Defend Rural Health Act of 2026

P.L.119-21 - One Big Beautiful Bill Act H.R.1 and Senate-Passed Amendment to H.R.1 Fiscal Year 2025 Budget Reconciliation H.Con.Res. 14 Fiscal Year 2026 Budget Reconciliation Issue: Educate Congress on potential financial implications of Medicare and Medicaid cuts and entitlement reform on academic health systems and teaching hospitals, medical schools, and faculty practices and the impact on patients access to care and the nations health. Support preservation of non-profit tax status of AAMC member institutions. Oppose reduction in Medicare hospital outpatient department reimbursement and site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital and provider cuts, including Medicare graduate medical education (GME) reforms, reduction or elimination of bad debt reimbursement, reforming Medicare disproportionate share hospital payments and uncompensated care, prevention of rural reclassification, and reductions in wage index. Oppose cuts to federal Medicaid funding, including reductions to the federal medical assistance percentage (FMAP), changes to provider taxes and state-directed payments, and the implementation of per-capita caps or block grants. Oppose policies that restrict access to coverage and care for the Medicaid population, such as work/community engagement requirements, more frequent eligibility redeterminations, and additional cost-sharing. Oppose limits on Affordable Care Act (ACA) premium tax credit eligibility and restrictions on eligibility for and enrollment in ACA Marketplace plans. Oppose reducing Medicare reimbursement for 340B-acquired drugs. Issue: Educate lawmakers on the need to delay, undo, or revise pending new restrictions on to provider taxes and state-directed payments, along with implement strategies to mitigate coverage losses due to the OBBBAs work requirements and more frequent eligibility redeterminations for the ACA expansion population. Issue: Educate lawmakers on the importance of academic health systems, teaching hospitals, and physician practice eligibility for Rural Health Transformation Program (RHTP), support increased funding for RHTP. Issue: Educate Congress and policymakers on the financial challenges facing academic health systems and teaching hospitals, medical schools, and faculty practices and the impact on patients access to care and the nations health. H.R.7409 - Defend Rural Health Act Issue: Oppose efforts to repeal or curtail the ability of urban hospitals to become rural referral centers or reclassify for the purposes of their wage index. Issue: Educate Congress and policymakers on the role academic health systems, teaching hospitals, medical schools, and faculty practices play in caring for rural patients and communities, training providers to practice in rural communities, and ensuring access to critical health care services not otherwise available. Issue: Educate Congress on impact of Statutory Pay-As-You-Go Act Medicare sequester H.R.1835 - Breaking the Gridlock Act S.3385 - Lower Health Care Costs Act S.3386 - Health Care Freedom for Patients Act of 2025 Issue: Support clean extension of Affordable Care Act enhanced premium tax credits (EPTCs) set to expire at the end of 2025 H.R.4371/S.2439 - Resident Physician Shortage Reduction Act of 2025 Issue: Support increased Medicare funding for graduate medical education (GME). Draft Bipartisan Senate Medicare GME Expansion proposal Issue: Support increased Medicare funding for graduate medical education (GME). Oppose duplicative teaching health system and hospital reporting and policies that increase regulatory burden. H.R.2314/S.2715 - Fair Access in Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. H.R.1153 - Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare graduate medical education (GME) payment formulas that reduce current Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments to teaching hospitals. Issue: Educate Congress on teaching health system and hospital graduate medical education (GME) data collection practices and concerns related to duplicative reporting requirements. H.R.3178/S.2600 - Save Healthcare Workers Act Issue: Support legislation providing protection for health care workers by creating a criminal offense for knowingly assaulting or intimidating hospital workers and providing grants to reduce violence in hospitals. Issue: Oppose legislation that pays for workforce investments and mitigation of Medicaid Disproportionate Share Hospital (DSH) program cuts paid for by cuts to hospital outpatient departments. Issue: Support legislation that ensures the move to value-based care. Issue: Educate Congress about the likely impact of legislation that would alter the distribution of Medicare-supported graduate medical education (GME) slots from the Consolidated Appropriations Act (CAA), 2021 and 2023. Issue: Educate Congress on status of Centers for Medicare and Medicaid Services (CMS) distribution of the 1,000 new graduate medical education (GME) slots authorized by the Consolidated Appropriations Act (CAA), 2021 (P.L.116-260). Support CMS changing its distribution methodology to end the practice of super prioritization. Issue: CAA, 2021 Sec. 131 extension and RTP thresholds Issue: Support Medicare graduate medical education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose reduction of Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose the redesign of Medicare Indirect Medical Education (IME) financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare. Issue: Support creation of new Medicare outpatient Indirect Medical Education (IME) payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create budget neutral IME payments for outpatient services. Issue: Support efforts to reform the Medicare physician fee schedule. H.R.879 - Medicare Patient Access and Practice Stabilization Act of 2025 Issue: Support Medicare Physician Fee Schedule (PFS) reform. P.L.119-4 - Full-Year Continuing Appropriations and Extensions Act, 2025 P.L.118-158 - American Relief Act 2025 Issues: Oppose reduction in Medicare hospital outpatient department reimbursement for drug administration and other services. Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital, and provider cuts. Support mitigation of Medicare Physician Fee Schedule (PFS) cuts. Support delaying or eliminating scheduled cuts to the Medicaid disproportionate share hospital (DSH) program. Support extension of alternative payment model (APM) bonus. Support allowing hospitals to count costs and reimbursements for Medicaid patients with third-party coverage towards their DSH cap. Support extensions of Acute Hospital at Home program waiver of 24/7 nursing requirement and Medicare telehealth waivers and efforts to expand patient access to telehealth. H.R.5582/S.2355 - Patients Deserve Price Tags Act H.R.9393 - Lower Costs, More Transparency Act of 2026 H.R.9390 - Prices on the Wall Act of 2026 Issue: Oppose efforts to increase administrative burden on hospitals through expanded reporting measures. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives. H.R.9504 - Tax Exempt Hospital Transparency Act Issue: Oppose efforts that increase duplicative and burdensome reporting requirements on tax exempt hospitals through expanded IRS reporting measures. H.R.3514/ S.1816 - Improving Seniors' Timely Access to Care Act of 2025 Issue: Support efforts to decrease the burden of prior authorization in Medicare Advantage plans Issue: Protect patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency. Issue: Support elimination of scheduled reductions to the Medicaid disproportionate share hospital (DSH) program. H.R.8163 - Provider Reimbursement Stability Act of 2026 Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issue: Support policies to close the Medicaid coverage gap and ensure access to coverage in non-expansion states, as well as financial incentives to help states maintain existing expansions. Support mandatory 12-month Medicaid coverage for post-partum individuals. Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. H.R.4313 - Hospital Inpatient Services Modernization Act Issue: Support extension of the Acute Hospital Care at Home program. Issue: Support extension of Medicare telehealth waivers and efforts to expand patient access to telehealth. Issue: Support policy to permanently remove the requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services. Issue: Support legislation to eliminate the 190-day Lifetime Limit policy in the Medicare program. Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP. Issue: Support increased access to behavioral health and substance use disorder treatment services under Medicare and Medicaid. Support the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). S.2761/H.R.5269 - Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act Issue: Support legislation to modify Medicare payment rates for clinical diagnostic laboratory services to avoid statutory cuts to these payments. Issue: Support authorization of Medicare advance and accelerated payments in the wake of cyberattacks on providers. Issue: Support removing cost-sharing obligations from the chronic care management (CCM) code in Medicare. Issue: Oppose Department Homeland Security (DHS) proposed rule to expand public charge definition and educate Congress on potential impacts to health care providers.

Client expense: $821,438 · Firm income: Not reported

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

Draft, Medicare Compare Website (no bill number) - Rep. Guthrie, Brett - improvements to CMS Medicare compare website H.R. 1 - One Big Beautiful Bill Act - Rep. Arrington, Jodey - Medicaid eligibility and state financing, Marketplace coverage and enrollment, Health Savings Account expansion, Pharmacy Benefit Manager financing and regulation H.R. 497 - Medicaid Third Party Liability Act - Rep. Crenshaw, Dan - Medicaid liable third-party exceptions H.R. 538 - Critical Access Hospital Relief Act - Rep. Smith, Adrian - Medicare physician certification requirement H.R. 584 - No Medicaid for Illegal Immigrants Act - Rep. Kiley, Kevin - Medicaid eligibility requirements H.R. 608 - COVER Now Act - Rep. Doggett, Lloyd - Medicaid expansion demo H.R. 610 - Close the Medigap Act - Rep. Doggett, Lloyd - Medigap plan reform H.R. 879 - Medicare Patient Access and Practice Stabilization Act - Rep. Murphy, Gregory - Medicare physician reimbursement H.R. 936 - Medicaid Improvement and State Flexibility Act - Rep. Green, Mark - Medicaid demonstration programs H.R. 1019 - Medicaid Program Improvement Act - Rep. Miller-Meeks, Mariannette - Medicaid management care reporting H.R. 1059 - Jobs and Opportunities for Medicaid Act - Rep. Crenshaw, Dan - Medicaid eligibility requirements H.R. 1162 - Medicaid Primary Care Improvement Act - Rep. Crenshaw, Dan - Medicaid direct primary care arrangements H.R. 1191 - Supporting Access to Rural Community Hospitals Act - Rep. Flood, Mike - Medicare critical access hospitals definition H.R. 1195 - Protect Medicaid Act - Rep. Hudson, Richard - Medicaid eligibility requirements H.R. 1279 - To amend title XIX of the Social Security Act to establish a community engagement requirement for certain individuals under the Medicaid program. - Rep. Bean, Aaron - Medicaid eligibility requirements H.R. 1403 - LIVE Beneficiaries Act - Rep. Bilirakis, Gus - Medicaid registration audits H.R. 1598 - Ensuring Access to Medicaid Buy-in Programs Act - Rep. Ciscomani, Juan - Medicaid eligibility requirements H.R. 1683 - Protecting Rural Seniors Access to Care Act - Rep. Fischbach, Michelle - Minimum nursing home staffing H.R. 1775 - Second Chances for Rural Hospitals Act - Rep. Arrington, Jodey -Definition of rural emergency hospitals H.R. 1805 - ARCH Act - Rep. Miller, Carol - Extend Medicare-dependent and low-value hospitals payments H.R. 1924 - Securing Access to Care for Seniors in Critical Condition Act - Rep. Hern, Kevin - Medicare site-neutral payments for LTC hospitals H.R. 2045 - Medicare Dental, Vision, and Hearing Benefit Act - Rep. Doggett, Lloyd - Medicare dental, vision, and hearing coverage H.R. 2263 - Telehealth Coverage Act - Rep. Khanna, Ro - Telehealth flexibilities in Medicare H.R. 2309 - Medicare and Medicaid Fraud Prevention Act - Rep. Peters, Scott - provider screening for Federal programs H.R. 2433 - Reducing Medically Unnecessary Delays in Care Act - Rep. Green, Mark - Medicare Advantage prior authorization H.R. 2533 - EASE Act - Rep. Arrington, Jodey - CMS model for virtual technology H.R. 2586 - Reentry Act - Rep. Tonko, Paul - Medicaid coverage for incarcerated population H.R. 2590 - Mental and Physical Health Care Comorbidities Act - Rep. Boyle, Brendan - CMS demonstration to treat comorbidities H.R. 2610 - Protecting Options for Seniors Act - Rep. Tenney, Claudia - MA wage index reclassification H.R. 3023 - Preventing Hospital Overbilling of Medicare Act - Rep. Spartz, Victoria - Site-neutral payment reform H.R. 3069 - Medicare for All Act - Rep. Jayapal, Pramila - New national health insurance program H.R. 3222 - SMART Health Care Act - Rep. Spartz, Victoria - MA risk adjustment H.R. 3263 - PATCH Act - Rep. Tokuda, Jill - Medicare geographic practice cost indices H.R. 3321 - Ending Medicaid Discrimination Against the Most Vulnerable Act - Rep. Roy, Chip - Enhance FMAP phase out H.R. 3415 - Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act - Rep. Schakowsky, Janice - Nurse staffing ratio requirements H.R. 3467 - To amend title XVIII to reform the Medicare Advantage program - Rep. Schweikert, David - MA reforms H.R. 3808 - Expanding Seniors Access to Mental Health Services Act - Rep. Fitzpatrick, Brian - Medicare mental health services H.R. 4093 - Apples to Apples Comparison Act - Rep. Bean, Aaron - Medicare and Medicare Advantage spending reports H.R. 4139 - Cutting Copays Act - Rep. McGarvey, Morgan - Medicare cost-sharing for generic drugs H.R. 4277 - Rural Emergency Hospital Financial Stability Act - Rep. Davis, Donald - Medicaid treatment of rural emergency hospitals H.R. 4313 - Hospital Inpatient Services Modernization Act - Rep. Buchanan, Vern - Acute hospital care at home waiver H.R. 4559 - Prompt and Fair Pay Act - Rep. Doggett, Lloyd - Payment parity for MA and FFS; MA reimbursement requirements H.R. 4641 - Keep Kids Covered Act - Rep. Castor, Kathy - Continuous eligibility for children in Medicaid/CHIP H.R. 4807 - Protect Our Hospitals Act - Rep. Landsman, Greg - Medicaid provider tax repeal H.R. 5243 - To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. - Rep. McClellan, Jennifer - MA supplemental benefits data reporting H.R. 5281 - REAL Health Providers Act - Rep. Panetta, Jimmy - MA provider directory requirements H.R. 5584 - Medicaid Third Party Liability Act - Rep. Burgess, Michael - Impact of Third Party Liability on MCOs H.R. 6109 - To amend title XVIII of the Social Security Act to establish certain requirements with respect to rates of reversed prior authorization coverage determinations under Medicare Advantage plans. - Rep. Pocan, Mark -prior authorization under Medicare Advantage H.R. 6110 -To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage. - Rep. Pocan, Mark - reconsider denials under Medicare Advantage H.R. 6111 - To amend title XVIII of the Social Security Act to require any advertisement of a Medicare Advantage plan to include information related to the rates of prior authorization denials under such plan. - Rep. Pocan, Mark - advertise rates of prior authorization denials under Medicare Advantage H.R. 6112 - To amend title XVIII of the Social Security Act to establish certain requirements with respect to the average monthly cost to provide coverage to an enrollee under Medicare Advantage plans. - Rep. Pocan, Mark - require monthly coverage cost to enrollees under Medicare Advantage H.R. 6113 - To amend title XVIII of the Social Security Act to impose limitations on contracts with Medicare Advantage organizations offering multiple Medicare Advantage plans under the Medicare program. - Rep. Pocan, Mark - limit multiple Medicare Advantage plans H.R. 6114 - To prohibit funds made available to the Department of Health and Human Services by previous Appropriations Acts from being used for any activity that makes Medicare Advantage the default under the Medicare program. - Rep. Pocan, Mark - prohibit Medicare Advantage from becoming the default H.R. 6254 - Medicaid Staffing Flexibility and Protection Act of 2025 - Rep. Carter, Earl - extend eligibility determinations and redeterminations for Medicaid H.R. 6361 - Ban AI Denials in Medicare Act - Rep. Landsman, Greg - limit WISeR model H.R. 6951 - Stop Unfair Medicaid Recoveries Act - Rep. Schakowsky, Janice - State Medicaid cost recoupment H.R. 6974 - Improving MA SNP Act of 2026 - Rep. Arrington, Jodey - MA SNP beneficiary approval H.R. 7189 - PrEP Access Act - Rep. Pocan, Mark - HIV prevention services under Medicare H.R. 7409 - Defend Rural Health Act - Rep. Taylor, Dave - Medicare definition of rural hospital H.R. 7727 - Sustaining Rural Healthcare Act - Rep. Alford, Mark - Medicare CAH designation H.R. 7778 - Medicaid PNA Modernization Act - Rep. Subramanyam, Suhas - Medicaid minimum monthly personal needs allowance H.R. 7803 - Save Medicare Act - Rep. Pocan, Mark - Renames Medicare Advantage H.R. 7871 - MVP Act - Rep. Guthrie, Brett - Value-based purchasing arrangements in Medicaid S. 523 - Protect Medicaid Act - Sen. Cassidy, Bill - Medicaid eligibility requirements S. 678 - LIVE Beneficiaries Act - Sen. Scott, Rick - Medicaid enrollment audits S. 717 - Increasing Access to Quality Cardiac Rehabilitation Care Act - Sen. Capito, Shelley Moore - Expanding cardiac care coverage in Medicare S. 750 - Protecting Rural Seniors Access to Care Act - Sen. Fischer, Deb - Medicaid nursing home staff requirements S. 752 - Accelerating Kids Access to Care Act - Sen. Grassley, Chuck - Out-of-state provider access for Medicaid S. 939 - Medicare Dental, Hearing, and Vision Expansion Act - Sen. Sanders, Bernard - Medicare coverage requirements S. 1082 - Safeguarding Medicaid Act - Sen. Barrasso, John - Medicaid enrollee asset verification S. 1105 - No UPCODE Act - Sen. Cassidy, Bill - MA risk adjustment S. 1264 - Mental and Physical Health Care Comorbidities Act - Sen. Bennet, Michael - CMS demonstration to treat comorbidities S. 1399 - Health Tech Investment Act - Sen. Rounds, Mike - Medicare coverage for algorithm-based services S. 1506 - Medicare for All Act - Sen. Sanders, Bernard - New national health insurance program S. 1624 - PATCH Act - Sen. Schatz, Brian - Medicare geographic practice cost indices S. 1629 - Same Care, Lower Cost Act - Sen. Kennedy, John - Medicare site-neutral payment reform S. 1637 - MVP Act - Sen. Mullin, Markwayne - Medicaid value-based purchasing agreements S. 1709 - Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act - Sen. Padilla, Alex - Nurse staffing ratio requirements S. 1816 - Improving Seniors Timely Access to Care Act - Sen. Marshall, Roger - MA prior authorization S. 1903 - A bill to prohibit changes to Medicare and Medicaid in reconciliation - Sen. Reed, Jack - Medicare and Medicaid safeguards against reconciliation cuts S. 2237 - Hospital Inpatient Services Modernization Act - Sen. Scott, Tim - Acute hospital care at home waiver S. 2279 - Protect Medicaid and Rural Hospitals Act - Sen. Hawley, Josh - Medicaid provider tax and State directed payments S. 2289 - Healthy Moms and Babies Act - Sen. Grassley, Chuck - Medicaid/CHIP maternal health coverage improvements S. 2496 - Keep Kids Covered Act - Sen. Bennet, Michael - Continuous eligibility for children in Medicaid/CHIP S. 2497 - Fair Billing Act - Sen. Hassan, Maggie - Medicare site-neutral transparency and identification requirements S. 2556 - Protecting Healthcare and Lowering Costs Act - Sen. Schumer, Charles - repeal of Medicaid provisions in the One Big Beautiful Bill Act S. 2793 - Ensuring Access to Essential Providers Act - Sen. Cassidy, Bill - Essential community provider coverage requirements for MA S. 3642 - WALZ Act - Sen. Marshall, Roger - Medicaid payment investigation and audits S. 3690 - Ensuring Access to Medicaid Buy-in Programs - Sen. Blackburn, Marsha - Medicaid eligibility parameters S. 3727 - Putting an N to Learing about Fraud Act - Sen. Ernst, Joni - Federal program fraud prevention S. 3729 - PBM Reporting Transparency Act - Sen. Warner, Mark - MedPAC reports on PBMs S. 3750 - REAL Health Providers Act - Sen. Bennet, Michael - MA provider directory accuracy S. 3762 - Prior Authorization Relief Act - Sen. Whitehouse, Sheldon - MA prior authorization restrictions S. 3848 - Apples to Apples Comparison Act - Sen. Scott, Tim - Medicare and Medicare Advantage spending reports S. 3886 - Nurses Belong in Nursing Homes Act - Sen. Wyden, Ron - Nursing home staffing hours Issues related to mental health and Medicare; Medicare and Medicaid funding; Medicaid expansion; State innovation waivers; Medicaid and CHIP; Medicaid FMAP; Medicare Supplement Coverage; Medicare Transparency in Coverage; Medicaid Access Final Rule; Medicaid Redeterminations; Medicaid rate actuarial soundness; value of Medicaid Managed Care; value of Medicare Advantage; Medicare Advantage Health Risk Assessment and chart reviews; Medicare Advantage supplemental benefits and Social Determinants of health; CBO estimates of MA and FFS costs; coverage of weight loss drugs; Inflation Reduction Act implementation; Medicare Advantage Rate Notice; Part D Payment Issues; Part D VBID Issues; RADV; MA payment issues; Part D issues; prior authorization; MA prompt pay; agent/broker issues; implementation of the One Big Beautiful Bill Act; provider taxes; Medicaid community engagement requirements; and VAs community care program.

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.

P.L.119-21 - One Big Beautiful Bill Act H.R.1 and Senate-Passed Amendment to H.R.1 Fiscal Year 2025 Budget Reconciliation H.Con.Res. 14 Fiscal Year 2026 Budget Reconciliation Issue: Educate Congress on potential financial implications of Medicare and Medicaid cuts and entitlement reform on academic health systems and teaching hospitals, medical schools, and faculty practices and the impact on patients access to care and the nations health. Support preservation of non-profit tax status of AAMC member institutions. Oppose reduction in Medicare hospital outpatient department reimbursement and site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital and provider cuts, including Medicare graduate medical education (GME) reforms, reduction or elimination of bad debt reimbursement, reforming Medicare disproportionate share hospital payments and uncompensated care, prevention of rural reclassification, and reductions in wage index. Oppose cuts to federal Medicaid funding, including reductions to the federal medical assistance percentage (FMAP), changes to provider taxes and state-directed payments, and the implementation of per-capita caps or block grants. Oppose policies that restrict access to coverage and care for the Medicaid population, such as work/community engagement requirements, more frequent eligibility redeterminations, and additional cost-sharing. Oppose limits on Affordable Care Act (ACA) premium tax credit eligibility and restrictions on eligibility for and enrollment in ACA Marketplace plans. Oppose reducing Medicare reimbursement for 340B-acquired drugs. Issue: Educate lawmakers on the need to delay, undo, or revise pending new restrictions on to provider taxes and state-directed payments, along with strategies to mitigate coverage losses in light of the implementation of work requirements and more frequent eligibility redeterminations for the ACA expansion population. Issue: Educate lawmakers on the importance of academic health systems, teaching hospitals, and physician practice eligibility for Rural Health Transformation Program (RHTP), support increased funding for RHTP. Issue: Educate Congress and policymakers on the financial challenges facing academic health systems and teaching hospitals, medical schools, and faculty practices and the impact on patients access to care and the nations health. H.R.7409 - Defend Rural Health Act Issue: Oppose efforts to repeal or curtail the ability of urban hospitals to become rural referral centers or reclassify for the purposes of their wage index. Issue: Educate Congress and policymakers on the role academic health systems, teaching hospitals, medical schools, and faculty practices play in caring for rural patients and communities, training providers to practice in rural communities, and ensuring access to critical health care services not otherwise available. Issue: Educate Congress on impact of Statutory Pay-As-You-Go Act Medicare sequester H.R.1835 - Breaking the Gridlock Act S.3385 - Lower Health Care Costs Act S.3386 - Health Care Freedom for Patients Act of 2025 Issue: Support clean extension of Affordable Care Act enhanced premium tax credits (EPTCs) set to expire at the end of 2025 H.R.4371/S.2439 - Resident Physician Shortage Reduction Act of 2025 Issue: Support increased Medicare funding for graduate medical education (GME). Draft Bipartisan Senate Medicare GME Expansion proposal Issue: Support increased Medicare funding for graduate medical education (GME). Oppose duplicative teaching health system and hospital reporting and policies that increase regulatory burden. H.R.2314/S.2715 - Fair Access in Residency Act Issue: Oppose legislative interference in residency training program requirements and policies requiring the Medicare program to consider specific physician licensing exams for residency program applications. H.R.1153 - Rural Physician Workforce Production Act Issue: Oppose legislation redesigning Medicare graduate medical education (GME) payment formulas that reduce current Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments to teaching hospitals. Issue: Educate Congress on teaching health system and hospital graduate medical education (GME) data collection practices and concerns related to duplicative reporting requirements. H.R.3178/S.2600 - Save Healthcare Workers Act Issue: Support legislation providing protection for health care workers by creating a criminal offense for knowingly assaulting or intimidating hospital workers and providing grants to reduce violence in hospitals. Issue: Oppose legislation that pays for workforce investments and mitigation of Medicaid Disproportionate Share Hospital (DSH) program cuts paid for by cuts to hospital outpatient departments. Issue: Support legislation that ensures the move to value-based care. Issue: Educate Congress about the likely impact of legislation that would alter the distribution of Medicare-supported graduate medical education (GME) slots from the Consolidated Appropriations Act (CAA), 2021 and 2023. Issue: Educate Congress on status of Centers for Medicare and Medicaid Services (CMS) distribution of the 1,000 new graduate medical education (GME) slots authorized by the Consolidated Appropriations Act (CAA), 2021 (P.L.116-260). Support CMS changing its distribution methodology to end the practice of super prioritization. Issue: CAA, 2021 Sec. 131 extension and RTP thresholds Issue: Support Medicare graduate medical education (GME) per resident amount and cap-setting technical corrections and administrative relief. Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose reduction of Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Issue: Oppose the redesign of Medicare Indirect Medical Education (IME) financing and redistribution. Issue: Oppose establishing nationality-based restrictions on medical residencies supported by Medicare. Issue: Support creation of new Medicare outpatient Indirect Medical Education (IME) payment in addition to existing Medicare IME payment inpatient methodology. Oppose policies to create budget neutral IME payments for outpatient services. Issue: Support efforts to reform the Medicare physician fee schedule. H.R.879 - Medicare Patient Access and Practice Stabilization Act of 2025 Issue: Support Medicare Physician Fee Schedule (PFS) reform. P.L.119-4 - Full-Year Continuing Appropriations and Extensions Act, 2025 P.L.118-158 - American Relief Act 2025 Issues: Oppose reduction in Medicare hospital outpatient department reimbursement for drug administration and other services. Oppose site-neutral expansion to excepted off-campus provider-based departments (PBDs). Oppose creation of National Provider Number/unique identifier for off-campus hospital outpatient departments. Oppose Medicare hospital, and provider cuts. Support mitigation of Medicare Physician Fee Schedule (PFS) cuts. Support delaying or eliminating scheduled cuts to the Medicaid disproportionate share hospital (DSH) program. Support extension of alternative payment model (APM) bonus. Support allowing hospitals to count costs and reimbursements for Medicaid patients with third-party coverage towards their DSH cap. Support extensions of Acute Hospital at Home program waiver of 24/7 nursing requirement and Medicare telehealth waivers and efforts to expand patient access to telehealth. S.2355 - Patients Deserve Price Tags Act Issue: Oppose efforts to increase administrative burden on hospitals through expanded reporting measures. Issue: Educate Congress on role of academic medicine as it relates to price transparency or disclosure initiatives. Issue: Protect patients from delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program and providing program oversight and transparency. Issue: Support elimination of scheduled reductions to the Medicaid disproportionate share hospital (DSH) program. Issue: Support necessary changes and improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Issue: Support policies to close the Medicaid coverage gap and ensure access to coverage in non-expansion states, as well as financial incentives to help states maintain existing expansions. Support mandatory 12-month Medicaid coverage for post-partum individuals. Issue: Support waiving budget neutrality requirements associated with the E/M code changes or temporarily holding harmless physicians and other health care professionals. H.R.4313 - Hospital Inpatient Services Modernization Act Issue: Support extension of the Acute Hospital Care at Home program. Issue: Support extension of Medicare telehealth waivers and efforts to expand patient access to telehealth. Issue: Support policy to permanently remove the requirement for Medicare beneficiaries to be seen in-person every six months for telehealth visits for mental health services. Issue: Support legislation to eliminate the 190-day Lifetime Limit policy in the Medicare program. Issue: Support providing states with guidance to increase telehealth access in Medicaid and CHIP. Issue: Support increased access to behavioral health and substance use disorder treatment services under Medicare and Medicaid. Support the removal of regulatory barriers to telehealth-enabled mental health care, including electronic interprofessional consults (eConsults). S.2761/H.R.5269 - Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act Issue: Support legislation to modify Medicare payment rates for clinical diagnostic laboratory services to avoid statutory cuts to these payments. Issue: Support authorization of Medicare advance and accelerated payments in the wake of cyberattacks on providers. Issue: Support removing cost-sharing obligations from the chronic care management (CCM) code in Medicare. Issue: Oppose Department Homeland Security (DHS) proposed rule to expand public charge definition and educate Congress on potential impacts to health care providers.

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)