collection and sharing among health plans, providers, and community-based organizations issues In-home Heath Risk Assessments issues Issues related to mental and behavioral health issues in Medicare Advantage Rural Network Adequacy Issues CY2027 Medicare Advantage and Part D Rate Notice

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

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

Medicare Advantage (MA) Policy and Reimbursement Medicare Part D Issues Medicaid Policy Issues Including Dual Eligibles Pharmacy Benefit Managers (PBM) and Pharmacy Policy and Reimbursement Issues Home Health Policy and Reimbursement Issues Implementation of Inflation Reduction Act of 2022 Public Law No. 117-169 H.R. 3514/S.1816, Improving Seniors' Timely Access to Care Act of 2025 (119th Congress) Prior Authorization Policy and Regulatory Issues CMS-4185-F2 Medicare Advantage Risk Adjustment Data Validation Final Rule Primary Care and Value-Based Care Policy and Reimbursement Clinical Policy Issues Including Workforce and Mental Health Hospital Outpatient Prospective Payment System (OPPS): Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 Final Rule (CMS 1793-F) Implementation of CMS Interoperability and Prior Authorization final rule (CMS-0057-F) Calendar Year (CY) 2025 Home Health Prospective Payment System Final Rule (CMS-1803-F) Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F) Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies Final Calendar Year (CY) 2025 Part D Redesign Program Instructions Fiscal Year (FY) 2025 Hospice Payment Rate Update Final Rule (CMS-1810-F) PL 119-21, One Big Beautiful Bill Act S.1105, No Unreasonable Payments, Coding, or Diagnoses for the Elderly Act H.R. 3467, Medicare Advantage Reform Act Policy issues related to VA-eligible Medicare beneficiaries Final Calendar Year (CY) 2026 Part D Redesign Program Instructions Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4208-F) Fiscal Year (FY) 2026 Skilled Nursing Facility (SNF) Prospective Payment System Final Rule (CMS-1827-F) Final Guidance for Medicare Drug Price Negotiation Program guidance for initial price applicability year 2028 CMS Health Tech Ecosystem initiative H.R. 1732, GUARD VA Benefits Act H.R. 5454/S. 2789, Medicare Advantage Prompt Pay Act Calendar Year (CY) 2026 Home Health Prospective Payment System Final Rule (CMS-1828-F) Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program (CMS-4212-P) Calendar Year (CY) 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the CY 2027 Advance Notice)

Client expense: $2,550,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office

Care Across Generations Act (H.R. 1812) Seeking additional support for funding of multigenerational programs in Long-Term Care. Protecting Rural Seniors' Access to Care Act (S. 750/H.R. 1683) - Establishing an advisory panel to support the nursing home workforce. Train More Nurses Act (S. 547/H.R. 2151) - Requiring the Secretary of HHS and Secretary of Labor to conduct a study and issue a report on grant programs to support the nursing workforce. One Big Beautiful Bill Act (H.R. 1) - Medicaid reductions impact on Senior Care. The Medicare Advantage Prompt Pay Act (S. 2879/H.R. 5454) Entire Legislation. Improving Seniors' Timely Access to Care Act (S. 1816/H.R. 3514) Entire Legislation. General discussions on legislative proposals related to tariffs. Health Tech Investment Act (H.R. 6197) - technology investment in senior care communities (USHR). Protecting Medicare Choice Act (H.R. 6114) - automatic enrollment prohibition for beneficiaries in Medicare Advantage Plans (USHR). Geriatrics Workforce Improvement Act (S. 2699) - training and workforce support for caregivers (USS).

Client expense: $220,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PBM Reform; Medicare Advantage payment issues; Medicaid Reform; One Big Beautiful Bill Act (H.R. 1, P.L. 119-21); S.1105, No UPCODE Act; HR 5454, Medicare Advantage Prompt Pay Act

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

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

PBM Reform; Medicare Advantage payment issues; Medicaid Reform; One Big Beautiful Bill Act (H.R. 1, P.L. 119-21); enhanced premium tax credits; S.1105, No UPCODE Act; HR 5454, Medicare Advantage Prompt Pay Act

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

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

Support Medicare graduate medical education (GME) expansion and legislative proposals to expand Medicare GME program: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act, additional GME slots in CAA, 2021 and CAA, 2023; Rural Residency Planning and Development Act. Discuss technical amendment to CAA, 2021, Sec. 131 to address artificially low GME caps with Congressional staff. Discuss with Congressional staff distribution methodology for Medicare GME slots created in the CAA, 2021. Discuss rural reclassification for Medicare wage index and Medicare GME purposes with Congressional staff. Discuss COVID-19 Public Health Emergency (PHE) Medicare flexibilities with Congressional staff and HHS staff and support legislative proposals to permanently extend PHE telehealth flexibilities and two-year extension of Acute Hospital Care at Home Waiver. Oppose Medicare site-neutral payment policies. Oppose unique national provider identifier (NPI) requirement for hospital outpatient departments and discuss implementation - H.R. 7148-Sec. 6225. Discuss CY 2026 OPPS final rule with Congressional staff: 340B drug acquisition survey, opposition to site-neutral cuts for drug administration services. Support Medicare Advantage reforms - Improving Seniors Timely Access to Care Act (H.R. 3514/S. 1816), MA Prompt Pay Act (H.R. 5454/S.2879). Discuss Medicare wage index issues with CMS. Discuss proposals that stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support), make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Oppose Medicaid program and financing in H.R.1: work requirements as a condition of coverage, changes to state-directed payments, reductions to Federal matching funds, reductions to the safe harbor threshold for provider taxes, sunset of broad-based and uniform provider tax waivers, rescission of Medicaid Eligibility rule and Medicaid/CHIP Access rule, reductions to retroactive coverage. Discuss H.R. 1 phase-out of non-broad-based and uniform Medicaid provider tax waivers and support maximum phase-out period. Support certain changes to Medicaid DSH payments: support two-year elimination of Medicaid DSH cut; support Save Our Safety Net Hospitals Act (H.R. 5064) to restore pre-CAA, 2021 DSH cap calculation methodology and include dual-eligible patients in state DSH cap calculation. Discuss Medicaid Section 1115 waiver with Congressional staff and HHS. Oppose proposed rule - Medicare and Medicaid Conditions of Participation: Limiting Participation Based on the Performance of Sex Trait Modification Procedures on Children with Congressional staff. Discuss nursing and allied health cost report issues. Discuss uncompensated care.

Client expense: $560,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, White House Office

Medicaid funding, issues related to implementation of PL 119-21, Medicare Advantage (H.R. 5454/S. 2879 Medicare Advantage Prompt Pay Act), site-neutral payment policies

Client expense: $150,000 · Firm income: Not reported

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

Issues related to the Medicare/Medicaid dual eligible population Issues related to Medicare uncompensated care payments Issues related to Medicare Advantage Issues related to Medicaid DSH Cuts Issues related to Medicaid financing Issues related to Medicaid eligibility Issues related to Medicaid state directed payments Issues related to Medicaid provider taxes Issues related to essential hospital designation Issues related to Maternal health equity S.1261 - CONNECT for Health Act of 2025 HR 4150 - Advancing Maternal Health Equity Under Medicaid Act of 2025 S2879/HR5454 - Medicare Advantage Prompt Pay Act Issues related to Medicare Issues related to Medicare Prior Authorization Issues related to Medicare Payment Cuts Issues related to telehealth services under the Medicare program HR 7444- amend title XVIII of the Social Security Act to protect access to telehealth services under the Medicare program HR 5064- the Save Our Safety Net Hospitals Act HR 7145 - the Reinforcing Essential Health Systems for Communities Act

Client expense: $660,000 · Firm income: Not reported

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

Q1 Lobbying Report (Jan. 1-March 31) HCR FEMA re: COVID-19 related reimbursement Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Expanding Medical Education Act (H.R. 2106) Preserving Emergency Access in Key Sites Act (H.R. 3778/S.1860) Improving Seniors Timely Access to Care Act (H.R. 3514/S.1816) Prompt and Fair Pay Act (H.R. 4559) Medicare Advantage Prompt Pay Act (H.R.5454) Apples to Apples Comparison Act of 2025 (H.R. 4093) Protect Our Hospitals Act (H.R. 4807) Resident Physician Shortage Reduction Act of 2025 (H.R. 4731/S.2439) H-1Bs for Physicians and the Healthcare Workforce Act (H.R. 7961) MMM Graduate Medical Education (GME) funding Telehealth flexibilities and payment Californias Medicaid Hospital Quality Assurance Fee Program Medicaid 340B Restoring Rural Health Act (S. 3047) Rural Hospital Fairness Act (H.R. 5821) Defend Rural Health Act of 2026 (H.R.7409) BUD FY 2025 budget FY 2026 appropriations One Big Beautiful Bill Act (H.R. 1)

Client expense: $500,000 · 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. 879, Medicare Patient Access and Practice Stabilization Act of 2025: payment rates H.R. 1317 (2025-2026), I CAN Act: provision of service under Medicare Medicare sequester, PAYGO Medicare Advantage Upcoding Medicare for All/Public Option Historical Medicare payment undervaluation for anesthesiology services (33% problem) Anesthesia Conversion Factor Medicare Physician Fee Schedule Rule Budget neutrality Medicare Economic Index: Medicare inflationary increase Medicaid Bundled payments H.R. 5454/S. 2879 Medicare Advantage Prompt Pay Act WISeR Model Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCD) Practice Expense (PE) Opioid sparing Labor, Health and Human Services (LHHS) Appropriation S.586 - NOPAIN Act: Non-Opioids Prevent Addiction In the Nation Act or the NOPAIN Act

Client expense: $219,480 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Issues related to the Medicare/Medicaid dual eligible population Issues related to Medicare Site-neutral payment cuts Issues related to Medicare uncompensated care payments Issues related to Medicare Advantage Issues related to Medicaid DSH Cuts Issues related to Medicaid financing Issues related to Medicaid eligibility Issues related to Medicaid state directed payments Issues related to Medicaid provider taxes Issues related to essential hospital designation Issues related to Maternal health equity S.1261 - CONNECT for Health Act of 2025 HR 4150 - Advancing Maternal Health Equity Under Medicaid Act of 2025 S2879/HR5454 - Medicare Advantage Prompt Pay Act

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

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

Healthcare issues related to clinical laboratories; H.R. 5269/S. 2761,the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, and Section 6209 of the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extension Act, 2026, Pub. L. 119-37, provisions relating to reform of Medicare reimbursement for clinical laboratory services under Section 216 of the Protecting Access to Medicare Act, Pub. L. 113-93; Section 8001 of H.R. 5371, the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extension Act, 2026, Pub. L. 119-37, provisions relating to implementation of Medicare reimbursement cuts under the Statutory Pay-As-You-Go Act of 2010, Pub. L. 111-139; H.R. 6280, the Access to Genetic Counselor Services Act, provisions relating to Medicare coverage of genetic counselor services; H.R. 5582/S. 2355, the Patients Deserve Price Tags Act, provisions relating to lab test price transparency; H.R. 5454/S. 2879, the Medicare Advantage Prompt Pay Act, and H.R. 4559, the Prompt and Fair Pay Act, provisions relating to prompt payment of Medicare Advantage claims; Federal policy relating to access to mandatory code sets for administrative transactions; Federal policy relating to oversight of laboratory-developed tests; and Federal policy relating to supply chain issues affecting pre-clinical biomedical research for drug development.

Client expense: $310,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid funding, Medicare Advantage (H.R. 5454/S. 2879 Medicare Advantage Prompt Pay Act), telehealth, OPPS, PFS

Client expense: $140,000 · Firm income: Not reported

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

Q4 Lobbying Report (October 1-December 31) HCR FEMA re: COVID-19 related reimbursement Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Expanding Medical Education Act (H.R. 2106) Preserving Emergency Access in Key Sites Act (H.R. 3778/S.1860) Improving Seniors Timely Access to Care Act (H.R. 3514/S.1816) Prompt and Fair Pay Act (H.R. 4559) Medicare Advantage Prompt Pay Act (H.R.5454) Apples to Apples Comparison Act of 2025 (H.R. 4093) Protect Our Hospitals Act (H.R. 4807) Resident Physician Shortage Reduction Act of 2025 (H.R. 4731/S.2439) MMM Graduate Medical Education (GME) funding Telehealth flexibilities and payment Californias Medicaid Hospital Quality Assurance Fee Program Medicaid 340B Restoring Rural Health Act (S. 3047) Rural Hospital Fairness Act (H.R. 5821) BUD FY 2025 budget FY 2026 appropriations One Big Beautiful Bill Act (H.R. 1)

Client expense: $520,000 · 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)

Acute Hospital Care at Home - Recommended Congress make certain flexibilities related to the Acute Hospital Care at Home Program permanent or, pass an extension before flexibilities expire. Issues related to hospital and provider payment - Supported increasing hospital reimbursement to ensure continued access to care for vulnerable populations, highlighted the criticality of Medicaid to sustaining vital healthcare services. Medicaid Disproportionate Share Hospital (DSH) Program - Urged Congress to avert the cuts to Medicaid DSH payments set to take place, encouraged passage of legislation to preserve DSH payments on a longer-term basis Medicare and Medicaid Programs; CY 2026 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Ratings; and Hospital Price Transparency (CMS-1834-P) final rule - Monitored development and eventual release of the CY26 Final Rule Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program (CMS-1832-P) final rule - Monitored development and eventual release of the CY26 Final Rule Monitored development and passage of the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026 (H.R. 5371) Physician Payment - Urged Congress to consider long-term legislative solutions to refine the current Medicare physician payment system Prior Authorization - Provided feedback to improve prior authorization (PA) processes for various plans and payers, including MA organizations and Medicaid managed care plans. Continued monitoring and encouraged passage of the Medicare Advantage Prompt Pay Act (H.R.5454) Rural Emergency Hospital (REH) Designation - Urged corrective action to allow REHs to bill both the Medicare and Medicaid programs. Advocated for increased eligibility among REHs to allow for future Medicaid DSH payments to certain hospital facilities. Site-Neutral Payment Policies - Opposed adoption of site-neutral payment policies for drug administration and increased fines related to price transparency requirements for hospitals. Urged Congress to redirect its focus from site-neutral payment policies to reducing administrative burdens and increasing, rather than reducing, payments for care delivery in rural areas.

Client expense: $320,000 · Firm income: Not reported

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

H.R.5454/S.2879, Medicare Advantage Prompt Pay Act. H.R.4559 - Prompt and Fair Pay Act H.R.3514/S.1816, Improving Seniors Timely Access to Care Act. H.R.5142, Home Health Stabilization Act S.3300, ANCHOR Act. S.3299, DSH in Tennessee Act. Issues related to implementation of healthcare provisions in H.R.1. Issues related to reintroduction of the Access to Genetic Counselor Services Act Issues related to CMS telehealth policies. Issues related to hospital outpatient reimbursement. Issues related to the Medicare area wage index. Issues related to Medicare Advantage. Issues related to Medicare GME. Issues related to the PAYGO Scorecard.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare payment reform - Sent letter of support to the bill sponsors of the Strengthening Medicare for Patients and Providers Act (H.R. 6160) that would add an inflationary update to Medicare Part B reimbursement as measured by the Medicare Economic Index (MEI). Sent letter to congressional leadership with our end of 2025 Medicare payment reform priorities - add an inflationary update, reform the budget neutrality aspect of Medicare, permanently extend the 1.0 work GPCI floor. Prior Authorization - Supported the Improving Seniors Timely Access to Care Act (S. 1816, H.R. 3514) in Congress to reform prior authorization, joined a letter to congressional leadership in support of the bill. Joined letter to Congress on the need to reform the Medicare Wasteful and Inappropriate Service Reduction (WISeR) Model that is being tested under the CMS Innovation Center. Sent a letter of support to the bill sponsors for reintroducing the Safe Step Act (H.R. 5509) to reform step therapy protocols. Telehealth - Joined a letter to OMB and the DEA urging for the extension of flexibilities related to prescribing controlled substances via telehealth. Joined a letter to Congress to act to extend telehealth flexibilities long-term that were at the time expired during the government shutdown. Sent letter to congressional leadership with our end of 2025 telehealth policy priorities. Physician-Owned Hospitals - Joined a letter to Congress in support of repealing the ban on physician-owned hospitals. Joined a letter of support of the Patient Access to Higher Quality Health Care Act of 2025 (H.R. 4002) that would repeal statutory restrictions on the whole hospital exception to Stark physician self- referral law. Cybersecurity - Joined a letter to HHS opposing the finalization of the proposed rule to make changes to HIPAA cybersecurity regulations. Artificial Intelligence (AI) - Joined a coalition letter on artificial intelligence policies for medical groups in response to the White House Office of Science and Technology Policy request for information on AI reform. Value-Based Care - Sent letter to congressional leadership supporting the Preserving Patient Access to Accountable Care Act (H.R. 786, S. 1460). Joined a letter to CMS urging them to use existing authority to ensure ACOs and MIPS eligible clinicians are held harmless from challenges posed by increased billing for skin substitutes. Expiration of healthcare policies due to lapse in federal government funding - Sent letter to congressional leadership urging them to reinstate the healthcare provisions (telehealth flexibilities, the 1.0 work GPCI floor) that expired on September 30 as part of the government shutdown. Urged CMS to release claims that were being held as a result of the pause on processing Medicare claims from the government shutdown. Sent letter to CMS requesting guidance on the rebilling of claims following the government shutdown and subsequent legislation extending numerous healthcare policies. Supported Congress extending healthcare policies that expired during the government shutdown and urged permanent reform to enshrine these policies. Enhanced ACA Tax Credits - Urged Congress to extend the enhanced Marketplace premium tax credits as part of our end of 2025 legislative priorities. Clinical Lab Cuts -Joined a coalition letter of support to the bill sponsors for the RESULTS Act (H.R. 5269) that would reform the clinical laboratory fee schedule and stop potential cuts to laboratory reimbursement. Included support for the RESULTS Act in our end of 2025 legislative priorities. Medicare Advantage - Sent letter of support to bill sponsors of the Medicare Advantage Prompt Pay Act (H.R. 5454) that would help ensure prompt payment to medical groups from Medicare Advantage plans.

Client expense: $300,000 · 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), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE