Medicare Advantage Cost Transparency Act

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

Client expense: $1,240,000 · Firm income: Not reported

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

Client expense: Not reported · Firm income: Not reported

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

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

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

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

Medicare/Transparency; Medicaid Cuts; Medicaid Managed Care; Medicare Advantage & MA Rate Notice; Youth Mental Health; community engagement implementation; Site neutral payment reform; Fraud, Waste, and Abuse. H.R.4077 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Rep. Doggett, Lloyd [D-TX-37] H.R.9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Sponsor: Rep. DeGette, Diana [D-CO-1] H.R.3514 - Improving Seniors Timely Access to Care Act of 2025 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16]

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage (MA) and MA Rate Notice; Medicaid Cuts; Site Neutral Payment reform; MA Reform; Program Fraud Waste and Abuse; Durable Medical Equipment S. 1105 - No UPCODE Act To amend title XVIII of the Social Security Act to improve risk adjustment under Medicare Advantage H.R. 842 - Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act To amend title XVIII of the Social Security Act to provide for Medicare coverage of multi-cancer early detection screening tests. Sponsor: Rep Jodey Arrington H.R. 9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. H.R. 3514 - Improving Seniors Timely Access to Care Act of 2025 To amend Title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. H.R. 8871 - DME Scammer Prevention Act of 2026 To amend title XVIII of the Social Security Act to promote Medicare program integrity with respect to certain medical equipment and supplies. S. 3762 - Prior Authorization Relief Act To amend part C of the title XVIII of the Social Security Act to provide for prior authorization reforms under the Medicare Advantage program.

Client expense: $420,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid strengthening and public benefit policy, including adult dental benefits, pediatric dental/EPSDT protections, Medicaid financing, and Medicaid managed care. CMS Chief Dental Officer position in the Office of the Administrator CMS Rural Health Transformation Program guidance Implementation of changes to Medicaid programs put forth in the One Big Beautiful Bill Act of 2025 H.R. 5243, To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage H.R. 9392, Medicare Advantage Cost Transparency Act

Client expense: $1,100,000 · Firm income: Not reported

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

Issues: Medicare Advantage & MA Rate Notice; Medicare/Transparency; Mental Health Care, Youth Mental Health; Site neutral payment reform; MA Reform; Program Fraud, Waste, and Abuse Bills: H.R.4077 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Rep. Doggett, Lloyd [D-TX-37] S.2145 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Sen. Warren, Elizabeth [D-MA] H.R.668 - Coordinating Care for Senior Veterans and Wounded Warriors Act To require the Secretary of Veterans Affairs to carry out a pilot program to coordinate, navigate, and manage care and benefits for veterans enrolled in both the Medicare program and the system of annual patient enrollment of the Department of Veterans Affairs. Sponsor: Rep. Ciscomani, Juan [R-AZ-6] S.506 - Coordinating Care for Senior Veterans and Wounded Warriors Act This bill requires the Department of Veterans Affairs (VA) to implement a three-year pilot program to coordinate, navigate, and manage care and benefits for veterans who are enrolled in both the Medicare program and the VA health care system. Sponsor: Sen. Moran, Jerry [R-KS] H.R.1227 - Alternatives to PAIN Act To amend title XVIII of the Social Security Act to ensure appropriate access to non-opioid pain management drugs under part D of the Medicare program. Sponsor: Rep. Miller-Meeks, Mariannette [R-IA-1] H.R.9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Sponsor: Rep. DeGette, Diana [D-CO-1] H.R. 5243 - Supplemental Benefits Transparency Bill To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. McClellan, Jennifer L. [D-VA-4] H.R.9395 - Transparency in Medicare Advantage Steering Act To amend title XVIII of the Social Security Act to require certain reporting with respect to agents and brokers of Medicare Advantage organizations. Sponsor: Rep. Ocasio-Cortez, Alexandria [D-NY-14] H.R.3514 - Improving Seniors Timely Access to Care Act of 2025 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R.8163 - Provider Reimbursement Stability Act of 2026 To amend title XVIII of the Social Security Act to ensure stability for provider payments under the Medicare program. Sponsor: Rep. Murphy, Gregory F. [R-NC-3] H.R.8883 - Protecting Seniors and Stopping Fraudsters Act To amend title XVIII of the Social Security Act to provide for additional oversight of hospice programs and home health agencies under the Medicare program, and for other purposes. Sponsor: Rep. Van Duyne, Beth [R-TX-24] H.R.8871 - DME Scammer Prevention Act of 2026 To amend title XVIII of the Social Security Act to promote Medicare program integrity with respect to certain medical equipment and supplies. Sponsor: Rep. Bean, Aaron [R-FL-4] S.3762 - Prior Authorization Relief Act To amend part C of title XVIII of the Social Security Act to provide for prior authorization reforms under the Medicare Advantage program. Sponsor: Sen. Whitehouse, Sheldon [D-RI]

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

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

Client expense: $590,000 · Firm income: Not reported

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

Medicare Advantage; Medicare/Transparency; Medicaid Cuts; Medicaid Managed Care; Medicare Advantage & MA Rate Notice; Youth Mental Health; community engagement implementation; Site neutral payment reform; Fraud, Waste, and Abuse. H.R.4077 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Rep. Doggett, Lloyd [D-TX-37] H.R.9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Sponsor: Rep. DeGette, Diana [D-CO-1] H.R.3514 - Improving Seniors Timely Access to Care Act of 2025 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16]

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Same-day billing restrictions in Medicaid; Medicare Advantage & MA Rate Notice; Medicare/Transparency; Mental Health Care, Youth Mental Health; Site neutral payment reform; MA Reform; Program Fraud, Waste, and Abuse; Medicaid Managed Care H.R. 7996, Improving CARE for Youth Act (118th) To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Rep. Dunn, Neal P. [R-FL-2] S.2556 - Improving CARE for Youth Act (118th) To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Sen. Carper, Thomas R. [D-DE] H.R.4077 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Rep. Doggett, Lloyd [D-TX-37] S.2145 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Sen. Warren, Elizabeth [D-MA] H.R.668 - Coordinating Care for Senior Veterans and Wounded Warriors Act To require the Secretary of Veterans Affairs to carry out a pilot program to coordinate, navigate, and manage care and benefits for veterans enrolled in both the Medicare program and the system of annual patient enrollment of the Department of Veterans Affairs. Sponsor: Rep. Ciscomani, Juan [R-AZ-6] S.506 - Coordinating Care for Senior Veterans and Wounded Warriors Act This bill requires the Department of Veterans Affairs (VA) to implement a three-year pilot program to coordinate, navigate, and manage care and benefits for veterans who are enrolled in both the Medicare program and the VA health care system. Sponsor: Sen. Moran, Jerry [R-KS] H.R.1227 - Alternatives to PAIN Act To amend title XVIII of the Social Security Act to ensure appropriate access to non-opioid pain management drugs under part D of the Medicare program. Sponsor: Rep. Miller-Meeks, Mariannette [R-IA-1] H.R.9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Sponsor: Rep. DeGette, Diana [D-CO-1] H.R. 5243 - Supplemental Benefits Transparency Bill To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. McClellan, Jennifer L. [D-VA-4] H.R.9395 - Transparency in Medicare Advantage Steering Act To amend title XVIII of the Social Security Act to require certain reporting with respect to agents and brokers of Medicare Advantage organizations. Sponsor: Rep. Ocasio-Cortez, Alexandria [D-NY-14] H.R.3514 - Improving Seniors Timely Access to Care Act of 2025 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R.8163 - Provider Reimbursement Stability Act of 2026 To amend title XVIII of the Social Security Act to ensure stability for provider payments under the Medicare program. Sponsor: Rep. Murphy, Gregory F. [R-NC-3] H.R.8883 - Protecting Seniors and Stopping Fraudsters Act To amend title XVIII of the Social Security Act to provide for additional oversight of hospice programs and home health agencies under the Medicare program, and for other purposes. Sponsor: Rep. Van Duyne, Beth [R-TX-24] H.R.8871 - DME Scammer Prevention Act of 2026 To amend title XVIII of the Social Security Act to promote Medicare program integrity with respect to certain medical equipment and supplies. Sponsor: Rep. Bean, Aaron [R-FL-4] S.3762 - Prior Authorization Relief Act To amend part C of title XVIII of the Social Security Act to provide for prior authorization reforms under the Medicare Advantage program. Sponsor: Sen. Whitehouse, Sheldon [D-RI]

Client expense: $990,000 · Firm income: Not reported

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

Issues: Medicare Advantage & MA Rate Notice; Medicare/Transparency; Site neutral payment reform; MA Reform; Program Fraud, Waste, and Abuse; Medicaid Managed Care Bills: H.R.4077 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Rep. Doggett, Lloyd [D-TX-37] S.2145 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Sen. Warren, Elizabeth [D-MA] H.R.668 - Coordinating Care for Senior Veterans and Wounded Warriors Act To require the Secretary of Veterans Affairs to carry out a pilot program to coordinate, navigate, and manage care and benefits for veterans enrolled in both the Medicare program and the system of annual patient enrollment of the Department of Veterans Affairs. Sponsor: Rep. Ciscomani, Juan [R-AZ-6] S.506 - Coordinating Care for Senior Veterans and Wounded Warriors Act This bill requires the Department of Veterans Affairs (VA) to implement a three-year pilot program to coordinate, navigate, and manage care and benefits for veterans who are enrolled in both the Medicare program and the VA health care system. Sponsor: Sen. Moran, Jerry [R-KS] H.R.1227 - Alternatives to PAIN Act To amend title XVIII of the Social Security Act to ensure appropriate access to non-opioid pain management drugs under part D of the Medicare program. Sponsor: Rep. Miller-Meeks, Mariannette [R-IA-1] H.R.9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Sponsor: Rep. DeGette, Diana [D-CO-1] H.R. 5243 - Supplemental Benefits Transparency Bill To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. McClellan, Jennifer L. [D-VA-4] H.R.9395 - Transparency in Medicare Advantage Steering Act To amend title XVIII of the Social Security Act to require certain reporting with respect to agents and brokers of Medicare Advantage organizations. Sponsor: Rep. Ocasio-Cortez, Alexandria [D-NY-14] H.R.3514 - Improving Seniors Timely Access to Care Act of 2025 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R.8163 - Provider Reimbursement Stability Act of 2026 To amend title XVIII of the Social Security Act to ensure stability for provider payments under the Medicare program. Sponsor: Rep. Murphy, Gregory F. [R-NC-3] H.R.8883 - Protecting Seniors and Stopping Fraudsters Act To amend title XVIII of the Social Security Act to provide for additional oversight of hospice programs and home health agencies under the Medicare program, and for other purposes. Sponsor: Rep. Van Duyne, Beth [R-TX-24] H.R.8871 - DME Scammer Prevention Act of 2026 To amend title XVIII of the Social Security Act to promote Medicare program integrity with respect to certain medical equipment and supplies. Sponsor: Rep. Bean, Aaron [R-FL-4] S.3762 - Prior Authorization Relief Act To amend part C of title XVIII of the Social Security Act to provide for prior authorization reforms under the Medicare Advantage program. Sponsor: Sen. Whitehouse, Sheldon [D-RI]

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

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

Issues: Same-day billing restrictions in Medicaid; Medicare Advantage & MA Rate Notice; Medicare/Transparency; Mental Health Care, Youth Mental Health; Site neutral payment reform; MA Reform; Program Fraud, Waste, and Abuse; Medicaid Managed Care Bills: H.R.4077 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Rep. Doggett, Lloyd [D-TX-37] S.2145 - GUARD Veterans Health Care Act To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes. Sponsor: Sen. Warren, Elizabeth [D-MA] H.R.9392 - Medicare Advantage Cost Transparency Act To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Sponsor: Rep. DeGette, Diana [D-CO-1] H.R. 5243 - Supplemental Benefits Transparency Bill To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. McClellan, Jennifer L. [D-VA-4] H.R.9395 - Transparency in Medicare Advantage Steering Act To amend title XVIII of the Social Security Act to require certain reporting with respect to agents and brokers of Medicare Advantage organizations. Sponsor: Rep. Ocasio-Cortez, Alexandria [D-NY-14] H.R.3514 - Improving Seniors Timely Access to Care Act of 2025 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R.8163 - Provider Reimbursement Stability Act of 2026 To amend title XVIII of the Social Security Act to ensure stability for provider payments under the Medicare program. Sponsor: Rep. Murphy, Gregory F. [R-NC-3] H.R.8883 - Protecting Seniors and Stopping Fraudsters Act To amend title XVIII of the Social Security Act to provide for additional oversight of hospice programs and home health agencies under the Medicare program, and for other purposes. Sponsor: Rep. Van Duyne, Beth [R-TX-24] S.3762 - Prior Authorization Relief Act To amend part C of title XVIII of the Social Security Act to provide for prior authorization reforms under the Medicare Advantage program. Sponsor: Sen. Whitehouse, Sheldon [D-RI]

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE