Medicare Advantage Improvement Act of 2026

Medicaid Reform Implementation, Medicare Advantage, Risk Adjustment, Star Ratings, Prior Authorization, Site Neutral Payments, Prompt Pay, Provider Directories, Transparency H.R.8375 - Medicare Advantage Improvement Act of 2026 - A bill to provide for certain reforms under the Medicare Advantage program, and for other purposes. S. 1105 - No Unreasonable Payments, Coding, Or Diagnoses for the Elderly Act (No UPCODE) Act - This bill modifies certain factors that are used to determine Medicare Advantage (MA) payments, particularly relating to health status and related data. H.R. 4077/S. 2145 - GUARD Veterans Health Care Act - To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. H.R. 3514/S. 1816 - Improving Seniors Timely Access to Care Act of 2025 - To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. S. 3848/H.R. 4093 - Apples to Apples Comparison Act of 2025 - to require the Secretary of Health and Human Services to publish information on expenditures under the Medicare program, and for other purposes. H.R.5243 - A bill to increase data transparency for supplemental benefits under Medicare Advantage. H.R. 9392, Medicare Advantage Cost Transparency Act - A bill to require MA plans to report specified information on encounter data submitted to CMS. H.R. 9395, Transparency in Medicare Advantage Steering Act - Requires MA plans to annually identify individuals enrolled by an agent, broker or other third-party and report information about compensation paid.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 8883, Protecting Seniors and Stopping Fraudsters Act; Medicare Home Health benefit; Medicaid Home and Community-Based Services (HCBS) benefits; Medicare Hospice benefit; H.R. 3467, To amend title XVIII to reform the Medicare Advantage program; H.R. 5142, Home Health Stabilization Act of 2025; Hospice Medicare Advantage Carve-in; Issues related to Medicare and Medicaid fraud; Issues related to Senate Finance Dear Colleague Process; Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs) CMS issued on 5/13/26; Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of Nationwide Temporary Moratorium on Enrollment of Hospices CMS issued on 5/13/26; Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based Purchasing Model; Medicare Provider Enrollment, Durable Medical Equipment (DME), and DME, Prosthetics, Orthotics, and Supplies (DMEPOS) Policies; S. 5250, Medicare Home Health Payment Integrity and Protection Act; DEAs registration pathway letting practitioners prescribe controlled substances via telemedicine without a prior in-person evaluation under the Ryan Haight Act; Medicare Advantage Home Health Network Adequacy; H.R. 8375, S. 4384, Medicare Advantage Improvement Act of 2026

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Observation Stays and 3-Day Stay Outreach (S. 4641/H.R. 3954) Improving Access to Medicare Coverage Act of 2025 (S. 4384/H.R. 8375) Ensuring Seniors Access to Quality Care Act (S. 4467/H.R. 7096) Survey Relief/Civil Monetary Penalties SNF Payment Rule Medicare Advantage Administration Nursing Home Reform (Better Way Package) Outreach related to LTPAC Health Information Technology Needs Outreach on Physician Fee Schedule Reform Protecting Rural Senior Access to Care Act Outreach on Telehealth Reforms Improving Seniors Timely Access to Care Act Fighting Medicaid Cuts/Provider Taxes Medicaid Coalition Outreach Medicaid/Budget Reconciliation SNF Off Cycle Provider Enrollment Reporting Private Equity RFI in the Post Acute Care Sector Advocacy around HUD 232/223(f) matters HR 1, One Big Beautiful Act Section 232 National Security Investigation of Imports of Personal Protective Equipment, Medical Consumables, and Medical Equipment, Including Devices Network Adequacy

Client expense: $830,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), SENATE

S. 2120--Older Americans Act Reauthorization Act of 2025--Reauthorizes through FY2030, modifies, and establishes programs under the Older Americans Act, which supports social services and activities for individuals aged 60 years or older. 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 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--Transparency in Medicare Advantage Steering Act--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 Alternative Payment Model (APM) incentives H.R. 8375--Medicare Advantage Improvement Act--Prior authorization reform, plan transparency, prompt pay, and coverage standards alignment H.R. 9397--Premium Transparency Act--Requires MA plans to publish overhead costs, claims payment data, and MLR revenue detail H.R. 9396-Prior Authorization Accountability Act--Public posting of PA approval/denial rates, appeal outcomes, and processing times H.R. 9693--Patients First Act--Physician Fee Schedule reform H.R. 9645--Health Care Price Certainty for All Americans Act--Price transparency reform Health CARE Act of 2026--Reverse health care provisions from H.R. 1

Client expense: $290,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues: Same-day billing restrictions in Medicaid; Medicare Advantage & MA Rate Notice; Medicare/Transparency; Mental Health Care, Youth Mental Health; Site neutral payment reform; Program Fraud, Waste, and Abuse Bills: H.R.4077 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Rep. Doggett, Lloyd [D-TX-37] S.2145 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Sen. Warren, Elizabeth [D-MA] H.R.668 - Coordinating Care for Senior Veterans and Wounded Warriors Act To require the Secretary of Veterans Affairs to carry out a pilot program to coordinate, navigate, and manage care and benefits for veterans enrolled in both the Medicare program and the system of annual patient enrollment of the Department of Veterans Affairs. Sponsor: Rep. Ciscomani, Juan [R-AZ-6] S.506 - Coordinating Care for Senior Veterans and Wounded Warriors Act This bill requires the Department of Veterans Affairs (VA) to implement a three-year pilot program to coordinate, navigate, and manage care and benefits for veterans who are enrolled in both the Medicare program and the VA health care system. Sponsor: Sen. Moran, Jerry [R-KS] H.R.9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Sponsor: Rep. DeGette, Diana [D-CO-1] H.R. 5243 - Supplemental Benefits Transparency Bill To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. McClellan, Jennifer L. [D-VA-4] H.R.3514 - Improving Seniors Timely Access to Care Act of 2025 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R.8883 - Protecting Seniors and Stopping Fraudsters Act To amend title XVIII of the Social Security Act to provide for additional oversight of hospice programs and home health agencies under the Medicare program, and for other purposes. Sponsor: Rep. Van Duyne, Beth [R-TX-24] H.R.8871 - DME Scammer Prevention Act of 2026 To amend title XVIII of the Social Security Act to promote Medicare program integrity with respect to certain medical equipment and supplies. Sponsor: Rep. Bean, Aaron [R-FL-4] H.R.9693 - Patients First Act of 2026 To amend title XVIII of the Social Security Act to modify certain physician payments under the Medicare program. Sponsor: Rep. Joyce, John [R-PA-13] H.R.8375 - Medicare Advantage Improvement Act of 2026 To amend title XVIII of the Social Security Act to provide for certain reforms under the Medicare Advantage program, and for other purposes. Sponsor: Rep. Joyce, John [R-PA-13] S.4384 - Medicare Advantage Improvement Act of 2026 To amend title XVIII of the Social Security Act to provide for certain reforms under the Medicare Advantage program, and for other purposes. Sponsor: Sen. Marshall, Roger [R-KS]

Client expense: $100,000 · 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), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, White House Office

Same-day billing restrictions in Medicaid; Medicare Advantage & MA Rate Notice; Medicare/Transparency; Mental Health Care, Youth Mental Health; Site neutral payment reform; Program Fraud, Waste, and Abuse H.R. 7996, Improving CARE for Youth Act (118th) To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Rep. Dunn, Neal P. [R-FL-2] S.2556 - Improving CARE for Youth Act (118th) To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Sen. Carper, Thomas R. [D-DE] H.R.4077 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Rep. Doggett, Lloyd [D-TX-37] S.2145 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Sen. Warren, Elizabeth [D-MA] H.R.668 - Coordinating Care for Senior Veterans and Wounded Warriors Act To require the Secretary of Veterans Affairs to carry out a pilot program to coordinate, navigate, and manage care and benefits for veterans enrolled in both the Medicare program and the system of annual patient enrollment of the Department of Veterans Affairs. Sponsor: Rep. Ciscomani, Juan [R-AZ-6] S.506 - Coordinating Care for Senior Veterans and Wounded Warriors Act This bill requires the Department of Veterans Affairs (VA) to implement a three-year pilot program to coordinate, navigate, and manage care and benefits for veterans who are enrolled in both the Medicare program and the VA health care system. Sponsor: Sen. Moran, Jerry [R-KS] H.R.9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Sponsor: Rep. DeGette, Diana [D-CO-1] H.R. 5243 - Supplemental Benefits Transparency Bill To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. McClellan, Jennifer L. [D-VA-4] H.R.3514 - Improving Seniors Timely Access to Care Act of 2025 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R.8883 - Protecting Seniors and Stopping Fraudsters Act To amend title XVIII of the Social Security Act to provide for additional oversight of hospice programs and home health agencies under the Medicare program, and for other purposes. Sponsor: Rep. Van Duyne, Beth [R-TX-24] H.R.8871 - DME Scammer Prevention Act of 2026 To amend title XVIII of the Social Security Act to promote Medicare program integrity with respect to certain medical equipment and supplies. Sponsor: Rep. Bean, Aaron [R-FL-4] H.R.9847 - Improving CARE for Youth Act To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services or substance use disorder services and primary care services furnished on the same day. Sponsor: Rep. Dunn, Neal P. [R-FL-2] S.5236 - Improving CARE for Youth Act To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Sen. Hassan, Margaret Wood [D-NH] H.R.9693 - Patients First Act of 2026 To amend title XVIII of the Social Security Act to modify certain physician payments under the Medicare program. Sponsor: Rep. Joyce, John [R-PA-13] H.R.8375 - Medicare Advantage Improvement Act of 2026 To amend title XVIII of the Social Security Act to provide for certain reforms under the Medicare Advantage program, and for other purposes. Sponsor: Rep. Joyce, John [R-PA-13] S.4384 - Medicare Advantage Improvement Act of 2026 To amend title XVIII of the Social Security Act to provide for certain reforms under the Medicare Advantage program, and for other purposes. Sponsor: Sen. Marshall, Roger [R-KS]

Client expense: $1,240,000 · 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

Issues: Medicare Advantage & MA Rate Notice; Medicare/Transparency; Mental Health Care, Youth Mental Health; Site neutral payment reform; Program Fraud, Waste, and Abuse Bills: H.R.4077 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Rep. Doggett, Lloyd [D-TX-37] S.2145 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Sen. Warren, Elizabeth [D-MA] H.R.9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Sponsor: Rep. DeGette, Diana [D-CO-1] H.R. 5243 - Supplemental Benefits Transparency Bill To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. McClellan, Jennifer L. [D-VA-4] H.R.3514 - Improving Seniors Timely Access to Care Act of 2025 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R.8883 - Protecting Seniors and Stopping Fraudsters Act To amend title XVIII of the Social Security Act to provide for additional oversight of hospice programs and home health agencies under the Medicare program, and for other purposes. Sponsor: Rep. Van Duyne, Beth [R-TX-24] H.R.8871 - DME Scammer Prevention Act of 2026 To amend title XVIII of the Social Security Act to promote Medicare program integrity with respect to certain medical equipment and supplies. Sponsor: Rep. Bean, Aaron [R-FL-4] H.R.9693 - Patients First Act of 2026 To amend title XVIII of the Social Security Act to modify certain physician payments under the Medicare program. Sponsor: Rep. Joyce, John [R-PA-13] H.R.8375 - Medicare Advantage Improvement Act of 2026 To amend title XVIII of the Social Security Act to provide for certain reforms under the Medicare Advantage program, and for other purposes. Sponsor: Rep. Joyce, John [R-PA-13] S.4384 - Medicare Advantage Improvement Act of 2026 To amend title XVIII of the Social Security Act to provide for certain reforms under the Medicare Advantage program, and for other purposes. Sponsor: Sen. Marshall, Roger [R-KS]

Client expense: $276,347 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues: Same-day billing restrictions in Medicaid; Medicare Advantage & MA Rate Notice; Medicare/Transparency; Mental Health Care, Youth Mental Health; Site neutral payment reform; Program Fraud, Waste, and Abuse Bills: H.R.4077 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Rep. Doggett, Lloyd [D-TX-37] S.2145 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Sen. Warren, Elizabeth [D-MA] H.R.668 - Coordinating Care for Senior Veterans and Wounded Warriors Act To require the Secretary of Veterans Affairs to carry out a pilot program to coordinate, navigate, and manage care and benefits for veterans enrolled in both the Medicare program and the system of annual patient enrollment of the Department of Veterans Affairs. Sponsor: Rep. Ciscomani, Juan [R-AZ-6] S.506 - Coordinating Care for Senior Veterans and Wounded Warriors Act This bill requires the Department of Veterans Affairs (VA) to implement a three-year pilot program to coordinate, navigate, and manage care and benefits for veterans who are enrolled in both the Medicare program and the VA health care system. Sponsor: Sen. Moran, Jerry [R-KS] H.R.9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Sponsor: Rep. DeGette, Diana [D-CO-1] H.R. 5243 - Supplemental Benefits Transparency Bill To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. McClellan, Jennifer L. [D-VA-4] H.R.3514 - Improving Seniors Timely Access to Care Act of 2025 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R.8883 - Protecting Seniors and Stopping Fraudsters Act To amend title XVIII of the Social Security Act to provide for additional oversight of hospice programs and home health agencies under the Medicare program, and for other purposes. Sponsor: Rep. Van Duyne, Beth [R-TX-24] H.R.8871 - DME Scammer Prevention Act of 2026 To amend title XVIII of the Social Security Act to promote Medicare program integrity with respect to certain medical equipment and supplies. Sponsor: Rep. Bean, Aaron [R-FL-4] H.R.9693 - Patients First Act of 2026 To amend title XVIII of the Social Security Act to modify certain physician payments under the Medicare program. Sponsor: Rep. Joyce, John [R-PA-13] H.R.8375 - Medicare Advantage Improvement Act of 2026 To amend title XVIII of the Social Security Act to provide for certain reforms under the Medicare Advantage program, and for other purposes. Sponsor: Rep. Joyce, John [R-PA-13] S.4384 - Medicare Advantage Improvement Act of 2026 To amend title XVIII of the Social Security Act to provide for certain reforms under the Medicare Advantage program, and for other purposes. Sponsor: Sen. Marshall, Roger [R-KS]

Client expense: Not reported · 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), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, White House Office

H.R. 8375/S. 4834 Medicare Advantage Improvement Act; issues related to Inpatient Rehabilitation Facility (IRF) patient experience with Medicare Advantage Organizations; issues related to CMS FY 27 IRF Proposed Rule; issues related to Medicare Review Choice Demonstration Program.

Client expense: Not reported · Firm income: $110,000

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

HR 3514 / S 1816, the Improving Seniors Timely Access to Care Act; HR 5243, a bill to increase data transparency for supplemental benefits under Medicare Advantage; HR 8375 / S 4384, the Medicare Advantage Improvement Act; HR 9392, Medicare Advantage Cost Transparency Act; S 1105, No UPCODE Act; S 1629, Same Care, Lower Cost Act; S 1936, Improving Access to Transfusion Care for Patients Act; S 4886, Medicare Cost Cap Act; CMS Interim Final Rule on Medicaid Work Requirements; Regulatory and legislative proposals to expand site-neutral payment in Medicare; Implementation of the Accelerating Kids Access to Care Act (HR 1509, S 752) Regulatory proposals related to most-favored nation drug pricing; Issues related to the cost of care, including consolidation and anti-competitive contracting

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

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

H.R. 8375/.4834 Medicare Advantage Improvement Act; issues related to Medicare Advantage enrollee access to inpatient rehabilitation facility care; issues related to affordability and quality of IRF care; issues related to FY 27 proposed rule for Inpatient Rehabilitation Facility Services; issues related to Review Choice Demonstration Program.

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

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

S. 4384 / H.R. 8375, the Medicare Advantage Improvement Act of 2026 Monitoring site-neutral policy

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 4384 / H.R. 8375, the Medicare Advantage Improvement Act of 2026 Monitoring site-neutral policy

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 4384 / H.R. 8375, the Medicare Advantage Improvement Act of 2026 Monitoring site-neutral policy

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 7336/S.3763 - ALS Better Care Act - All provisions. H.R. 6423/S. 864 - HELP Copays Act -- Provisions related to health insurance plans requirement to apply payments made by or on behalf of plan enrollees toward a plan's cost-sharing requirements, i.e. a ban on copay-accumulator adjust programs. H.R. 4206 / S. 1261 - CONNECT for Health Act - Provisions related to permanent telehealth services in Medicare and interstate telehealth services. H.R. 2491 / S. 1227 - Alleviating Barriers for Caregivers (ABC) Act - All provisions. H.R. 2560 / S.830 - Lifespan Respite Care Reauthorization Act - All provisions H.R. 3514 / S. 1816 - Improving Seniors Timely Access to Care Act of 2025 All provisions relating to prior authorization usage under Medicare Advantage Plans. H.R. 6280/S. 3607- Genetic Counselor Services Act - All provisions H.R.2172/S.1058 - Preserving Patient Access to Home Infusion Act - All Provisions H.R.8375/S.4284 - Medicare Advantage Improvement Act of 2026 - Provisions related to expedited care authorizations, increased transparency and oversight, align coverage criteria with traditional Medicare, and strengthen beneficiary protections, in Medicare Advantage plans. H.R.8500 - Timely Access to Coverage Decisions Act of 2026 - All Provisions H.R. 9364 FAST Repairs for Wheelchairs Act - All provisions H.R. 10787-the Access to Medical Supplies Act - All provisions

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to Medicare reimbursement of long term care hospitals Medicare Advantage, Prior authorization related issues Patient Access to LTCH Care Act, Reimbursement of long term care hospitals H.R.1924, Securing Access to Care for Seniors in Critical Condition Act of 2025, LTCH relief issues H.R.9468, Saving Todays Acute-Care Resources Act (STAR Act), Entirety H.R.8375, Medicare Advantage Improvement Act of 2026, Entirety

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare reimbursement issues. H.R.8375/S.4384, Medicare Advantage Improvement Act of 2026.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.879, Medicare Patient Access and Practice Stabilization Act of 2025. General provisions to address Medicare physician fee schedule payment policies and access to physician services. In general, policies impacting physician burden and sustaining the private practice physician model. H.R.3514/S.1816, Improving Seniors Timely Access to Care Act of 2025. Pub. L. No. 119-21, One Big Beautiful Bill Act, provisions regarding Medicare physicians payment increase, reform. H.R.9693, Patients First Act. H.R.8163/S.5180, Provider Reimbursement Stability Act. H.R.8375/S.4384, Medicare Advantage Improvement Act.

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

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

H.R. 4093 - Apples to Apples Comparison Act of 2025, all provisions H.R. 483 - Health Care Efficiency Through Flexibility Act, all provisions H.R. 6728 - Linking Seniors to Needed Legal Services Act of 2025, all provisions H.R. 9393 - Lower Costs, More Transparency Act, all provisions H.R. 9397 - Premium Transparency Act, all provisions H.R. 9468 - Saving Today's Ascute-Care Resouces (STAR) act, all provisions H.R. 9693 - The Patients First Act of 2026 - all provisions H.R.1 - An act to provide for reconciliation pursuant to title II of H. Con. Res. 14 (PL 119-21), provisions related to Medicare payment reform, Medicaid reforms, Alternative Payment Models (APMs) H.R.1317 - I CAN Act, all provisions H.R.1614 - To amend title XVIII of the Social Security Act to expand practitioners eligible to furnish telehealth services under the Medicare program, all provisions H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015 (PL 114-10) H.R.2120 - ROCR Value Based Program Act, all provisions H.R.2433 - Reducing Medically Unnecessary Delays in Care Act of 2025, all provisions H.R.2757 - Medicare Audiology Access Improvement Act of 2025, all provisions H.R.2902 - SOAR Act of 2025, all provisions H.R.3069 - Medicare for All Act, all provisions H.R.3108 - RPM Access Act, all provisions, all provisions H.R.3514 - Improving Seniors Timely Access to Care Act of 2025, all provisions H.R.3878 - RNs for Rural Health Act of 2025, all provisions H.R.4002 - Patient Access to Higher Quality Health Care Act of 2025, all provisions H.R.4206 - CONNECT for Health Act of 2025, all provisions H.R.483 - Health Care Efficiency Through Flexibility Act, all provisions H.R.4977 - Connected MOM Act, all provisions H.R.5081 - Telehealth Modernization Act, all provisions H.R.5178 - Sickle Cell Disease Comprehensive Care Act, all provisions H.R.5243 - To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. H.R.5347 - Health Care Efficiency Through Flexibility Act, all provisions H.R.539 - Chiropractic Medicare Coverage Modernization Act of 2025, all provisions H.R.5467 - PAAT Act, all provisions H.R.5940 - Seniors Deserve SMARTER Care Act of 2025, all provisions H.R.6160 - Strengthening Medicare for Patients and Providers Act, all provisions H.R.6280 - Access to Genetic Counselor Services Act of 2025, all provisions H.R.7520 - Efficiency Adjustment Delay Act, all provisions H.R.786 - Preserving Patient Access to Accountable Care Act, all provisions H.R.7905 - Diabetes Foot Health Access and Modernization Act of 2026, all provisions H.R.8129 - To amend title XVIII of the Social Security Act to establish a full risk ACO program, all provisions H.R.8163 - Provider Reimbursement Stability Act of 2026, all provisions H.R.8261 - Chronic Care Management Improvement Act of 2026, all provisions H.R.8375 - Medicare Advantage Improvement Act of 2026, all provisions H.R.8500 - Timely Access to Coverage Decisions Act of 2026, all provisions H.R.8622 - Medicare Physician Data-driven Performance Payment System Act of 2026, all provisions H.R.879 - Medicare Patient Access and Practice Stabilization Act of 2025, all provisions H.R.9392 - Medicare Advantage Cost Transparency Act, all provisions H.R.9644 - Medicare Advantage MLR Transparency Act, all provisions S.1031 - ROCR Value Based Program Act, all provisions S.106 - Chiropractic Medicare Coverage Modernization Act of 2025, all provisions S.1105 - No UPCODE Act, all provisions S.1261 - CONNECT for Health Act of 2025, all provisions S.1399 - Health Tech Investment Act, all provisions S.141 - Connected MOM Act, all provisions S.1460 - Preserving Patient Access to Accountable Care Act, all provisions S.1535 - Rural Patient Monitoring (RPM) Access Act, all provisions S.1640 - Medicare Patient Access and Practice Stabilization Act of 2025, all provisions S.1816 - Improving Seniors Timely Access to Care Act of 2025, all provisions S.1996 - Medicare Audiology Access Improvement Act of 2025, all provisions S.2709 - Telehealth Modernization Act, all provisions S.3480 - Seniors Deserve SMARTER Care Act of 2025, all provisions S.3607 - Access to Genetic Counselor Services Act of 2026, all provisions S.5168 - Provider Reimbursement Stability Act of 2026, all provisions S.5180 - Provider Reimbursement Stability Act, all provisions S.665 - Fatal Overdose Reduction Act of 2025, all provisions S.721 - Sickle Cell Disease Comprehensive Care Act, all provisions S.891 - Bipartisan Health Care Act, all provisions Comment Letter: [CMS 0057 F] 2024 CMS Interoperability and Prior Authorization final rule Comment Letter: [CMS-0062-P] Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges Comment Letter: [CMS-1844-P] CY 2027 Home Health Prospective Payment System proposed rule Comment Letter: [CMS-1848-P] Medicare Physician Fee Schedule, including conversion factors, Modifier -25 payment reduction, efficiency adjustment, RPM/RTM, Maternity Care Services codes, CPT request for information, MIPS/MVP transition, Medicare Shared Savings Program, and Qualifying APM Participant determinations Comment Letter: [CMS-1850-P] 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 Comment Letter: [CMS-2452-P] Medicaid Program; Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes Comment Letter: [CMS-2454-IFC] Medicaid Program; Community Engagement Requirement for Certain Individuals Comment Letter: [CMS-3847-NC] Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway Comment Letter: [CMS-9874-NC] Request for Information; Comprehensive Review of the Essential Health Benefits Framework and Typical Employer Plan Standard Comment Letter: [HHS-OS-2026-0332] Request for Information: Categories Used in Federal Vaccine Recommendations and the Role of Shared Clinical Decision-Making Comment Letter: Request for Information (RFI) Strengthening the Medicare Physician Payment System Statement for the Record: Examining Legislative Proposals to Reform Medicare Provider Payment and Bolster Health Care Cybersecurity Medicare program: ACO (Accountable Care Organization) REACH Model Medicare program: ACO/APM flexibilities Medicare program: Advanced APM reporting Medicare program: AI chatbots/Medicare Advantage preventive screens Medicare program: AI services/payment Medicare program: Aligned Networks and interoperability Medicare program: Alternative Payment Models (APMs) Medicare program: Certified electronic health record and PI Medicare program: Coding Medicare program: Data privacy/cybersecurity Medicare program: Data-Driven Performance Payment System Medicare program: Digital quality measures Medicare program: G2211 Inherent Complexity Code Medicare program: Health Information Technology/physician burdens Medicare program: Indirect practice expense Medicare program: Informed decision-making among beneficiaries Medicare program: Medicare Advantage provider networks/physician experience Medicare program: Medicare Diabetes Prevention Program Medicare program: Medicare Economic Index (MEI)/inflationary updates Medicare program: Medicare Part D issues Medicare program: Medicare physician payment/budget neutrality Medicare program: Merit-based Incentive Payment System (MIPS)/reforms and penalties Medicare program: MIPS Promoting Interoperability Medicare program: MIPS quality and cost measures Medicare program: MIPS Value Pathways (MVPs) reform Medicare program: Organ transplantation access Medicare program: Prior authorization/Medical billing transition Medicare program: Promoting Interoperability (PI) Program Medicare program: Provider directories Medicare program: Public Health Reporting and Data Exchange Medicare program: Quality Payment Program Medicare program: Review Choice Demonstration (RCD)/Inpatient Rehabilitation Facility (IRF) Medicare program: RVS Update Committee (RUC) and Current Procedural Terminology (CPT) issues Medicare program: Shared Savings Program Medicare program: Site Neutral Payment Medicare program: Traditional Medicare/Medicare Advantage enrollment difficulties Medicare program: Wasteful and Inappropriate Service Reduction (WISeR) and Ambulatory Specialty Model Medicaid program: Changes in Children's Health Insurance Program (CHIP) and Affordable Care Act insurance marketplaces Medicaid program: Community engagement/medical frailty exemption Medicaid program: Practice of Medicine Medicaid program: State directed payments Medicaid program: Work requirements, per capita caps, provider taxes, Federal Medical Assistance Percentage (FMAP) changes Medicare and Medicaid programs: ACO REACH (Realizing Equity, Access, and Community Health) Model Reform Medicare and Medicaid programs: Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model reform. Medicare and Medicaid programs: Center for Medicare and Medicaid Innovation (CMMI) reforms Medicare and Medicaid programs: CMMI reform/Physician AI use Medicare and Medicaid programs: Evaluation and Management (E/M) codes Medicare and Medicaid programs: High-cost disposable supplies/billing codes Medicare and Medicaid programs: Indirect Practice Expense Relative Value Updates (RVU) changes Medicare and Medicaid programs: Interoperability Medicare and Medicaid programs: LEAD (Long-term Enhanced ACO Design) Model Reform Medicare and Medicaid programs: MACRA/physician burdens Medicare and Medicaid programs: Medicare Access and CHIP Reauthorization Act (MACRA)/broad reform Medicare and Medicaid programs: Prior authorization Medicare and Medicaid programs: TEAM (Transforming Episode Accountability Model) changes Medicare and Medicaid programs: Telehealth and Digital Health Draft: Artificial intelligence in prior authorization denials by Medicare Advantage organizations Draft: GOLD CARD Act Draft: MACRA/MIPS program reform Draft: Transparency in Downcoding Model Act Draft: Value in Health Care Act Matters related to downcoding by Insurace plans Matters related to drug price negotiations Matters related to expiring Medicare Physician payment rates Matters related to Modifier-25/Multiple Procedure Payment Reductions

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

Issues related to the following: H.R. 7148 - Consolidated Appropriations Act, 2026 (implementation of hospice telehealth provisions) FY 2027 Hospice Proposed Rule H.R. 7966 / S. 4118 - Hospice CARE Act of 2026 H.R. 7199 - Gerald's Law Act S. 3898 - Gerald's Law Reauthorization Act of 2026 H.R. 4425 / S. 2287 - Palliative Care and Hospice Education and Training Act S. 1935 - Expanding Access to Palliative Care Act H.R. 8375 / S. 4384 - Medicare Advantage Improvement Act of 2026 H.R. 8883 - Protecting Seniors and Stopping Fraudsters Act Home Health and Hospice Nationwide Moratoria Hospice Service and Spending Variation Index (SSVI) CY 2027 Home Health Proposed Rule - Payment and Provider Enrollment H.R. 2036/S. 925- Credit for Caring Act H.R. 5514 / S. 2562 - Choose Home Care Act of 2021 (not introduced in current Congress)

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

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

Lobbying related to Medicare Advantage Reform and prior authorization; H.R.8375 and S.4384

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Lobbying related to Medicare Advantage Reform and prior authorization; H.R. 8375, S. 4384

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS), Access to Inpatient Rehabilitation Therapy Act, Improving Seniors' Timely Access to Care Act (H.R.3514/S.1816), Medicare Advantage Improvement Act (H.R.8375/S.4384), WISeR, Medicare Advantage, IRF Review Choice Demonstration

Client expense: $200,000 · 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

Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS), Access to Inpatient Rehabilitation Therapy Act, Improving Seniors' Timely Access to Care Act (H.R.3514/S.1816), Medicare Advantage Improvement Act (H.R.8375/S.4384), WISeR, Medicare Advantage, IRF Review Choice Demonstration

Client expense: $200,000 · Firm income: Not reported

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

S. 4384 / H.R. 8375, the Medicare Advantage Improvement Act of 2026; Monitoring site-neutral policy

Client expense: Not reported · Firm income: Not reported

S. 4384 / H.R. 8375, the Medicare Advantage Improvement Act of 2026; Monitoring site-neutral policy

Client expense: Not reported · Firm income: Not reported

S. 4384 / H.R. 8375, the Medicare Advantage Improvement Act of 2026; Monitoring site-neutral policy

Client expense: Not reported · Firm income: Not reported

Medicare Advantage: Star Ratings, Risk Adjustment, Supplemental Benefits (H.R. 5746, H.R. 5243), No UPCODE Act (S. 1105), Medicare Prior Authorization and Electronic Prior Authorization (H.R. 3514, H.R. 8375), Provider Directories (S. 891), Telehealth Extending Flexibilities (H.R. 4206, S. 1261), Transparency & PBMs (S. 882; S. 891, S. 3345, H.R. 9392), Physician Fee Schedule, Site Neutrality (H.R. 7149), Broker/Agents (H.R. 9395), MLR (H.R. 9644).

Client expense: $670,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, 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

Monitored proposals that impact access to acute and long term acute care hospital services, including: the "Saving Today's Acute-Care Resources Act (H.R. 9468)", the "Lower Costs, More Transparency Act (H.R. 9393)", the "Medicare Advantage Improvement Act (S. 4384/H.R. 8375)" and the "Continuing Appropriations and Extension Act, 2027 (H.R. 6500)".

Client expense: Not reported · Firm income: $52,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- Joined a letter jointly led by the Long-term Services and Supports Task Force (LTSS TF) of the Consortium of Constituents with Disabilities (CCD) and the Disability and Aging Collaborative (DAC) to Congress, opposing the inclusion of any further cuts to Medicaid or restrictions to state capacity to raise revenue in the Budget Reconciliation Process or any other bills, as this would inevitably lead to cuts in HCBS; - Joined a letter spearheaded by the National Health Law Program (NHeLP) to the House of Representatives to express opposition to the Ensuring Medicaid Continuity for Children in Foster Care Act of 2026 (H.R. 8095) that would encourage treating foster youth in large congregate care mental health institutions rather than the community-based family-like settings that are more effective; - Organizational endorsement of the LIFT the BAR act that would restores access to basic needs programs like Medicaid, CHIP, SNAP, and other federal benefit programs for immigrants authorized to be in the United States; - Joined a letter led by the Coalition to Preserve Rehabilitation (CPR) that supports S. 4384/H.R. 8375, the Medicare Advantage Improvement Act (MAIA), a bipartisan bill that addresses unjustified prior authorization and other medical necessity-related restrictions that MA plans place on coverage of healthcare services for Medicare enrollees;

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

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

United Spinal with other stakeholders discussed with members of Congress introducing legislation to delay the implementation of competitive bidding for ostomy and urological supplies under the Medicare program. United Spinal, along with other members of the Coalition to Preserve Rehabilitation (CPR), submitted comments to the administrator of the Centers for Medicare & Medicaid Services (CMS) in response to Fiscal Year 2027 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Proposed Rule (proposed rule), (CMS-1845-P). The comments read in part, Our comments focus on key provisions of the proposed rule-including proposed updates impacting IRF coverage and documentation, proposed changes to the IRF Quality Reporting Program, proposed updates to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program, and responses to the various requests for information included in the proposed rule-with the goal of ensuring that Medicare beneficiaries continue to have access to the full range of medically necessary rehabilitation services, including those provided in inpatient rehabilitation hospitals. United Spinal, along with other members of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, wrote to the administrator of the Centers for Medicare and Medicaid Services (CMS) requesting a meeting to discuss the status of the long-pending National Coverage Analysis (NCA) for standing systems in Group 3 power wheelchairs. The letter read in part, We strongly urge CMS to proceed expeditiously with opening this NCA for public comment without further delay. As the 36th Anniversary of the Americans with Disabilities Act (ADA) approaches on July 26th, we believe there is no better way to celebrate the successes of this landmark law for people with disabilities over the past three and a half decades than for CMS to open this critically important NCA to address the mobility needs of individuals with disabilities. United Spinal, along with numerous other organizations, signed onto comments from the Not Dead Yet, a grassroots disability rights organization that opposes assisted suicide and Euthanasia. The comments were in response to a notice: Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements The comments in part read, appreciates the opportunity to respond to the Centers for Medicare and Medicaid ServicesNot Dead Yet supports CMS intent to improve transparency and institute data guardrails for hospice care. This will help in the gathering of important data on U.S. patients as the population ages, potentially increasing the demand for hospice options. Not Dead Yets comments, since we are not hospice care providers, primarily introduce additional issues related to assisted suicide and palliative care. United Spinal, along with numerous other members of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, wrote to the bipartisan leadership of the Congressional Vision Caucus to bring to their attention a Medicare regulation-the Medicare Low Vision Aid Exclusion at 42 C.F.R. 411.15(b)-that significantly limits beneficiary access to technologies and devices essential to the treatment of low vision. The letter read in part, We respectfully request your support in encouraging the Centers for Medicare and Medicaid Services (CMS) to rescind that outdated and overly broad regulation. Specifically, we request that you send a bipartisan Congressional sign-on letter to CMS, as well as a Dear Colleague letter to garner co-signers supporting this effort. United Spinal continues to oppose the Centers for Medicare and Medicaid Services rule (CMS-1828-P) to expand and redesign the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program which will harm people who depend upon these supplies to live and will increase healthcare costs. It may conflict with the Presidents directives on deregulation, trade, and domestic industrial strength. United Spinal continues advocating for Medicare coverage of power wheelchairs standing systems. United Spinal supports legislation introduced by U.S. Representative Ayanna Pressley (D-MA-07), H. R. 9364, the FAST Repairs for Wheelchairs Act, that would eliminate prior authorization requirements for Complex Rehabilitation Technology (CRT) wheelchair maintenance and repairs under the Medicare Advantage (MA) program, aligning MA with traditional Medicare, which generally does not impose these barriers. United Spinal policy staff met with Centers for Medicare and Medicaid Services officials to advocate against implementing the agencys final rule about competitively bidding urological and ostomy supplies: The Centers for Medicare & Medicaid Services (CMS) is making some important changes in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) so that we can protect the Medicare Trust Funds and lower copays for beneficiaries. For more details, refer to the Calendar Year (CY) 2026 Home Health Prospective Payment System Final Rule (CMS-1828-F) displayed in the Federal Register on November 28, 2025. United Spinal, as a member of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition met with officials from the Office of Management and Budget to advocate against the Centers for Medicare and Medicaid Services rule about competitively bidding urological and ostomy supplies. United Spinal, as a member of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, wrote the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) in strong opposition to the proposed revisions to the Local Coverage Determination (LCD) DL33789, which would restrict Medicare coverage for certain power mobility devices, specifically, Group 2 standard power wheelchairs with seat elevation systems but without complex rehabilitative technology (CRT) capability. If finalized, this restriction in access to these critical devices would negatively impact Medicare beneficiaries who rely on such features to reach, transfer, and perform or participate in Mobility Related Activities of Daily Living (MRADLs) in their homes, which is the standard for coverage under the power wheelchair and seat elevation National Coverage Determination. United Spinal, along with other members of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, submitted comments to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) on the proposed Local Coverage Determination (LCD) for Wheelchair Options/Accessories (DL33792). The ITEM Coalition strongly opposes the proposed determination that power seat elevation systems used with standard, non-complex rehabilitation technology (CRT) power wheelchairs are not reasonable and necessary, and urge the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) to reconsider and withdraw this proposed LCD as soon as possible. For the reasons outlined below, if finalized, this change in policy would significantly restrict access to a critical functional mobility technology for Medicare beneficiaries who rely on power wheelchairs to perform mobility-related activities of daily living (MRADLs) within the home, which is the standard for coverage under the power wheelchair and seat elevation National Coverage Determinations. United Spinal, as a member of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, wrote to the Centers for Medicare and Medicaid Services to reiterate significant concerns with the Agencys decision to include ostomy and urological supplies in the next round of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). Combined with the implementation of a national Remote Item Delivery (RID) program for distributing these items to Medicare beneficiaries, this policy represents a fundamental shift away from patient-centered, clinically appropriate care for individuals with disabilities and complex medical needs. United Spinal signed onto a letter, along with 358 members of the Disability and Aging Collaborative (DAC), the Health and Long Term Services and Supports (LTSS) Taskforces of the Consortium for Constituents with Disabilities (CCD), and allied organizations to urge the bipartisan, bicameral leadership of the Congress to exclude any funding cuts or harmful changes to Medicaid from any budget reconciliation or other legislation. The letter read in part, Medicaid is our communities lifeline, and that lifeline just suffered the largest cut in funding since its inception. We cannot afford any further cuts, and we urge Congress to prioritize reinvesting in Medicaid. United Spinal, along with other members of the Coalition to Preserve Rehabilitation, wrote in strong support for H.R. 8375, the Medicare Advantage Improvement Act to its bipartisan sponsors. Medicare Advantage (MA) increasingly serves Medicare beneficiaries with complex, disabling conditions who depend on timely access in medical rehabilitation services of all kinds, including inpatient rehabilitation. However, persistent utilization management barriers-including prior authorization delays, inappropriate denials, and disruptions in care-continue to impede access to medically necessary rehabilitation services and undermine patient outcomes. United Spinal, along with other members of the Coalition to Preserve Rehabilitation, wrote in strong support for S. 4384, the Medicare Advantage Improvement Act toots bipartisan sponsors. Medicare Advantage (MA) increasingly serves Medicare beneficiaries with complex, disabling conditions who depend on timely access in medical rehabilitation services of all kinds, including inpatient rehabilitation facility (IRF) care, to achieve optimal recovery and maintain independence. However, persistent utilization management barriers-including prior authorization delays, inappropriate denials, and disruptions in care-continue to impede access to medically necessary rehabilitation services and undermine patient outcomes.

Client expense: Not reported · Firm income: Not reported

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

Medicare Reimbursement / Physician Payment Schedule Cuts - H.R. 879, the Medicare Patient Access and Practice Stabilization Act of 2025 - H.R. 7520, the Efficiency Adjustment Delay Act of 2026 - H.R. 8163, the Provider Reimbursement Stability Act of 2026 Prior Authorization Reform - H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act of 2025 - H.R. 3514/S. 1816, the Improving Seniors' Timely Access to Care Act - H.R. 8375/S. 4384, the Medicare Advantage Improvement Act Federal Funding for Disability and Rehabilitation Research Permanently Extending Telehealth Flexibilities Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration (RCD) Project WISeR Model - H.R. 5940/S. 3480, Seniors Deserve SMARTER Care Act of 2025

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

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

Medicare Reimbursement / Physician Payment Schedule Cuts - H.R. 879, the Medicare Patient Access and Practice Stabilization Act of 2025 - H.R. 7520, the Efficiency Adjustment Delay Act of 2026 - H.R. 8163, the Provider Reimbursement Stability Act of 2026 Prior Authorization Reform - H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act of 2025 - H.R. 3514/S. 1816, the Improving Seniors' Timely Access to Care Act of 2025 - H.R. 8375/S. 4384, the Medicare Advantage Improvement Act Permanently Extending Telehealth Flexibilities Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration (RCD) Project WISeR Model - H.R. 5940/S. 3480, Seniors Deserve SMARTER Care Act of 2025

Client expense: $30,000 · 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 H.R. 8375 - Medicare Advantage Improvement Act - Rep. Joyce, John - MA programmatic reforms H.R. 8377 - Stop Deadly Denials Act - Rep. Khanna, Ro - MA prior authorization prohibition H.R. 8875 - Improving Home Dialysis Act - Rep. Miller, Carol - Home dialysis coverage under Medicare 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 S. 4384 - Medicare Advantage Improvement Act - Sen. Marshall, Roger - MA programmatic reforms 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; Waste Fraud and Abuse; 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; MA reporting requirements; MA provider networks and network adequacy; implementation of the One Big Beautiful Bill Act; Medicaid provider taxes; Medicaid community engagement requirements; and VA's community care program.

Client expense: $3,010,000 · Firm income: Not reported

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

Healthcare supply chain and resiliency, issues related to federal Medicare/Medicaid reimbursement for medical products, DMEPOS Relief Act of 2025/Competitive Bidding Relief Act (H.R. 2005/S. 2951), Choices For Increased Mobility Act (H.R. 1703/S. 247), Supplemental Oxygen Access Reform Act of 2025 (H.R. 2902/S. 1406), Diabetes Interventions Addressing Barriers to Enrollment, Technology, and Education Services (DIABETES) Act (S. 4037), The Medicare Advantage Improvement Act of 2026 (S. 4384/H.R. 8375), The Improving Access to Medicare Coverage Act (S. 4641/H.R. 3954), The Ensuring Seniors Access to Quality Care Act (S.4467/H.R. 7096)

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

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

Issues related to the following: H.R. 7148 - Consolidated Appropriations Act, 2026 (implementation of hospice telehealth provisions) FY 2027 Hospice Proposed Rule H.R. 7966 / S. 4118 - Hospice CARE Act of 2026 H.R. 7199 - Gerald's Law Act S. 3898 - Gerald's Law Reauthorization Act of 2026 H.R. 4425 / S. 2287 - Palliative Care and Hospice Education and Training Act S. 1935 - Expanding Access to Palliative Care Act H.R. 8375 / S. 4384 - Medicare Advantage Improvement Act of 2026 H.R. 8883 - Protecting Seniors and Stopping Fraudsters Act

Client expense: $610,000 · Firm income: Not reported

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

Observation Stays and 3-Day Stay Outreach (S. 4641/H.R. 3954) Improving Access to Medicare Coverage Act of 2025 (S. 4384/H.R. 8375) Ensuring Seniors Access to Quality Care Act (S. 4467/H.R. 7096) Survey Relief/Civil Monetary Penalties SNF Payment Rule Medicare Advantage Administration Nursing Home Reform (Better Way Package) Outreach related to LTPAC Health Information Technology Needs Outreach on Physician Fee Schedule Reform Protecting Rural Senior Access to Care Act Outreach on Telehealth Reforms Improving Seniors Timely Access to Care Act Fighting Medicaid Cuts/Provider Taxes Medicaid Coalition Outreach Medicaid/Budget Reconciliation SNF Off Cycle Provider Enrollment Reporting Private Equity RFI in the Post Acute Care Sector Advocacy around HUD 232/223(f) matters HR 1, One Big Beautiful Act Section 232 National Security Investigation of Imports of Personal Protective Equipment, Medical Consumables, and Medical Equipment, Including Devices Network Adequacy

Client expense: $840,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), SENATE

Medicaid State Directed Payments; 340B modernization; funding for Disproportionate Share Hospitals (Medicaid DSH); funding for Medicare graduate medical education (GME); Medicare site neutrality policies; support of telehealth policies; impact of regional oversaturation of trauma care on patient outcomes and health system costs; H.R. 4313/S. 2237, Hospital Inpatient Services Modernization Act; H.R. 267, the Health Care Price Transparency Act; H.R. 2590/S. 1264, the Mental and Physical Health Care Comorbidities Act of 2025; H.R. 8375/S. 4384, Medicare Advantage Improvement Act of 2026.

Client expense: $210,000 · Firm income: Not reported

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

Medicare Payment - Submitted testimony for House Energy and Commerce Subcommittee on Health hearing on opportunities for Medicare payment reform that included support for the Strengthening Medicare for Patients and Providers Act (H.R. 6160) to include annual inflationary updates to Medicare and the Provider Reimbursement Stability Act (H.R. 8163) to modernize budget neutrality rules in Medicare. Joined letter of support for the Provider Reimbursement Stability Act ahead of a Ways and Means Committee markup of the bill. Prior Authorization - Supported the Improving Seniors Timely Access to Care Act (H.R. 3514, S. 1816) to reform prior authorization. Joined healthcare organizations comment letter on CMS proposed rule on electronic prior authorization for drugs. Submitted our own comments on CMS proposed rule on electronic prior authorization for drugs. Sent letter of support for the Medicare Advantage Improvement Act (H.R. 8375, S. 4384) that would reform prior authorization for Medicare Advantage plans. MIPS Reform - Sent letter of support for the Medicare Physician Data-driven Performance Payment System Act of 2026 (H.R. 8622) to reform the Merit-based Incentive Payment System (MIPS). Supported reforming MIPS in our testimony to the House Energy and Commerce Subcommittee on Healths hearing on opportunities for Medicare payment reform. Value-Based Care - Supported alternative payment model (APM) reforms in our testimony to the House Energy and Commerce Subcommittee on Health hearing on opportunities for Medicare payment reform. Physician Workforce - Joined letter to the Department of State and Department of Homeland Security on addressing physician visa processing delays. No Surprises Act - Joined letter of support for the No Surprises Act Enforcement Act (H.R. 4710, S. 2420). Joined letter to Department of Health and Human Services (HHS), Department of Labor, and Department of the Treasury on strengthening oversight of the No Surprises Act. Section 504 - Sent letter to HHS asking for a delay of effective dates related to a 2024 final rule making changes to regulations under Section 504 of the Rehabilitation Act of 1973. Chronic Care Management - Joined letter of support for the Chronic Care Management Improvement Act (H.R. 8261) to remove patient cost-sharing obligations for the Chronic Care Management code.

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

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

Medicare Payment - Submitted testimony for House Energy and Commerce Subcommittee on Health hearing on opportunities for Medicare payment reform that included support for the Strengthening Medicare for Patients and Providers Act (H.R. 6160) to include annual inflationary updates to Medicare and the Provider Reimbursement Stability Act (H.R. 8163) to modernize budget neutrality rules in Medicare. Joined letter of support for the Provider Reimbursement Stability Act ahead of a Ways and Means Committee markup of the bill. Prior Authorization - Supported the Improving Seniors Timely Access to Care Act (H.R. 3514, S. 1816) to reform prior authorization. Joined healthcare organizations comment letter on CMS proposed rule on electronic prior authorization for drugs. Submitted our own comments on CMS proposed rule on electronic prior authorization for drugs. Sent letter of support for the Medicare Advantage Improvement Act (H.R. 8375, S. 4384) that would reform prior authorization for Medicare Advantage plans. MIPS Reform - Sent letter of support for the Medicare Physician Data-driven Performance Payment System Act of 2026 (H.R. 8622) to reform the Merit-based Incentive Payment System (MIPS). Supported reforming MIPS in our testimony to the House Energy and Commerce Subcommittee on Healths hearing on opportunities for Medicare payment reform. Value-Based Care - Supported alternative payment model (APM) reforms in our testimony to the House Energy and Commerce Subcommittee on Health hearing on opportunities for Medicare payment reform. Physician Workforce - Joined letter to the Department of State and Department of Homeland Security on addressing physician visa processing delays. No Surprises Act - Joined letter of support for the No Surprises Act Enforcement Act (H.R. 4710, S. 2420). Joined letter to Department of Health and Human Services (HHS), Department of Labor, and Department of the Treasury on strengthening oversight of the No Surprises Act. Section 504 - Sent letter to HHS asking for a delay of effective dates related to a 2024 final rule making changes to regulations under Section 504 of the Rehabilitation Act of 1973. Chronic Care Management - Joined letter of support for the Chronic Care Management Improvement Act (H.R. 8261) to remove patient cost-sharing obligations for the Chronic Care Management code.

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

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