Medicare Physician Data-driven Performance Payment System Act of 2026
Legislative Progress
Introduced
April 30, 2026
Latest Action
April 30, 2026
Primary Sponsor
Mariannette Miller-MeeksRepublican(IA)
Momentum (last 30 days)
0
score
0 actions · 0 new cosponsors · 0 votes
Speed vs cohort
0pct
0d open
vs 10,940 other HR bills in the 119th — cohort avg 30d
No CRS summary is available for this bill yet. The source title, actions, sponsors, and text versions below come from Congress.gov.
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Filing registrants (11)
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Congress.gov source codes: 1000, Intro-H
Bills with similar content found using semantic analysis.
Sources: Congress.gov
2026 · third_quarter · Medicare/Medicaid
Physician payment reform Counting observation stays as satisfying Medicare three-day inpatient stay prerequisite for skilled nursing facility (SNF) coverage H.R. 1-One Big Beautiful Bill Act, to provide for reconciliation pursuant to title II of H. Con. Res. 14 H.R. 539-Chiropractic Medicare Coverage Modernization Act of 2025, to amend title XVIII of the Social Security Act to provide Medicare coverage for all physicians services furnished by doctors of chiropractic within the scope of their license, and for other purposes. H.R. 771-Rural Health Care Access Act of 2025, to eliminate the 35-mile requirement to qualify as a critical access hospital H.R. 772-Rural ER Access Act, to require the Centers for Medicare and Medicaid Services to repeal the 35-mile requirement for off-campus facilities H.R. 879- Medicare Patient Access and Practice Stabilization Act of 2025, to address the 2025 Medicare Physician Fee Schedule cuts and increaser support for physicians and other practitioners in adjusting to Medicare payment changes H.R.1968-Full-Year Continuing Appropriations and Extensions Act, to provide appropriations for federal departments and agencies and to provide an increase for the calendar year 2024 physician fee schedule conversion factor H.R. 2433-Reducing Unnecessary Medical Delays in Care Act of 2025, to ensure that prior authorization medical decisions under Medicare are determined by physicians. H.R. 3164-Ensuring Community Access to Pharmacist Services Act (ECAPS) Act, to amend title XVIII of the Social Security Act to provide pharmacy payment of certain services H.R. 4206-CONNECT for Health Act, to expand access to telehealth services H.R. 6160-Strengthening Medicare for Patients and Providers Act, provide for an update to a single conversion factor under the Medicare physician fee schedule that is based on the Medicare economic index H.R. 6721-Medicare Advance Planning for Care Act, to encourage Medicare beneficiaries to voluntarily adopt advance directives guiding the medical care they receive H.R. 7520-Efficiency Adjustment Delay Act, to delay the implementation of an efficiency adjustment to work relative value units under the Medicare physician fee schedule H.R. 8163-Provider Reimbursement Stability Act, ensure stability for provider payments under the Medicare program H.R. 8500-Timely Access to Coverage Decisions Act of 2026, to amend title XVIII of the Social Security Act to ensure timely review of local coverage determination requests under the Medicare program H.R. 8622-Medicare Data-driven Performance Payment System Act of 2026, to transform the Merit-based Incentive Payment System into the Data-driven Performance Payment System under the Medicare physician fee schedule H.R. 9693-Patients First Act of 2026, to modify certain physician payments under the Medicare program S. 106-Chiropractic Medicare Coverage Modernization Act of 2025, to amend title XVIII of the Social Security Act to provide Medicare coverage for all physicians services furnished by doctors of chiropractic within the scope of their license, and for other purposes. S.1261-CONNECT for Health Act, to expand access to telehealth services S. 1640- Medicare Patient Access and Practice Stabilization Act of 2025, to address the 2025 Medicare Physician Fee Schedule cuts and increaser support for physicians and other practitioners in adjusting to Medicare payment changes S. 2426-Ensuring Community Access to Pharmacist Services Act (ECAPS) Act, to amend title XVIII of the Social Security Act to provide pharmacy payment of certain services S. 3473-Medicare Advance Planning for Care Act, to encourage Medicare beneficiaries to voluntarily adopt advance directives guiding the medical care they receive S. 4927-Rural Hospital Emergency Room Guarantee Act, to establish a guaranteed funding stream to keep existing emergency rooms at America's rural hospitals open.
Client expense: $393,240 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2026 · third_quarter · Medicare/Medicaid
S. 1390/H.R.2191, Physician-Led and Rural Access to Quality Care Act: To revise certain physician self-referral exemptions relating to physician-owned hospitals. S. 1640, the Medicare Patient Access and Practice Stabilization Act: Io increase support for physicians and other practitioners in adjusting to Medicare payment changes S. 1816/H.R.3514, Improving Seniors Timely Access to Care Act of 2025: Prior authorization reform in Medicare Advantage S. 2439/H.R.3890, Resident Physician Shortage Reduction Act: Medicare funding for medical residency training. S.5180/H.R. 8163, Provider Reimbursement Stability Act: Modifying Medicare's budget neutrality rules under the Medicare physician fee schedule. H.R.4002, Patient Access to Higher Quality Health Care Act of 2025: To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. H.R. 4331, Access to Claims Data Act: To establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement. H.R.6160, Strengthening Medicare for Patients and Providers Act: To provide for an update to a single conversion factor under the Medicare physician fee schedule that is based on the Medicare economic index. H.R. 7520, Efficiency Adjustment Delay Act: To delay the implementation of an efficiency adjustment to work relative value units under the Medicare physician fee schedule. H.R. 8622. Medicare Physician Data-Driven Performance Payment System Act: To reform the Merit-based Incentive Payment System into the Data-driven Performance Payment System under the Medicare physician fee schedule. H.R.9693, Patients First Act: To modify MACRA to reform the Medicare physician payment system, including positive payment updates and improvements to the quality payment program. No Bill: Urging Congress to prevent funding for the proposed CMMI Wasteful and Inappropriate Service Reduction (WISeR) Model in the Medicare Fee-for-Service (FFS) program, which expandsprior authorization to traditional Medicare.
2026 · third_quarter · Medicare/Medicaid
S. 1390/H.R.2191, Physician-Led and Rural Access to Quality Care Act: To revise certain physician self-referral exemptions relating to physician-owned hospitals. S. 1640, the Medicare Patient Access and Practice Stabilization Act: Io increase support for physicians and other practitioners in adjusting to Medicare payment changes S. 1816/H.R.3514, Improving Seniors Timely Access to Care Act of 2025: Prior authorization reform in Medicare Advantage S. 2439/H.R.3890, Resident Physician Shortage Reduction Act: Medicare funding for medical residency training. S.5180/H.R. 8163, Provider Reimbursement Stability Act: Modifying Medicare's budget neutrality rules under the Medicare physician fee schedule. H.R.4002, Patient Access to Higher Quality Health Care Act of 2025: To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. H.R. 4331, Access to Claims Data Act: To establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement. H.R.6160, Strengthening Medicare for Patients and Providers Act: To provide for an update to a single conversion factor under the Medicare physician fee schedule that is based on the Medicare economic index. H.R. 7520, Efficiency Adjustment Delay Act: To delay the implementation of an efficiency adjustment to work relative value units under the Medicare physician fee schedule. H.R. 8622. Medicare Physician Data-Driven Performance Payment System Act: To reform the Merit-based Incentive Payment System into the Data-driven Performance Payment System under the Medicare physician fee schedule. H.R.9693, Patients First Act: To modify MACRA to reform the Medicare physician payment system, including positive payment updates and improvements to the quality payment program. No Bill: Urging Congress to prevent funding for the proposed CMMI Wasteful and Inappropriate Service Reduction (WISeR) Model in the Medicare Fee-for-Service (FFS) program, which expands prior authorization to traditional Medicare.
2026 · third_quarter · Medicare/Medicaid
H.R. 1805, Assistance for Rural Community Hospitals (ARCH) Act, all provisions; S. 1261 / H.R. 4206, CONNECT for Health Act of 2025, 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; 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. 8891, Rural Maternity Options for Medial Support (Rural MOMS) Act, all provisions; H.R. 3108 / S. 1535, Rural Patient Monitoring Access Act (RPM Access Act), all provisions; S. 2761 / H.R. 5269, the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act , all provisions; H.R. 5142, The Home Health Stabilization Act, all provisions; H.R. 8261, Chronic Care Management Improvement Act, all provisions; DRAFT, HCA Mission Act, all provisions; H.R. 9642, Medicare Access to Rural Anesthesiology Act, all provisions; H.R. 9644, Medicare Advantage MLR Transparency Act, all provisions; H.R. 9693, Patients First Act of 2026, all provisions; H.R. 8163, Provider Reimbursement Stability Act of 2026, all provisions; H.R. 8622, Medicare Physician Data-driven Performance Payment system, all provisions; DRAFT, Medicare Provider Reimbursement Step to Stabilization Act of 2026, Issues pertaining to physician fee schedule reforms; H.R.10666, Frontier Community Health Integration Project Extension Act, all provisions; H.R. 1775, Second Chances for Rural Hospitals Act, all provisions; Centers for Medicare & Medicaid Services (CMS), Issues regarding proposed rule on Medicaid managed care state-directed payments and Medicaid fee-for-service targeted practitioner payments; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to funding from the Rural Health Transformation Program and how it is distributed to hospitals; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the physician fee schedule and updates for the CY2027; Centers for Medicare & Medicaid Services (CMS), "Comments pertaining to the proposed rule regarding the indirect hold harmless threshold of healthcare-related taxes. "; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to interim final rule on community engagement requirements for certain Medicaid beneficiaries; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the hospital outpatient prospective payment system and ambulatory surgical center payment system proposed rule for calendar year 2027; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the calendar year 2027 home health prospective payment system proposed rule; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the CMS proposed rule implementing and codifying the Medicare Drug Benefit Program under the Inflation Reduction Act of 2022; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to Essential Health Benefits framework and Affordable Care Act requirements; 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; Expiring Health Care Programs, Issues pertaining to expiring health care programs such as GPCI, Physician reimbursement, Medicare Dependent Hospital Program, and Low-Volume Adjustment program.
2026 · third_quarter · Medicare/Medicaid
H.R. 5347: Health Care Efficiency Through Flexibility Act H.R. 786/ S. 1460: Preserving Patient Access to Accountable Care Act S. 1816/ 3514: Improving Seniors Timely Access to Care Act S. 1105: No UPCODE Act S. 2561/ H.R. 5768: Skin Substitute Access and Payment Reform Act H.R. 4773/ S.3350: ACO Assignment Improvement Act H.R. 8129: To amend title XVIII of the Social Security Act to establish a full risk ACO program H.R. 6852: Advanced Wound Care and Regenerative Medicine Access and Reform Act H.R. 8163: Provider Reimbursement Stability Act H.R. 8622: Medicare Physician Data Driven Performance Payment System H.R. 9693: Patients First Act S.5269: Pay PCPs Act Issues related to Medicare payments, Medicare Shared Savings Program, ACO REACH, Medicare Advantage, alternative payment model incentives, telehealth, and fraud, waste, abuse.
Client expense: $177,310 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $35,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $35,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $3,840,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2026 · third_quarter · Health Issues
2027 Medicare Physician Fee Schedule Proposed Rule: Submitted comments in response to the 2027 Medicare Physician Fee Schedule Proposed Rule that included recommendations on proposals related to Medicare physician payment, value-based care, MIPS, remote patient monitoring, and more. Joined coalition letter urging CMS to withdraw proposed changes to remote patient monitoring. Joined coalition of physician specialty organizations in urging CMS and the Administration (OMB and DPC) to withdraw its proposed policy to reduce payment by 50 percent when a separately identifiable office/outpatient (O/O) evaluation and management (E/M) service reported with modifier -25 is furnished on the same day as a procedure with a 0-, 10-, or 90-day global period. Medicare Physician Payment: Submitted Statement for the Record supporting the Patients First Act (H.R. 9693), the Provider Reimbursement Stability Act (H.R. 8163), and the Medicare Physician Data-driven Performance Payment System Act (H.R. 8622), three pieces of Medicare payment legislation that were discussed in the House Energy and Commerce Subcommittee on Health legislative hearing. Supported the introduction of the Patients First Act (H.R. 9693) that would make structural reforms to Medicare reimbursement. Medicare Enrollment: Submitted comments in response to the 2027 Home Health Prospective Payment System Proposed Rule urging CMS to withdraw Medicare enrollment proposals. Joined a coalition letter of provider organizations urging CMS to reconsider its proposed Medicare enrollment changes. H-1B: Submitted comments urging the Department of Homeland Security to exempt all healthcare workers from proposed $103,265 H-1B visa fees. Value-Based Care: Joined a coalition of provider groups in a letter to CMS urging the agency to support accountable care in Medicare. Prior Authorization: Supported the passage of the Improving Seniors Timely Access to Care Act (H.R. 3514), legislation that would reform prior authorization in Medicare Advantage, through both the Ways and Means and Energy and Commerce Committee. Medicare Advantage: Supported the introduction of the Protecting Approved Care Act (H.R. 10394) that would prohibit Medicare Advantage organizations from reversing payment decisions or downcoding after the plan approves prior authorization for an item or service.
Client expense: $300,000 · 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), Homeland Security, Dept of (DHS), Office of Management & Budget (OMB), SENATE
2026 · third_quarter · Medicare/Medicaid
2027 Medicare Physician Fee Schedule Proposed Rule: Submitted comments in response to the 2027 Medicare Physician Fee Schedule Proposed Rule that included recommendations on proposals related to Medicare physician payment, value-based care, MIPS, remote patient monitoring, and more. Joined coalition letter urging CMS to withdraw proposed changes to remote patient monitoring. Joined coalition of physician specialty organizations in urging CMS and the Administration (OMB and DPC) to withdraw its proposed policy to reduce payment by 50 percent when a separately identifiable office/outpatient (O/O) evaluation and management (E/M) service reported with modifier -25 is furnished on the same day as a procedure with a 0-, 10-, or 90-day global period. Medicare Physician Payment: Submitted Statement for the Record supporting the Patients First Act (H.R. 9693), the Provider Reimbursement Stability Act (H.R. 8163), and the Medicare Physician Data-driven Performance Payment System Act (H.R. 8622), three pieces of Medicare payment legislation that were discussed in the House Energy and Commerce Subcommittee on Health legislative hearing. Supported the introduction of the Patients First Act (H.R. 9693) that would make structural reforms to Medicare reimbursement. Medicare Enrollment: Submitted comments in response to the 2027 Home Health Prospective Payment System Proposed Rule urging CMS to withdraw Medicare enrollment proposals. Joined a coalition letter of provider organizations urging CMS to reconsider its proposed Medicare enrollment changes. H-1B: Submitted comments urging the Department of Homeland Security to exempt all healthcare workers from proposed $103,265 H-1B visa fees. Value-Based Care: Joined a coalition of provider groups in a letter to CMS urging the agency to support accountable care in Medicare. Prior Authorization: Supported the passage of the Improving Seniors Timely Access to Care Act (H.R. 3514), legislation that would reform prior authorization in Medicare Advantage, through both the Ways and Means and Energy and Commerce Committee. Medicare Advantage: Supported the introduction of the Protecting Approved Care Act (H.R. 10394) that would prohibit Medicare Advantage organizations from reversing payment decisions or downcoding after the plan approves prior authorization for an item or service.
Client expense: $300,000 · 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), Homeland Security, Dept of (DHS), Office of Management & Budget (OMB), SENATE
2026 · third_quarter · Medicare/Medicaid
H.R. 879/S. 1640, the Medicare Patient Access and Practice Stabilization Act of 2025; H.R. 1, the One Big Beautiful Bill Act; H.R. 3164/S. 2426, the Ensuring Community Access to Pharmacist Services Act; Draft legislation to amend title XVIII of the Social Security Act to modify the conversion factor updates applicable to physicians' services under the Medicare program; Implementation of Centers for Medicare & Medicaid Services. (2025). Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program. Federal Register, 88, 90 FR 49266-50481; H.R. 6160, the Strengthening Medicare for Patients and Providers Act; H.R. 8163, the Provider Reimbursement Stability Act; H.R. 7520, the Efficiency Adjustment Delay Act; H.R. 8622, the Medicare Physician Data-driven Performance Payment System Act of 2026 H.R.9693, Patients First Act of 2026 H.R.4331, Access to Claims Data Act Proposed CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
Client expense: $2,047,000 · 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), Office of Management & Budget (OMB), Office of Policy Development, SENATE, White House Office
2026 · third_quarter · Medicare/Medicaid
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
2026 · third_quarter · Medicare/Medicaid
H.R. 3514/S. 1816: Improving Seniors' Timely Access to Care Act of 2025 - requires Medicare Advantage plans to implement electronic prior authorization, increase transparency, protect enrollees, and adhere to new response timeframes to improve timely access to care. H.R. 2433: Reducing Medically Unnecessary Delays in Care Act - mandates that prior authorization decisions under Medicare be made by qualified physicians, based on medical necessity and evidence-based standards, with transparency and input from practicing physicians. H.R. 9693, Patients First Act of 2026 would finally make structural changes needed to prevent cuts and create a payment system that helps ensure physicians can keep their doors open and provide seniors with quality, value-based healthcare. S. 1640/H.R. 879: Medicare Patient Access and Practice Stabilization Act of 2025 - This bill increases certain payment adjustments under the Medicare physician fee schedule for services furnished between April 1, 2025, and January 1, 2026. H.R. 8163/S. 5180: Provider Reimbursement Stability Act, to amend title XVIII of the Social Security Act to ensure stability for provider payments under the Medicare program. H.R. 8622: Medicare Physician Data-driven Performance Payment System Act to amend title XVIII of the Social Security Act to transform the Merit-based Incentive Payment System into the Data-driven Performance Payment System under the Medicare physician fee schedule H.R. 6160: Strengthening Medicare for Patients and Providers Act to modify certain adjustments to payment amounts under the Medicare physician fee schedule S. 1460/H.R. 786: Preserving Patient Access to Accountable Care Act - extends Medicare incentive payments for alternative payment models to 2027, with a new rate of 3.53 percent, to promote continued participation and improve healthcare efficiency. H.R. 2120/S. 1031: ROCR Value Based Program Act - establishes a new payment program for radiation oncology services, focusing on stable payments, quality care, and patient access, while exempting it from budget neutrality adjustments. H.R. 4559: Prompt and Fair Pay Act - to establish payment parity between Medicare Advantage and fee-for-service Medicare, and to establish prompt payment requirements under Medicare Advantage. H.R. 2484: Seniors' Access to Critical Medications Act of 2025 - establishes an exception to the physician self-referral prohibition for certain outpatient drugs under Medicare, mandates a study on drug dispensing practices, and reduces the Medicare improvement fund by $18 million. H.R. 4299: Protecting Patient Access to Cancer and Complex Therapies Act - provide for a rebate by manufacturers for selected drugs and biological products subject to maximum fair price negotiation. H.R. 4206/S. 1261: CONNECT for Health Act - expands access to telehealth services under Medicare H.R. 5081/S. 2709: Telehealth Modernization Act - to extend certain telehealth flexibilities under the Medicare program. H.R. 4752/S. 2760: Reducing Hereditary Cancer Act - to provide hereditary cancer genetic testing for individuals with a history of a hereditary cancer gene mutation. H.R. 8500: Timely Access to Coverage Decisions Act of 2026: To amend title XVIII of the Social Security Act to ensure timely review of local coverage determination requests under the Medicare program. H.R. 4331, Access to Claims Data Act: To require the Secretary of Health and Human Services to establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement.
Client expense: $80,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2026 · third_quarter · Health Issues
ACPs 2026 Third Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Sent letter and met with legislators in support of the Patients First Act of 2026, (H.R. 9693) for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices, support for independent practices and replacement of MIPS with POINTS for quality measures. Supported and urged Congress to pass (H.R. 8163, S.5180), the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $57.64 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026, H.R. 8622. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Dr. Rebecca Andrews, Past Chair of ACPs Board of Regents, testified before the House E&C Health Subcommittee in favor of each of the bills mentioned above. ACP supported Pay PCPs Act of 2026 (S. 5269), to inject $10 billion federal investment from fiscal year 2027 through 2031 to provide for the establishment of hybrid primary care payments under Medicare. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. ACP supported H.R. 8765, the Prioritizing Primary Care Act. This legislation would mandate an annual report on federal spending on primary care as well as establish a working group to study and make recommendations on how each federal agency addresses the issue. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. ACP advocated before Senate offices against the marked-up bill coming out of House Ways and Means and renamed the Main Street Pharmacy Access Act enabling pharmacists to bill certain Medicare codes and to diagnose and treat flu, strep throat and other respiratory infections. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-Price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).
Client expense: $86,880 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)
2026 · third_quarter · Health Issues
ACPSs 2026 Third Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Sent letter and met with legislators in support of the Patients First Act of 2026, (H.R. 9693) for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices, support for independent practices and replacement of MIPS with POINTS for quality measures. Supported and urged Congress to pass (H.R. 8163, S.5180), the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $57.64 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026, H.R. 8622. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Dr. Rebecca Andrews, Past Chair of ACPs Board of Regents, testified before the House E&C Health Subcommittee in favor of each of the bills mentioned above. ACP supported Pay PCPs Act of 2026 (S. 5269), to inject $10 billion federal investment from fiscal year 2027 through 2031 to provide for the establishment of hybrid primary care payments under Medicare. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. ACP supported H.R. 8765, the Prioritizing Primary Care Act. This legislation would mandate an annual report on federal spending on primary care as well as establish a working group to study and make recommendations on how each federal agency addresses the issue. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. ACP advocated before Senate offices against the marked-up bill coming out of House Ways and Means and renamed the Main Street Pharmacy Access Act enabling pharmacists to bill certain Medicare codes and to diagnose and treat flu, strep throat and other respiratory infections. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-Price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).
Client expense: $119,057 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)
2026 · second_quarter · Medicare/Medicaid
Physician payment reform Counting observation stays as satisfying Medicare three-day inpatient stay prerequisite for skilled nursing facility (SNF) coverage H.R. 1-One Big Beautiful Bill Act, to provide for reconciliation pursuant to title II of H. Con. Res. 14 H.R. 539-Chiropractic Medicare Coverage Modernization Act of 2025, to amend title XVIII of the Social Security Act to provide Medicare coverage for all physicians services furnished by doctors of chiropractic within the scope of their license, and for other purposes. H.R. 771-Rural Health Care Access Act of 2025, to eliminate the 35-mile requirement to qualify as a critical access hospital H.R. 772-Rural ER Access Act, to require the Centers for Medicare and Medicaid Services to repeal the 35-mile requirement for off-campus facilities H.R. 879- Medicare Patient Access and Practice Stabilization Act of 2025, to address the 2025 Medicare Physician Fee Schedule cuts and increaser support for physicians and other practitioners in adjusting to Medicare payment changes H.R.1968-Full-Year Continuing Appropriations and Extensions Act, to provide appropriations for federal departments and agencies and to provide an increase for the calendar year 2024 physician fee schedule conversion factor H.R. 2433-Reducing Unnecessary Medical Delays in Care Act of 2025, to ensure that prior authorization medical decisions under Medicare are determined by physicians. H.R. 3164-Ensuring Community Access to Pharmacist Services Act (ECAPS) Act, to amend title XVIII of the Social Security Act to provide pharmacy payment of certain services H.R. 4206-CONNECT for Health Act, to expand access to telehealth services H.R. 6160-Strengthening Medicare for Patients and Providers Act, provide for an update to a single conversion factor under the Medicare physician fee schedule that is based on the Medicare economic index H.R. 6721-Medicare Advance Planning for Care Act, to encourage Medicare beneficiaries to voluntarily adopt advance directives guiding the medical care they receive H.R. 7520-Efficiency Adjustment Delay Act, to delay the implementation of an efficiency adjustment to work relative value units under the Medicare physician fee schedule H.R. 8163-Provider Reimbursement Stability Act, ensure stability for provider payments under the Medicare program H.R. 8622-Medicare Data-driven Performance Payment System Act of 2026, to transform the Merit-based Incentive Payment System into the Data-driven Performance Payment System under the Medicare physician fee schedule S. 106-Chiropractic Medicare Coverage Modernization Act of 2025, to amend title XVIII of the Social Security Act to provide Medicare coverage for all physicians services furnished by doctors of chiropractic within the scope of their license, and for other purposes. S.1261-CONNECT for Health Act, to expand access to telehealth services S. 1640- Medicare Patient Access and Practice Stabilization Act of 2025, to address the 2025 Medicare Physician Fee Schedule cuts and increaser support for physicians and other practitioners in adjusting to Medicare payment changes S. 2426-Ensuring Community Access to Pharmacist Services Act (ECAPS) Act, to amend title XVIII of the Social Security Act to provide pharmacy payment of certain services S. 3473-Medicare Advance Planning for Care Act, to encourage Medicare beneficiaries to voluntarily adopt advance directives guiding the medical care they receive S. 4927-Rural Hospital Emergency Room Guarantee Act, to establish a guaranteed funding stream to keep existing emergency rooms at America's rural hospitals open.
Client expense: $498,299 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2026 · second_quarter · Health Issues
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
2026 · second_quarter · Medicare/Medicaid
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
2026 · second_quarter · Medicare/Medicaid
H.R. 5347: Health Care Efficiency Through Flexibility Act H.R. 786/ S. 1460: Preserving Patient Access to Accountable Care Act S. 1816/ 3514: Improving Seniors Timely Access to Care Act S. 1105: No UPCODE Act S. 2561/ H.R. 5768: Skin Substitute Access and Payment Reform Act H.R. 4773/ S.3350: ACO Assignment Improvement Act H.R. 4313/ S.2237: Hospital Inpatient Services Modernization Act H.R. 8129: To amend title XVIII of the Social Security Act to establish a full risk ACO program H.R. 6852: Advanced Wound Care and Regenerative Medicine Access and Reform Act H.R. 8375/ S.4384: Medicare Advantage Improvement Act H.R. 8163: Provider Reimbursement Stability Act H.R. 8622: Medicare Physician Data Driven Performance Payment System H.J. Res 187/ S.J. Res 192: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services of the Department of Health and Human Services relating to Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model. Issues related to Medicare payments, Medicare Shared Savings Program, ACO REACH, Medicare Advantage, alternative payment model incentives, telehealth, and fraud, waste, abuse.
Client expense: $142,230 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2026 · second_quarter · Medicare/Medicaid
H.R. 879/S. 1640, the Medicare Patient Access and Practice Stabilization Act of 2025; H.R. 1, the One Big Beautiful Bill Act; H.R. 3164/S. 2426, the Ensuring Community Access to Pharmacist Services Act; Draft legislation to amend title XVIII of the Social Security Act to modify the conversion factor updates applicable to physicians' services under the Medicare program; Implementation of Centers for Medicare & Medicaid Services. (2025). Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program. Federal Register, 88, 90 FR 49266-50481; H.R. 6160, the Strengthening Medicare for Patients and Providers Act; H.R. 8163, the Provider Reimbursement Stability Act; H.R. 7520, the Efficiency Adjustment Delay Act; H.R. 8622, the Medicare Physician Data-driven Performance Payment System Act of 2026
Client expense: $580,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2026 · second_quarter · Medicare/Medicaid
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.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.4074 - Optimizing Postpartum Outcomes 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.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.5281 - REAL Health Providers Act, all provisions 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.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.8487 - Ensuring Excellence in Mental Health Act, 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 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 202, 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.3750 - REAL Health Providers Act, all provisions S.3762 - Prior Authorization Relief Act, all provisions S.4070 - Diabetes Foot Health Access and Modernization Act of 2026, all provisions S.4384 - Medicare Advantage Improvement Act of 2026, 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-1849-P] Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2027 Rates; Requirements for Quality Programs; and Other Policy Changes Comment Letter: [CMS-9874-NC] Request for Information; Comprehensive Review of the Essential Health Benefits Framework and Typical Employer Plan Standard Statement for the Record: Examining the Medicare Physician Fee Schedule, MACRA, and Opportunities for Payment Reforms Draft: Artificial intelligence in prior authorization denials by Medicare Advantage organizations Draft: GOLD CARD Act Draft: MACRA/MIPS program reform Draft: Medicare bonus payment for alternative payment model (APM) participation Draft: Medicare Budget Neutrality and MIPS reform 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: Work requirements, per capita caps, provider taxes, Federal Medical Assistance Percentage (FMAP) changes Medicare and Medicaid programs: LEAD (Long-term Enhanced ACO Design) Model Reform 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: 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 Medicare and Medicaid programs: Telehealth and Digital Health 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: CJR-X (Comprehensive Care for Joint Replacement Expanded) Model 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: Long-term Enhanced ACO Design (LEAD) Model 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: MEI Update Medicare program: Merit-based Incentive Payment System (MIPS)/reforms and penalties 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
Client expense: $5,130,000 · 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
2026 · second_quarter · Medicare/Medicaid
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.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.4074 - Optimizing Postpartum Outcomes 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.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.5281 - REAL Health Providers Act, all provisions 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.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.8487 - Ensuring Excellence in Mental Health Act, 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 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 202, 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.3750 - REAL Health Providers Act, all provisions S.3762 - Prior Authorization Relief Act, all provisions S.4070 - Diabetes Foot Health Access and Modernization Act of 2026, all provisions S.4384 - Medicare Advantage Improvement Act of 2026, 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-1849-P] Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2027 Rates; Requirements for Quality Programs; and Other Policy Changes Comment Letter: [CMS-9874-NC] Request for Information; Comprehensive Review of the Essential Health Benefits Framework and Typical Employer Plan Standard Statement for the Record: Examining the Medicare Physician Fee Schedule, MACRA, and Opportunities for Payment Reforms Draft: Artificial intelligence in prior authorization denials by Medicare Advantage organizations Draft: GOLD CARD Act Draft: MACRA/MIPS program reform Draft: Medicare bonus payment for alternative payment model (APM) participation Draft: Medicare Budget Neutrality and MIPS reform 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: Work requirements, per capita caps, provider taxes, Federal Medical Assistance Percentage (FMAP) changes Medicare and Medicaid programs: LEAD (Long-term Enhanced ACO Design) Model Reform 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: 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 Medicare and Medicaid programs: Telehealth and Digital Health 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: CJR-X (Comprehensive Care for Joint Replacement Expanded) Model 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: Long-term Enhanced ACO Design (LEAD) Model 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: MEI Update Medicare program: Merit-based Incentive Payment System (MIPS)/reforms and penalties 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
Client expense: $513,000 · 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
2026 · second_quarter · Medicare/Medicaid
H.R. 3514/S. 1816: Improving Seniors' Timely Access to Care Act of 2025 - requires Medicare Advantage plans to implement electronic prior authorization, increase transparency, protect enrollees, and adhere to new response timeframes to improve timely access to care. H.R. 2433: Reducing Medically Unnecessary Delays in Care Act - mandates that prior authorization decisions under Medicare be made by qualified physicians, based on medical necessity and evidence-based standards, with transparency and input from practicing physicians. S. 1640/H.R. 879: Medicare Patient Access and Practice Stabilization Act of 2025 - This bill increases certain payment adjustments under the Medicare physician fee schedule for services furnished between April 1, 2025, and January 1, 2026. H.R. 8163: Provider Reimbursement Stability Act, to amend title XVIII of the Social Security Act to ensure stability for provider payments under the Medicare program. H.R. 8622: Medicare Physician Data-driven Performance Payment System Act to amend title XVIII of the Social Security Act to transform the Merit-based Incentive Payment System into the Data-driven Performance Payment System under the Medicare physician fee schedule H.R. 6160: Strengthening Medicare for Patients and Providers Act to modify certain adjustments to payment amounts under the Medicare physician fee schedule S. 1460/H.R. 786: Preserving Patient Access to Accountable Care Act - extends Medicare incentive payments for alternative payment models to 2027, with a new rate of 3.53 percent, to promote continued participation and improve healthcare efficiency. H.R. 2120/S. 1031: ROCR Value Based Program Act - establishes a new payment program for radiation oncology services, focusing on stable payments, quality care, and patient access, while exempting it from budget neutrality adjustments. H.R. 4559: Prompt and Fair Pay Act - to establish payment parity between Medicare Advantage and fee-for-service Medicare, and to establish prompt payment requirements under Medicare Advantage. H.R. 2484: Seniors' Access to Critical Medications Act of 2025 - establishes an exception to the physician self-referral prohibition for certain outpatient drugs under Medicare, mandates a study on drug dispensing practices, and reduces the Medicare improvement fund by $18 million. H.R. 4299: Protecting Patient Access to Cancer and Complex Therapies Act - provide for a rebate by manufacturers for selected drugs and biological products subject to maximum fair price negotiation H.R. 4206/S. 1261: CONNECT for Health Act - expands access to telehealth services under Medicare H.R. 5081/S. 2709: Telehealth Modernization Act - to extend certain telehealth flexibilities under the Medicare program. H.R. 4752/S. 2760: Reducing Hereditary Cancer Act - to provide hereditary cancer genetic testing for individuals with a history of a hereditary cancer gene mutation.
Client expense: $480,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE